Is a doula like a midwife? Always, this question.

My client was a VBAC mom, but moreover, a doula I had trained, mentored, and built a friendship with. She was a part of our community, and as so many doulas do, she turned the trauma of her first birth into growth resilience, and her wounds into deep empathy and compassion for the birthing and new parents she supported.

For many of us who attend births, it’s a complicated journey when we birth our own, holding so many memories, both victorious, and traumatic, on a cellular level.

But that day was her day, and a day for her partner to heal as well.

And my promise to them was to hold a space of safety and strength.

So when the baby descended, and I saw some concerning decels on the monitor, I stepped squarely into that commitment.

Leaning in, eye to eye, breathing together, the mantra of encouragement joined the sweat and tears and the flush of one transition completed, and another moving into focus.

“You can do this. You can push this baby out, just as you’ve imagined. You’re so amazing and your baby is working with you to come into the world.”

The Nurse Midwife, very experienced, and someone I knew quite well, and had great regard for, pulled me aside after the next contraction to say “Do you not realize what is happening?”

As someone who was at that time trained as a midwife, I had the training and hands on experiences, and a foundation to know how to read a fetal monitoring strip to determine if there were signs that warranted further attention and physician management. I knew the nuance of a strip that indicated cord compression or fetal descent; the relevance of the pattern of recovery; had studied with care the alarming, but often undetected patterns that can accompany uterine rupture. I was never nonchalant about a concerning reading, and like many doulas, have grabbed the attention of a nurse when we knew things aren’t looking as they should and there isn’t the attention on it you would expect.

I did realize what was (potentially) happening and I reassured her that I understood the gravity of it all. We worked together enough to have a great rapport, and with great respect, I pointed out that I was going to be with the family to focus on each moment one at a time, while giving her the opportunity to pay close attention to that monitor, and to prepare for physician and possibly peds backup, and to maybe prep the OR. My job was to show up with trust and calm for my client. “You’re the midwife. I’m the doula. And she needs to push like she believes in herself.”

I often don’t tell this story, because it can sound as if I condone a doula telling others what to do or getting involved in or interfering with medical decisions. I ‘read’ the strip just as I would ‘read’ the room, knowing that there is something amiss. As a doula you know we aren’t there to create tension, but to ease it. You’ll just have to trust me that in this relationship with the midwife, I was attuned to her stress, and knew she had a recent fetal demise (because we had built that level of trust and friendship over years of work together), and was feeling anxious. She showed up, it turns out, with her full humanity as well as any of us. Of course she’s impacted by her own stress and fear. So I eased things with a joke, and if I recall, a hug. “You’re paid (much more than I am) to worry. I’m paid to love this family and to keep them focused on pushing this baby out unless you’re calling it and it’s time to shift. Then, together, we’ll help the family shift gears. But unless you want her to change positions or stop pushing, this is what I’m going to pay attention to.”

In the next several contractions, in a glorious space of healing, trust and safety, a woman pushed out her baby girl, vaginally, with an Apgar of 9/10. Her baby, and her uterus, were as strong as her will and trust in herself.

So a doula is “like a midwife” but has no need to step into the midwife scope. A midwife, is “like a doula,” but in my experience when I was holding those responsibilities, can’t be as fully engaged in doula’ing because, well, the job is to be the midwife. And sometimes, that’s to be scrutinizing the monitors while the doula keeps the family calmly focused on having, greeting and loving their baby.

And yes, midwives are compensated differently than doulas, but both deserve sustainable rich careers doing what they each do best.

We’re hoping you’ll join us to establish clearer understanding of what the doula actually does, and to address the invisibility in our industry around issues of compensation, workplace challenges, our financial health and wellbeing, our impacts and value, and the lived experience of those of us who are there not only for that “one more push” but for all the hours and days and weeks that precede and that follow the birth itself.