The Ins and Outs of Midwives and Doulas

What are Midwives and Doulas?

When it comes to women’s health and childbirth, midwives and doulas have been a long part of its history even before the 20th century. Both are keen on minimizing or eliminating technological intervention, as “natural birth” is believed to be the norm. Midwives established their cultural and capital significance as they were usually held in high regard and needed for their knowledge of maternal care in Western European societies; doulas were popularized in the United States around the 1960s where the “natural birth” gained more traction and needed doula support. However, there are major differences between the midwife and doula roles. Doulas are caretakers of mothers before, during, and after childbirth, where they provide emotional and physical support such as massages, breathing techniques, and even supporting the mother’s partner during labor. However, doulas are not medically trained; their extent of support goes until the actual deliverance of a baby. Midwives, on the other hand, offer numerous medical services, such as pap smears, breast exams, and prescribe medications. They are qualified to deliver babies, although they may need to hand off complicated cases to physicians when needed. After the 20th century, midwifery quickly diminished in the U.S., as they were also associated with the lower class, immigrants, and Black and Native American people even though midwives were essential in linking communities of immigrant women and families (“Midwifery in the Modern Era.”). They still remain in rural and lower-income populations and have even merged with the nursing practice, as nurses can become nurse-midwives, or people can become midwife-certified directly without a nursing background (“Midwifery in the Modern Era.”). 

Working together

Although doulas are extremely rare in the United States, accounting for 6% of births in the U.S., they have been gaining traction as a needed facilitator in the labor room (Declercq et. al). Their attention towards the mother’s physical and emotional status can alleviate tensions and apprehensions that the mother may have in a room full of nurses and physicians. However, due to the extremely rare presence of doulas throughout the nation, their role can be somewhat conflicting to nurses, physicians, and midwives. Nurses and physicians, depending on how they view technological and surgical interventions during birth, can have conflicting views with the doula present; most often, nurses and physicians see doulas overstepping their care. Midwives have a less abrupt stance against doulas, as they both encourage patient autonomy and fewer interventions (McLeish & Redshaw). Doulas served to be complementary to midwives, both focusing on the mother’s needs and health to a similar extent. However, as with any relationship between two seemingly knowledgeable roles, there can be disagreements in terms of care and deliverance between midwives and doulas. 

What Does it Mean for Women’s Health?

The collaboration and effective communication between whoever is in the labor room with the mother provides the best outcomes. More research and insight is needed for the place of doulas and midwives in maternal care and how they can best work with the advancing scientific field. The recognition of mother’s needs before, during, and after birth has been emphasized by doulas and midwives, but have failed to translate into current society’s practice of women’s health outside of the immediate labor room. Doulas and midwives highlight a key aspect of women’s health that has been easily forgotten; that the mother’s needs extend beyond just child deliverance.

— Jenny Kim