Is a Doula like a Midwife? Always, this question.

My client was a VBAC mom and a doula I had trained, mentored, and built a friendship with. She was a part of our community. 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 doulas who attend a lot of births, it’s a complicated journey when we birth our own because we hold so many experiences and memories, both victorious, and traumatic. 

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 was very experienced and someone I knew quite well and held in great regard. They pulled me aside after the next contraction and said, “Do you not realize what’s happening?” 

As someone who was a trained as a midwife and had attended many births as a doula, I knew 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, and had studied with care the alarming, often undetected, patterns that can accompany uterine rupture. And I was worried about this concerning reading. Like other doulas, I have grabbed the attention of a nurse when I noticed things aren’t looking as they should and there isn’t the attention given that you would expect. 

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

I don’t often tell this story because it can sound as if I condone that doulas should tell others what to do and that it’s okay to get involved, or interfere, in medical decisions. And we too often share stories of competing with other care partners (They thought x and I just KNEW they were wrong). This isn’t the point I’m trying to make. I ‘read’ the strip just as I would ‘read’ the room, knowing that something was amiss. As a doula, our role is to ease tension, not create it. I was attuned to the Midwife’s stress. I knew she had a recent fetal demise – because we had built that level of trust and friendship over years of work together – and was anxious. She was showing her humanity. Of course, she was impacted by her own stress and fear. I eased things with a joke, and we hugged. “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 decide 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, my client vaginally pushed out her baby girl with an Apgar of 9/10. This new mother’s tears of joy were as strong as her will and trust in herself. The midwife, who later shared with me that she was retiring later that month, was elated to tuck them in.

So, a doula is ‘like a midwife’ but does not step into the midwife’s scope of practice. A midwife is ‘like a doula,’ but, at least in my experience, can’t be as fully engaged in doula’ing because, well, the job is to be the midwife. And that might mean scrutinizing the monitors while the doula keeps the family calmly focused on having, greeting, and loving their baby.  

Yes, midwives are compensated differently than doulas, and both deserve rich, sustainable careers doing what they each do best.  

We’re hoping you’ll join us to establish a clearer and richer understanding of what doulas actually do, and to support us as we address the issues in our industry around compensation, workplace challenges, financial health and wellbeing, our impact, and value.  

You are the people who are there not only for “one more push,” but also for all the hours, days and weeks that precede and follow the birth itself – the doula whose job is to be the healing, regulating presence, no matter where the birth story takes us.