I see this question asked A LOT and so I thought I'd write up a little blog post about the different roles of doulas and midwives.
This question comes up most commonly in the homebirth community, but I also see it asked relatively often in the VBAC community.
There is a big difference between the roles of a doula and a private midwife, and it can really confusing to understand who does what and what is best for you. When I was thinking about trying to conceive my second baby (with whom I planned a HBAC) I knew I was going to hire a private midwife, but I wasn't sure whether I should also find a doula. When you are new to this world and these roles, it's all a little bit difficult to wrap your head around. Hopefully this can help.
First, let's understand the similarities in the roles. Both private midwives and doulas are independent business operators. This means they are employed by you, rather than working for the public health system. They also both provide support to women in pregnancy, birth and postpartum (although the type of support they provide is very different), and are generally agreed to be the most women-centred birth workers around.
Private Midwives
(may also be referred to as independent midwives, privately practising midwives, or endorsed midwives)
The term "midwife" is a protected title, meaning that it can only be used by those who have gone through the required training and education, and registered through their designated registration body.
Private midwives, therefore, have the same qualifications and training as midwives working in a hospital. In fact, to gain endorsement to become a privately practising midwife, they actually need to do extra qualification units. Plus, to maintain their endorsement, they need to complete 50 hours of continuing professional development a year, compared to the 20 hours required of midwives without endorsement (such as midwives employed by hospitals). When you hire a private midwife in Australia, you are hiring a midwife with some of the highest levels of education and training available.
Private midwives have clinical expertise and training, which means they are qualified to look after you and your baby's wellbeing in pregnancy, labour, birth and postpartum. They also have clinical guidelines to follow that inform them when and how to make recommendations or refer to a hospital/obstetrician if they suspect some kind of complication or situation where you may need additional support.
During pregnancy, a private midwife will look after your prenatal appointments so that you don't need to visit the hospital or see anyone else. They'll usually have a bit of a chat with you about how you're feeling, check your blood pressure, baby's heart rate and position, and your fundal height (how your belly is growing). The appointments will usually be every four weeks starting in the 2nd trimester, and then will increase in frequency in the last month or two of pregnancy. At different points along your pregnancy, a private midwife would discuss routine testing or scans that are recommended, and give you the risks and benefits of them to help you make an informed decision about whether or not you consent or decline.
During labour, a private midwife will attend and monitor you and your baby. Depending on what you may have discussed in advance, the midwife might make suggestions on positions or techniques to help with pain/discomfort or suspected poor positioning, or anything else, but often they will just be sitting back; listening and watching for signs of labour progression or early indicators of complications. They'll continue to monitor your blood pressure and baby's heart rate, with your consent. If needed, or particularly requested, they can do vaginal exams. Some private midwives have additional training in other areas like traditional Chinese medicine, massage, or aromatherapy, and may bring tools to use related to those fields to help with comfort in labour.
Private midwives are very good at picking up on potential issues very early, and if they suspect there may be a need for medical intervention, they will recommend a transfer to hospital, where they will continue to support you as an additional support person (unless they have admitting rights to the hospital, in which case, they can continue to be your primary care provider).
Private midwives also attend labouring women with a bunch of emergency gear in case it is needed, and are equipped for and trained to deal with most birth complications such as shoulder dystocia and postpartum haemorrhage. They can even perform episiotomies and suture tears, where required (although severe tears may need to be done in hospital, for which they would transfer you). However, the rates of birth complications in planned homebirths are far lower than for low risk women in hospital, so it is less likely that a complication will arise.
Of course, this is all given a private midwife hired for a homebirth. There are also private midwives who only offer prenatal and postnatal services, and there are some that will support women planning hospital births too. In the case of the latter, whether your midwife would be your primary care provider in labour would again depend on whether they had admitting rights to the hospital. If they don't, they would support you in more of a doula role, but with the ability to provide a clinical perspective where you needed it, but would not be able to take on the role of clinically monitoring you.
Postnatally, a private midwife will visit you and do all your clinical checks on you and bub, check how breastfeeding is going, how bub is growing, how wounds are healing, and how you're feeling emotionally. Private midwives offer the most postnatal care out of any care model, usually every couple of days over the first week and then once a week for a couple of weeks, followed by one or two more visits around 6 - 8 weeks postpartum.
