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Understanding the Roles of Midwives and Doulas

Updated: May 15

Monica with Christy D’Aquila, Magnolia Midwifery

As soon as you learned you were pregnant, you likely began researching what type of care and birth experience you want to have. Do you want to give birth in a hospital or at home? Water birth or on land? Do you want a traditional OB/GYN, a midwife, or a doula? If you have a midwife, do you need a doula as well?

Many people associate doulas with homebirths. Others assume that since they will have a midwife attending the home birth, they don’t need to have a doula as well. So, what are the roles of midwives and doulas? Do you need both? I recently sat down with Christy D’Aquila, owner and nurse midwife at Magnolia Midwifery to discuss the roles of midwives and doulas during pregnancy and childbirth.

The Role of Midwives and Doulas

Both midwives and doulas are specially trained to assist a woman through childbirth. While there is a lot of overlap in the services midwives and doulas provide, there is also a lot of divergence. The most significant difference is that midwives are medical professionals, while doulas are not. Many midwives are in private practice and specialize in home birth, although midwives may also attend hospital births. Doulas, likewise, will attend the birth at home or in the hospital. However, if a medical issue arises, a doula must refer the issue to a medical professional. “I would say 50% of my clients will have a doula, and 50% don’t,” Christy shared. “But I do more and more recommend a doula to especially first-time parents because there is so much unknown, and that template is completely missing.” First-time parents benefit from having a team to support them through this new experience. “They’ve never done this. And as we know, first time births tend to take a bit longer, so we work as a team with a doula involved to answer all of the questions [and] to give them a roadmap that kind of makes sense for them and connects them with the community,” she explained.

As a midwife, Christy appreciates the role of the doula. “Sometimes, as midwives we are trained and focused on the physical, but what midwifery is goes much beyond the physical. [T]here is such a role for the doula in supporting that process,” she explained. Doulas can be there for the emotional aspect of childbirth and help the partner know what their role is, while the midwife gets down to business making sure everything is going smoothly.

During active labor, there will be so many things happening at once. The midwife needs to focus on the body and health aspects of what is going on. “We really want our attention…to be focused on the time of birth, ushering in the safety of the birthing person, the mom, the newborn, and the placenta. And then the intensive care that we give in the first three to four hours. The doula is invaluable in that as well, just in the communication all around,” Christy explained.

What can Parents-to-be Expect from Midwife Care?

Midwife care begins during the prenatal phase and continues postpartum. Let’s take a look at each phase separately.

Prenatal Care

Most new parents come to midwifery through word-of-mouth referrals. For Christy, the match is super important. She offers an initial 30-minute phone call to find out what they are looking for and to tell them a little about her practice. Then she follows up with an e-mail and invites prospective clients to come for a free one-hour consultation visit. Christy encourages you to bring along everyone who will be on your birth team- mothers, partners, and anyone else who will be involved. Everyone is welcome to come and ask questions. After the consultation, some sign up right away, while others wait or even choose to transfer care to a midwife if their original choice turns out not to be what they really want. “My comfort level is taking clients before 30 weeks, because there is so much to be done,” Christy advises.

Family room

Midwives provide hours of prenatal visits. Each visit is about an hour long. “For the first 40 minutes, we’re just sitting, hanging out. We may talk about something very specific to [the] physical discomfort of pregnancy, but most of the time we’re just talking about life- other kids, previous experiences, things with partners. All of that affects how you are moving through the journey of the child-bearing year. Then the last 20 minutes, if lab work needs to be done, or something very specific, we check vital signs, baby’s growth, and position,” Christy explained. The midwife-client relationship is a special and intimate one. It is important that there is an understanding of the psychic, emotional, and lifestyle choices of the person and to have really informed decision making conversations. “We can tailor the appointment to that

person or family, what is going on in the moment,” she said.

During Active Labor

As part of the prenatal visits, you will have discussed birth plans. “I definitely talk about birth plans at different stages. I always say we have Birth Plan A, which is planning for home birth. Birth Plan B is what happens if the baby arrives before the midwife, and that’s not what you were expecting. And then Birth Plan C is if we move from home to hospital for whatever reason,” Christy explained. A lot of people have a birth plan, but Christy emphasized that it can’t be the whole plan. “We know there is always unexpected, I mean that is the one certainty in the child-bearing years, that unexpected things come up,” she says. If complications arise during the homebirth and delivery needs to be transferred to a

hospital, your midwife will no longer be the primary care provider. However, both she and your doula will be there to continue providing support.

If you are thinking about a water birth, Christy has you covered. “I support 2-4 clients a month, and I have 4 tubs. So I’m rarely ever like, ‘I’m sorry, I don’t have one for you.’ I just let people use my tub and then they just have to buy a few extra supplies,” she says.

In the Hours and Days Postpartum

As a nurse midwife, Christy does have prescribing privileges and will have medication and oxygen available if needed. She can also suture 1 st or 2 nd degree tears in the home. She will also do the initial health assessment for the baby and can even provide well baby care up to 28 days. Some midwives will provide well baby care up to 6 weeks. “If you are giving birth in the home, we really want to keep you there. And for us busy people, in our lives, we all get a little antsy. But really, we start talking early on that newborn care can happen in the home. Birth certificate paperwork can be started at two weeks… We really don’t want you going to get a notary out. The focus is really to keep you at home,” Christy explained. She encouraged looking for services, such as postpartum doulas, lactation consultants, and chiropractors, who will come to the home.

Midwives and Doulas Work Well Together

Both midwives and doulas bring valuable training and experience to your birth team. As your due date approaches, your midwife and your birth doula will be on call 24 hours a day for you. We also recognize and deeply respect the role of each individual on your birth team and want to support them, not take their place. The midwife and doula communities are tight-knit and can help you access resources such as chiropractors, lactation consultants, and other professionals who will improve your experience or help you navigate unexpected challenges. Many doulas, and some midwives, also bring specialties such as postpartum meal support, newborn care, and massage. If you are ready to see if a midwife is right for you, contact Christy at Magnolia Midwifery to set up your initial consultation. And don’t forget to also set up your consultation with us at Tiny Miracles care. Our birth doulas and postpartum doulas are excited to meet you!

You can check out my complete interview with Christy here.

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