Midwife versus Doctor versus Doula versus Partner

Let’s just start by saying that I am not, in any way, trying to compare the role of a labour support provider with those offering primary care to a pregnant or labouring mom. I am simply outlining the kinds of questions I get from clients in my classes and those I meet on the street when they find out what I do. The questions often unfold like this:

Client: “What do you do?”
Me: “I provide labour support to a woman or couple towards the end of pregnancy and through the first few weeks with a new baby. I am sometimes called a ‘doula.’”
Client: “Oh. Isn’t that like being a midwife?”
Me: “No, midwives are the primary care providers to their clients through the pregnancy and until the baby is 6 weeks old.”
Client: “So she sees a doctor as well as a midwife?”
Me: “No, she sees a midwife instead of seeing a doctor.”
Client: “Ahhh, but then when does the doctor come in?”

We run in circles for a while until I am able to explain that, in the majority of cases of midwife attended births, there isn’t ever a need for a mom to see a doctor. I remind this client that a midwife goes to university for many years (with five semesters dedicated to learning in a hands-on, cooperative setting). This often helps begin to unveil the understanding that I knew was bubbling just under the surface.

**Note: Midwifery care is different from country to country, indeed from region (within a country) to region. I am writing about what I have witnessed in the province of Ontario, Canada.**

So many people have this strange idea that all midwives want their clients to deliver by a babbling brook under the willow tree. It was a very carefully contrived image painted into the minds of many people during the years when doctors first began to attend births in hospitals instead of midwives attending women in their homes.

Most of the doctors I have met have a very healthy respect for midwives and the role they play in straight-forward, low-risk pregnancies and births. They appreciate the fact that midwives care for the patients that don’t require an obstetrician’s expertise, allowing them more space in their schedules to look after the moms who are experiencing what are considered “high risk” pregnancies.

It is true that there are some doctors who seem to view it as a competition and who see midwives as “less-skilled.” However, my experience has shown me that if they were to truly investigate why they feel this way, they would recognize that it is more often due to a jealousy they feel as a result of not being able to care for their patients in the same way a midwife cares for her own.

While there are very few truly “high risk” pregnancy and birth situations, they do sometimes exist. For those mothers it is essential that they have a chance to birth with an individual who specializes in risky birth scenarios. Obstetricians bring a surgical skill, developed through their medical school studies, that midwives just simply do not have. This skill is why a midwife will defer to an obstetrician when vacuum, forceps or caesarean birth are necessary.

Midwives hone their skills around catching babies born vaginally with minimal interventions in place. They have had a chance to develop a relationship with their clients through the course of the pregnancy. A typical prenatal visit with a midwife is 15-30 minutes in duration. They are scheduled that way to allow time for a comfort level to be established thereby creating a safe environment in which an expectant and new mother is able to voice her curiosities, fears, and celebrations.

The likelihood that a midwife you have met will be at your birth is considerably higher than the possibility you will see a doctor you know. This is due to fact that doctors practice in much higher group numbers than midwives.

So, I have outlined some of the key differences I see between birth doctors and midwives. What are some of the ways that midwives differ from the role of a ‘doula?’

The focus of the labour support provider (aka: doula) is to work for the woman/couple having the baby. She is there to provide emotional and physical information and support. She is not there to assess the well-being of the mom or the baby. She is also not going to perform any vaginal examinations or blood pressure checks.

Most of the couples I work with hire me because they have either been in my prenatal classes or they have heard about me from other people. When they have been in my classes they have had chance to learn what my approach to birth is and how I truly believe in the ability of a woman’s body to bring forth a baby. They like the way I trust them to be able to transcend their fears and be the pillar of strength as well as the epitome of calm. I am there to help them stay relaxed and focused. I am there to help their partner with the physical support mom will need as well as to offer ideas and suggestions about the best way to guide her along her journey.

Many midwives are able to offer exactly the same types of skills I bring. They are able to balance their charting and care-giving with aiding in providing the emotional and physical support mom needs. I don’t see myself taking away from how a midwife can help a labouring woman in a birth setting. I see myself there as a part of the circle of power she can draw upon.

I am often asked about whether or not my role might conflict with or diminish the role of mom’s partner. I truly hope I would never do that. I want to augment, support and highlight her partner’s place at her side. I firmly believe, and have witnessed myself, that the larger the circle of love and support a woman can create around herself the safer she feels. When she feels safe she is more easily able to relax and the smoother the birth process unfolds. When I write about having a large circle I want to be sure to underline that I don’t mean that everyone needs to be in the room with the mom-to-be. Just knowing the support is there is sometimes more than enough.

The biggest challenge for many moms-to-be is allowing herself to be completely honest with herself about who makes her feel the most safe. For some women that means she wants a midwife, doula, partner, family and friends nearby. For others it is important for her birth to be a private and intimate experience. I want each mom to listen to her heart and if she knows she won’t be able to let go and be herself if her mother, sister, or best friend from high school is in the room with her then they need to understand and show her respect by not making her feel badly when she asks them not to stand at her side.

As a labour support provider, I am also there to help the partner through the process. Yes, mom is my primary focus however, birth and becoming parents is a life changing experience and it is supposed to be monumental. It isn’t meant to be easy. It isn’t meant to be painless. It is supposed to be intense (emotionally and physically) as well as joyful, empowering and enlightening.

There is a time and a place for everyone who works in the field of labour and birth. I am not one to suggest otherwise. I simply want people to see the value in creating the kind of care network that makes you, as a pregnant woman, feel the very best and most safe.

Doctors have a role to play. Some births absolutely would NOT happen without the benefit of their skills. When it comes to vaginal birth though their part is often fairly small when it comes down to the actual labour and birth. That said they, as midwives, should be working with moms through the pregnancy to give women the power to believe in their bodies’ ability to birth babies. If you have that in your care provider, you are luckier than you know!

Posted by Sam

(The first two pictures in this post are of me - the first immediately after the birth of a baby, the second with a baby whose birth I attended - and finally a photo of three past clients and their first babies. These three have become friends as they have gone on to birth more babies with me.)