By Tempest Wright

According to the United Health Foundation, the United States infant mortality rate is higher than the majority of nations within the Organization for Economic Co-operation and Development (OECD). Of the 37 developed nations within the Organization, the U.S. ranks 33 for the number of infants kept alive beyond their first birthday. However, the work of midwives and doulas help to drastically improve these numbers.

Though midwives have been delivering babies for hundreds of years, and are a normal part of the birthing experience all over the world, they are still widely unknown and underutilized in the U.S. As the country grapples with its maternal health crisis, the importance of midwifery grows more pronounced, especially as this generation of parents demands more autonomy over their bodies.

The relationship between a midwife and patient is one of trust and collaboration, as the patient is an active participant in decisions regarding their health, instead of leaving these decisions solely up to their doctor. Additionally, people who have had negative birthing experiences are more likely to seek out a midwife or doula to assist with their labor.

Midwife or Doula?

To highlight the importance of midwives and doulas, it’s important to define what they are, their functions in childbirth, and the difference between the two professions. The most significant difference between midwives and doulas is that midwives are medical professionals while doulas are not.

Midwives are responsible for the health and safety of their patients, and can provide prenatal and gynecological care, even for people who aren’t pregnant and aren’t planning to have a baby. It’s not uncommon for a midwife to also be a registered nurse, but there are different types of midwives based on training and education.

Doulas, on the other hand, are responsible for providing their patients emotional support during the birthing process and during the postpartum stage. As with midwives, laws on doula certification and training varies from state to state. Doulas don’t need a degree or certification, but they are not allowed to carry out medical procedures and they don’t deliver babies. However, doulas are capable of advocating on behalf of their clients in hospital settings, which is imperative for parents who must remain focused on delivering their children. Rave Sinclair, president of DONA International, states, “If you’re in pain and worried about your baby, it can be difficult to navigate the doctors and hospital and nurses. Doulas kind of serve as a cheat sheet of your options.”

It’s not impossible or uncommon for an expectant parent to have both a midwife and a doula, as each serves a different – and important – purpose. A midwife is crucial if medical problems arise, especially during a home birth. Midwives monitor both parent and baby and anticipate potential issues before they arise. Some prescribe necessary medications and order epidurals in hospital settings.

Doulas provide comfort to the parent and every person, such as the spouse and other loved ones, attending the birth. As with midwives, different doulas offer different services. Bereavement or loss doulas support families if they lose their baby, while full-spectrum doulas support families throughout fertility treatments, pregnancy, birth, or adoption. Finally, antenatal doulas support families just through the course of the pregnancy.

When both are present, doulas and midwives work together as a team to ensure families have all the care and support needed to bring a healthy child into the world, while keeping the person in labor safe. Doulas fill in for the parent’s non-medical needs so that midwives can stay focused on any clinical concern.

Doulas, Midwives, and Their Importance

Midwives and doulas are crucial to the birthing experience because they allow pregnant people to be hands-on with their care. From the moment a pregnancy test comes back positive, midwives are there to help parents make the healthiest decisions throughout the gestational period.

Midwives aren’t there to force their medical opinions on patients, but they coach, inform, and answer questions. Midwives look out for and recommend treatment for dangerous pregnancy complications, such as preeclampsia, and perform physical exams, Pap smears, and other prenatal care.

Doulas are important in that, in addition to emotional support, they provide natural pain management for parents who want to minimize their reliance on pharmaceuticals during the birthing process. Doulas also help with mobility (helping the client get up and walk around), birthing positions, and coping strategies during labor. They provide emotional support for those who experience miscarriage, stillbirth, and even abortion. Finally, they are there to assist both parents during the postpartum period, with some doulas making house calls or doing an overnight stay within the weeks after birth.

According to the National Institutes of Health (NIH), mothers who seek the care of a midwife, doula, or both are more likely to have a vaginal birth (less likely to have a C-section) and are more likely to be in labor for less amount of time. Additionally, mothers who go the midwife or doula route are less likely to request an epidural, although the option for one always remains open.

Most importantly, the involvement of a midwife or doula improves infant and maternal health outcomes, as reported by the NIH. Parents assisted by doulas are four times less likely to have a baby with low birth weight and two times less likely to experience birthing complications. Parents who opt to have a doula or midwife assist them in birth are also more likely to breastfeed their child. In a hospital setting, nurses are unable to remain with parents throughout the entire birthing experience, as they have other patients to attend to. The presence of midwives and doulas amend this issue. Doulas are also beneficial for parents who are socially disadvantaged, especially Black mothers who are dying at three to four times the rate of pregnancy-related complications as white women. The presence of doulas also determine a better outcome for Black babies, whose mortality rates are twice that of their white counterparts.

How to Find a Doula or Midwife

Before hiring a doula or a midwife, it’s important that parents know exactly what they’re looking for. Important qualities in both doulas and midwives include someone who is a strong advocate for their patients and respects their decisions. WebMD also offers several tips for those looking for a midwife or doula.

Pregnancy and childbirth represent pockets of times when people are at their most vulnerable, and the type of care they receive could be a matter of life or death. Having a doula or a midwife in the room might seem antiquated or old-fashioned in the modern world, but the importance of their work is so great that it cannot be quantified.