Doula vs midwife: What's the difference?

If you're wondering whether to hire a doula for your birth, or what role the midwife plays, then we've got all the answers for you.

A doula and a midwife have a unique and important role to play in your birth plan. A midwife is a specialist who's qualified to deliver babies and care for a woman and her baby during pregnancy, labour and after the birth. A doula, on the other hand, can offer support, guidance and practical help throughout your birth and beyond. Some doulas may be trained midwives, but the term itself refers to a role that's not medically qualified.

Some women choose to have a midwife, others have a doula, or you can receive guidance from both. Anthonissa Moger, Founder of The Hypnobirthing Midwife explains: "A midwife looks after the clinical picture including observations of the baby’s heart rate, your blood pressure, documentation and managing any issues or complications. A doula’s role is to focus on your emotional wellbeing and support normality during the birth process. Although the roles cross over, it is wonderful to have both so that all of your needs are fully supported."

Should you get a doula or midwife? Here's what you need to know.

What to expect from your midwife What is a private midwife? What does a midwife do? What is a doula? The two types of doula What does a doula do? How do I find a doula?

What to expect from your midwife

A midwife is a medically qualified specialist who will support you and deliver your baby. Midwives can deliver your baby at home, in the hospital, or in a midwife-led unit (MLU).

Midwives don't have to call in a doctor unless there's a problem that requires medical assistance. A midwife can therefore provide total care from early pregnancy onwards, throughout childbirth and for both the mum and her newborn until the baby is 28 days old.

Midwives are closely supervised and have rules and standards from the Nursing and Midwifery Council which they must abide by in order to work legally as a midwife.

You and your baby's needs are a midwife's primary focus. She should share information with you and empower you to make decisions about your own care. Women who feel involved in the birthing process are more likely to feel in control of their pregnancy and birth, and therefore have a more satisfying experience. The Standards for competence for registered midwives from the Nursing and Midwifery Council, outline that among other things a midwife should:

• Communicate with women throughout their pregnancy, labour and the period following birth
• Determine and provide programmes of care and support for women which: are made in partnership with women and are appropriate to the needs, contexts, culture and choices of women, babies and their families
• Listen to women and help them to identify their feelings and anxieties about their pregnancies, the birth and the related changes to themselves and their lives.

What is a private midwife?

Some women choose to employ an independent midwife and opt-out of the NHS system. Private midwives guarantee the same point of contact throughout the process, rather than dealing with different NHS midwives at every appointment. Reports from the Royal College of Midwives have shown that continuity of care significantly increases the healthy birth rate and reduces Caesarean delivery. With continuity of care, mothers feel more supported, relaxed, and more empowered to have the birth they want.

Private midwives are often more experienced with complicated pregnancies and births such as VBAC, breach or twins. Private midwives can also deliver your baby at home or in your local hospital.

The cost of private midwife care varies. A complete package of care throughout pregnancy, birth and the postnatal period can cost between £2,000 and £5,000 according to the Independent Midwifery association (IMUK). IMUK is also a great resource to find a local independent midwife or for more information on independent midwifery.

What does a midwife do?

Before birth your private or NHS midwife will:

• Have regular antenatal appointments to check up on your health and the development of the baby
• Measure your bump, blood pressure, take urine or blood samples if needed, and check the baby's heartbeat regularly
• Answer any questions you may have about pregnancy or birth
• Run postnatal information sessions on how to breastfeed and care for your baby
• Help you make a birth plan
• Identify any high-risk issues such as the baby's position after 32 weeks
• Show you around the midwife-led unit if your hospital has one

During the birth your midwife will:

• Admit you into hospital or the MLU once you're sufficiently dilated
• Monitor you and the baby's health during labour. This could involve a membrane sweep or external monitoring.
• Consult you on any medical decisions if an intervention is needed
• Keep medical records of the labour and birth
• Deliver the baby safely

How to contact your midwife: You will be given the mobile number of one midwife or a team of local midwives to contact. At your first antenatal meeting your midwife will explain how best to get in touch with them. Some midwives are happy for you to text any non-urgent queries, or you may leave a message for a call back. "Do not worry about calling the midwife," says Lesley Gilchrist, Registered Midwife and Founder of My Expert Midwife. "They would much rather you contacted them for advice rather than stayed at home becoming worried and anxious!"

It's also useful to have your labour ward's direct number in your local hospital. If you need to speak to a midwife urgently, you can call the labour ward where they can advise you.

Can I change my midwife? Yes, if you don't feel comfortable with your midwife you can ask for a different midwife. Write or call the Head of Midwifery at your local maternity unit or call the hospital switchboard and speak to a Supervisor of Midwives. You can request a different midwife, and you don't have to give a reason unless you want to.

