In the world of birth, we have gotten to this cool place where terms like doula and midwife are commonplace, but there is still much confusion around the roll that each play. Are they one in the same? Is one like a doctor while the other is a nurse? Can I get a doula in lieu of a midwife? These are all questions I get almost every time someone reaches out to me for doula services, and understandably so since for the past 200 years or so doctors, specifically surgeons, have been working hard to erase these words all together along with the professions themselves. In fact, granny midwives (black midwives who served pregnant people well before the time of obstetrics), have been completely wiped out, and all their knowledge and wisdom with them.
Now, there are birthing people fighting back against the oppressive system that is obstetrics, and there has been ground made in some ways, but the name Midwife has forever been tarnished by the slanderous lies spread by obstetricians and the meaning of the name doula has changed only to include advocate.
So, lets get right to it. What is a midwife, and what is doula?
Midwives of all types are so much more than just a medical provider. These people see birth as a normal bodily process and understand that intervention comes only when needed.
Midwives go into birth work, not to manage pregnancy and birth, but to truly support birthers.
Here are the different types of midwives, and an explanation of what each can provide a pregnant and birthing person.
CNM (Certified Nurse Midwife)
You may have heard of midwives working in hospitals. Those are CNMs. CNMs are first trained as nurses and then as midwives. They don’t always work in hospitals, but only CNMs can work in hospitals. These midwives are within the very system that tried to eliminate midwifery and are following the rules of said systems in order to practice within it. That being said, there are many fantastic CNMs that serve as a barrier between the system and the birthing person. A CNM can be a great choice for someone who feels better being at the hospital, but doesn’t want to work with a surgeon, otherwise known as an obstetrician. A CNM is trained in normal, physiological birth, and if you find a good one will resort to physiology first instead of medical intervention.
CPM (Certified Professional Midwife)
CPMs only attend out of hospital birth. Occasionally CPMs and CNMs will mingle within a free-standing birth center. However, the majority of CPMs practice within the community at the birthers’ homes. CPMs are either trained through university, apprenticeship or a combination of the two. These midwives are not without restriction. The certifying body, NARM, does not maintain certain guidelines for the midwives that certify with them. They only require that the midwives draft their own protocol based on their own philosophies and beliefs. That being said, many states who regulate home-birth midwives require the CPM credential and may have their own limitations in place regarding what a CPM may or may not do in their practice. A CPM is a great choice for someone who is choosing out of hospital birth.
Community or “Lay” Midwife
A community midwife only attends out of hospital birth. Their training can include self-study and/or university study, but almost always includes many years of apprentice study under an experienced home-birth midwife. Community midwives are a treasure. They do not answer to a governing body of any kind, and therefore can practice in whatever ways their skills allow as long as they are keeping within the scope of midwifery.
When it comes down to choosing the type of midwife you’d like to attend your birth the best thing you can do is interview several until you find one that you really click with. Some things that are important to know are:
- Do they have a working relationship with any of the OBs in the area? This can be important in the case of a home-birth transfer. It’s not 100% necessary but can make the transfer go much more smoothly.
- What kind of training do they have, and how many births have they attended?
- What is their transfer rate, and why? An abnormally high transfer rate isn’t necessarily a negative thing depending on why. For example one study showed that out of 5,418 birthing people 655 transferred. Of the people who transferred, 51.2% where due to failure to progress, pain relief, or exhaustion. These are all non-emergent reasons to transfer.
- If they have back-up and if you can meet that person. No one wants to think about their midwife not being able to attend their birth, but life happens. People get sick, cars stop working, and families have emergencies. Due to the nature of birth, and simply the unpredictability of life, it’s wise to have a back-up plan if possible.
- Anything else that you find important. Do you desire a water birth? You’ll want to make sure your midwife is experienced with that. Do you have a special scar? Make sure she knows what that means and if she’ll even take you on as a client.
There are many questions to ask a midwife before deciding which one you’ll ask to provide care during your pregnancy and ultimately invite to your birth, but these are a good place to start.
Throughout history, doulas have been the old wise people who have birthed and the young ones who hope to birth. There was no title for these people. It was simply expected that they would be there to support and learn from the birther. This created a free-flowing chain of knowing that wasn’t broken until recent history.
In the modern world, Merriam-Webster defines a doula as, “a person trained to provide advice, information, emotional support, and physical comfort to a mother before, during, and just after childbirth.”
A doula can be either of these things or land somewhere in the middle of the old world and modern doula. A doula doesn’t necessarily need to be trained by anyone. A doula could be a massage therapist who has been called to attend birth. They could be someone who was invited to attend someone’s birth and fell in love with it. They could be someone who has studied birth for years but has never been invited to a birth.
Doula lives in the soul. Doula holds strong to the knowledge that the keepers of wombs are powerful and wise. Doula remains open to each new conception, pregnancy, birth and postpartum experience. Doula holds ancient wisdom within from the birthers that have come before. Doula is not a person. Doula can take the form of a person. That person can learn what birth is. They may even experience birth firsthand. They may choose to learn the physiology of pregnancy and birth, birthing positions, conception methods, the stages of grief, pregnancy symptom relief, postpartum care and so much more, but without the doula in them, these things are not complete.
As a birther, a doula can prove to be an essential part of your reproductive experience in ways you could’ve never predicted. Your doula could potentially see you through conception all the way through your first year postpartum. They will see you at your most vulnerable times while you transition into and through pregnancy, birth, and through postpartum. They will see you with love and the knowing that you are doing it all with the ancient wisdom that was given to you as your birth right, and that doula will be there with their given wisdom to serve in whatever ways they are needed.
Many doulas choose to train as full spectrum doulas. Different people will give different definitions of this type of doula, but the idea is that this person can provide physical and emotional support and wisdom through any reproductive happening. This includes, but is not limited to miscarriage, choosing to end a pregnancy, end of life support, conception, birth, and postpartum support. A full spectrum doula should understand the needs of all populations especially those of black birthers, LBGTQ birthers, those at a socioeconomic disadvantage, and all other social and specifically birth justice issues of the time.
A doula should be someone you click with on an energetic level. Anyone can doula, but anyone can’t doula for everyone.