What is the difference between a doula and a midwife?
I think this is one of the most common questions I’ve received as a midwife!
A doula is an unregulated expert in prenatal education, advocacy, providing comfort measures and support to birthing people without providing medical care.
Most doulas excel in labour and delivery, but there are also doulas who offer more prenatal education, and some offer more postpartum support. A doula is someone hired by the family on top of having a regulated health professional care for them in pregnancy, such as their family physician, midwife or OB.
What does it mean to be “unregulated”?
Being “unregulated” means that anyone can call themselves a doula without fulfilling any specific requirement. This means you can have a doula who is extensively trained and has attended hundreds of births, but you can also come across a doula who has done none of that.
Every regulated profession has a governing body whose mandate is to protect the public by creating a framework for training, certification, and maintaining skills.
Being unregulated means there is no governing body for doulas, however their care is governed by general laws such as the Regulated Health Professions Act of 1991 which mandates what professionals, and only professionals, with a license can do.
This means that doulas are held to the same standard as your best friend or neighbor in that they can’t perform any medical duties such as cervical exams, fetal heart rate monitoring, etc.
This lack of regulation also means there is no disciplinary process for a doula who offers poor care.
Are their benefits to being unregulated?
Absolutely! For one, there’s more freedom of care and an ability to offer very personalized packages based on the needs of a community, but the most obvious benefit is that they aren’t held to policies and procedures like other health care professions in a way that can sometimes stifle individualized care.
So where are doulas being trained?
Because of this lack of regulation, various non-profit organizations have been created to both certify and register doulas, so that birthing families have a place to go where they can find a local doula who has a degree of training and has attended births.
The most recognized certifying body is called DONA International, and was formed in 1992. DONA offers various degrees of training for prospective doulas and registers doulas who have fulfilled a series of requisites.
Ontario has its own registry and certifying organization called the Association of Ontario Doulas, which was formed in 2000.
What is the evidence on doulas?
A 2017 Cochrane Review of continuous labour support (that wasn’t the partner) demonstrated that these women were:
- More likely to have a vaginal delivery (39% less likely to have a CS),
- Less likely to use pain medication,
- 31% less likely to have negative feelings of the birth,
- 15% less likely to require vacuum/forceps,
- Have shorter labours (by about 40 minutes on average),
- And their babies were less likely to have low apgar scores (38% less likely).
There is NO evidence that there are negative effects of having continuous support. Duh.
So why does having a doula provide all these benefits?
The doula can be a buffer between a harsh, rule-driven hospital environment and the vulnerable family. The doula isn’t employed by the hospital thus isn’t beholden to their policies and procedures.
Their loyalty is to the woman and their family, which puts them in a unique position to be true to the family’s needs and wishes.
Women feel less pain when their doula is present: the doula is a pain killer! The doula provides a sense of safety and security, helping to alleviate fear and anxiety. This can break the fear-tension-pain cycle.
Having the doula present increases natural oxytocin with the attachment they bring to the birth. This is why your doula will meet with you several times prenatally to make sure you are a good fit and that this bond forms to be able to serve you well in labour.
So how much does a doula cost?
The cost of a doula varies, depending on the services provided. Most doulas have various packages available that may range from $500 to $3000. Expect to pay about a month’s cost of childcare, so prices vary depending on your community’s economics.
Some insurance companies will cover a certified doula, so check with your benefits provider.
If you just spat out the cold coffee you were trying to drink after reheating it for the third time, tell me how much you paid for that luxury stroller or dock-a-tot or gorgeous wall art? Yah, that’s what I thought.
A doula is a major investment in having a fulfilling and empowering birth. Don’t underestimate their power or worth.
Who should hire a doula?
Everyone. Plain and simple. Even if you are planning a very hands-off birth at home, birth can be unpredictable and you can find yourself readjusting expectations for a hospital birth and finding a lot of value in a third party who knows your birth plan and will advocate for your goals in hospital. They are even more vital for families planning a hospital birth.
Just because you have a midwife DOES NOT mean you don’t need a doula. As much as your midwife may really advocate for your goals and ideals and provides lower intervention rates than delivering with a physician, they cannot provide the care of a doula due to the other responsibilities of charting, birth room preparation, consulting with other care providers, and navigating the politics of the Birth World.
Now that I know I need a doula, where can I find one?
Check out the two registries I mentioned above, DONA and the Association of Ontario Doulas.
You can also ask your care provider for recommendations, but take their recommendation with a grain of salt. Remember how I said that a doula acts as a buffer? This means that your care provider may actually view the doula as a BARRIER between them and the client, especially in a paternalistic hospital environment.
Do your homework and interview more than one doula. Childbirth Connection provides some great questions to ask a prospective doula.
“A doula is cheaper than therapy!”
Check out my interview with a fellow mom who discusses many of the components of my e-Course “Prenatal Education for a Fulfilling Birth” in her lived experiences of infant loss, Caesarean, VBAC, working through birth trauma, filing complaints, the importance of hiring a doula and more!
Dekker, R. “Evidence on: Doulas”. Originally published 27 March 2013 and updated 4 May 2019. Evidence Based Birth. Accessed online 14 April 2021.