A midwife should be your advocate, give you appropriate advice, support you in your choices, and help you have a positive birth experience. If you don't feel this is the case, then you should report it immediately.

In case you don't feel happy with your midwife when you're in labour, it's essential that you ask for a new one. If you're not happy with your care, then either you or your birth partner can speak to the midwife in charge of the labour ward. It is within your rights to politely but firmly state that you'd prefer to have another midwife care for you.

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What is a doula?

Doulas provide a similar service to midwives, as they advocate and support women throughout pregnancy and birth. However, they are not medically qualified and they usually work alongside medical professionals. You'll be assigned a midwife on the NHS, but there are only a small number of NHS-employed doulas, so you'll often have to hire one independently.

The World Health Organisation recommends that all women should have a companion present during labour and childbirth. The report showed that outcomes for women and babies were improved in the presence of continuous support, such as a doula.

What does a doula do?

A doula will meet with you, get to know you and your birth partner if you have one, and understand what kind of birth you would like to have. Whether it's at home, in hospital, or in a midwife-led unit, and if you're hoping for a gentle caesarean, vaginal birth after caesarean (VBAC), or a vaginal birth. They can also help you work through particular worries or doubts, and ensure they're not triggered during the birthing process.

Most importantly doulas advocate for you during the birthing process. The doula deals with any practical issues that arise such as liaising with midwives, doctors or administration, which means the mother can concentrate on giving birth, and the birth partner concentrates on supporting the mother. It's essential that mothers feel safe and supported during birth to maintain oxytocin levels and progress labour effectively. It's the doula's job to make that possible.

As Doula UK – the non-profit association of doulas in the UK – explains: 'The services offered by a doula vary greatly according to the needs of the women, couple or family that she is working with.' Doulas can just offer emotional advice and support, or they can be in labour with you and hold your hand every step of the way.

If a private midwife is out of your budget, doulas offer a continuity of care, which can complement and strengthen the midwifery services offered by the NHS.

What does a doula do during labour and birth?

Services during labour might include:

• Massaging the mother's back, shoulders, or points of tension
• Squeezing hips to relieve pressure
• Keeping water in the birthing pool the right temperature
• Getting the birthing partner or mother food and drink as needed
• Supporting the mother with breathing techniques
• Holding the mother in comfortable birthing positions
• Answering any questions the mother or birth partner might have
• Keeping the atmosphere feeling calm as possible
• Liaising with the midwives and doctors if there are any questions or concerns
• Helping the mother achieve her birth plan as much as possible

Can a doula deliver my baby?: Doulas are not hired to deliver babies, although in an emergency an experienced doula may well assist a birth.

Should I get a doula?: Only you can answer this question. If you are curious about the role a doula could play in your birth, you should contact a local doula to have an informal chat. There is no obligation to hire them, and it will give you a sense of value for money as well as the emotional value they might bring.

The two types of doula

There are two main types of doula:

• Birth doulas: support women and couples through pregnancy, labour, birth and the immediate postnatal time. These doulas often assist with alternative births and pain relief techniques.
• Postnatal doulas: support women and couples after the birth of their child in their own homes. Some doulas are able to fulfil both of these roles, whereas others specialise in a particular area.

Doulas are not regulated in the same way as midwives. They, therefore, cannot offer professional medical advice, only counsel and support. You may want to check that your doula has taken a Doula UK approved qualification and speak to their previous clients to check their credentials. You should also check your doula's insurance policy and sign a contract to ensure you receive a full, professional service.

How do I find a doula?

Doula UK has a database which you can search by postcode to find an available local doula. Most doulas work within a 25-mile radius, although some will travel further.

Initially, you just need to know your doula's fees and availability. You may want to have a no-obligation phone call to make sure their philosophy and attitude to birth suits you. Once you've settled on a doula, you can go into more detail about your birth options and the type of support you'll need. Birth doulas will meet with you at least twice, then be available via phone or email for questions during your pregnancy. At 38 weeks, they go 'on-call', so that you can let them know when you're in labour and they will attend immediately.

Postnatal doulas will start working with you after birth, and for as long as you wish. They can help you with various tasks, from successful breastfeeding techniques to help around the house. As Doula UK notes: 'Unlike a maternity nurse, a doula is not there to take care of the baby for you. Instead, a postnatal doula supports you to be the parent you want to be.'

Actress Danielle Brooks from "Orange Is The New Black" takes a real-life look at doulas, midwives, and the difference between them:

https://www.youtube.com/watch?v=O9zLvSRbV_E

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