Doulas
In contrast to midwives, the term "doula" is not a protected title and therefore, anyone can really decide to call themselves a doula and offer doula services. However, doulas are becoming a more and more popular option for women as birth support in Australia, and as a result, we're seeing more and more doula training courses popping up. Some are run by large and long-standing organisations, and others are courses developed by experienced doulas wishing to share their knowledge and expertise with others.
These are usually informal training courses, meaning they don't have a recognised qualification like a Diploma, for example. That doesn't mean that they aren't valuable training courses, and some are endorsed by different organisations and bodies (for example, my training with Vicki Hobbs' Doula Training Academy* is an International Institute of Complementary Therapies approved course) but it does mean that there can be a big discrepancy between the training that doulas have done (if any!)
*This is an affiliate link - I may make a commission from any purchases you make when using this link
Most doulas around today will have either gone through some kind of doula training or have years of experience working as a doula. Some might have both. If it matters to you, it's worth adding to your interview question list when speaking with doulas you are considering hiring.
The biggest and most important difference between doulas and midwives is that doulas DO NOT have clinical training. It is completely outside their scope to do any kind of monitoring of you or bub, or anything that resembles clinical care such as vaginal exams, palpating bellies, etc.
A doula's main role is to support you emotionally, mentally, spiritually and physically in pregnancy, labour, and postpartum.
This can look like so different from woman to woman because it is totally dependent on what each individual needs. There are no guidelines or checklists for doulas to follow (unless they've made them for themselves!)
You might have several prenatal appointments with your doula, or none. You might have your doula with you for the majority of your labour or hardly any of it. You might have them booked to provide a few weeks' worth of postnatal support, or none.
For prenatal support, a doula might offer birth debriefing, birth planning or mapping, birth and postpartum preparation, assistance on finding evidence-based information, support for prenatal appointments at hospital, organising and facilitating mother blessings, or a whole range of other possible options.
For labour and birth support, a doula might just be present, holding your hands and giving quiet words of encouragement. Or they might be providing you with assistance in bodywork, massage, aromatherapy, acupressure, hip squeezes, keeping siblings busy, going for a walk with you, helping you with a rebozo or birth sling, or a supported squat, giving your partner encouragement, reminding you of your birth plan/map, reminding care providers about birth plan/map, or really - anything else! What each woman needs from a doula in labour will be different. And many offer different things depending on their training and experience.
In postpartum, a doula will generally offer debriefing and emotional support, assistance with breastfeeding, baby wearing and settling, provide nutritious food and drinks, help entertain older kids, tidy up/light housework and cleaning, help you find extra support services where you need them, or again - potentially much more!
I hope that helps to clarify some of the differences in these roles! Of course, you might get some crossover between them here and there, but the biggest thing to understand is that doulas are NOT clinicians and they cannot take responsibility for your clinical care or yours and baby's physical wellbeing.
This doesn't mean that you can't homebirth with only doula support, but if you do, it comes under the umbrella of "unassisted birth" or "freebirth" which is definitely something to research and understand if that's what you are drawn to. It also doesn't mean that a doula is your only option for a planned hospital birth, as there are private midwives who will support women planning hospitals births, but it is certainly more common for women to hire doulas to support them in hospital births because they already have access to some kind of clinical care.
Honestly, if you can swing it and it feels right for you (particularly if you're planning a homebirth) I'd totally recommend having both! I ended up hiring both, and I would definitely do so again. They each provided a very different kind of support, but I needed and wanted both kinds.
My name is Katelyn Commerford and I am a doula and next birth after caesarean guide who has completed comprehensive doula education at Vicki Hobbs’ Doula Academy. If you want to know more about what I do and how I can help you, please visit my website where you can get your free cheat sheet of my favourite VBAC resources, or find me on instagram @thenbacguide where I answer commonly asked questions about planning the next birth after caesarean and share loads pregnancy, birth, postpartum and parenting content.
Business Name: Katelyn Commerford - Doula and NBAC Guide
Phone: 0431 369 352
Email: hello@katelynthedoula.com.au
Instagram: https://www.instagram.com/thenbacguide/
Website: www.katelynthedoula.com.au
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