• The Rosewater Doula

Is a Doula a Midwife?

Updated: Jan 30, 2019

Since becoming a doula, I have been asked countless times if I was a midwife, or if a midwife and a doula were the same thing. The answer is no. Doulas and midwives have completely different trainings, and different roles in a birth space.


A Midwife’s primary focus is the medical side of the birth, the health of the birthing person and the baby. midwifery privileges vary from state to state. It is a common misconception that certain types of Midwives are illegal in some states. That actually isn't the case. It’s not that any particular midwife is illegal, it is that certain types of midwives do not have legal protection. With that being said, there are quite a few different types of midwives.


There are TWO types of midwives in the United States: 1. Direct Entry Midwife, or a DEM 2. A Nurse-Midwife, denoting that the midwife has some level of formal nursing education. The most uncommon type of midwife (less than 5%) is a DEM, or Direct Entry Midwife. DEM's will only take low-risk, healthy pregnancies. A DEM's main focus is most commonly on home births, and is typically an independent practitioner. Occasionally, DEMs will work with a free-standing birth center, in more regulated states. DEM's have restrictions in many states. A DEM's training is not standardized, and will vary from Midwife to Midwife, their trainings may include apprenticeship, self-study, and/or midwifery school. These types of Midwives have the least formal education, but volumes of practical knowledge and experience. A DEM in states where midwifery is regulated most commonly will be called a Licensed Midwife, or a LM, other states might use slightly different wording, like a LDEM or a LDM.


Certified Professional Midwives or a, CPMs. CPM's have met the North American Registry of Midwives (NARM) requirements, and they are qualified to provide the Midwives Model of Care. Many CPMs have formal education but as a whole their education is heavily based on the apprenticeship model and are trained exclusively for out of hospital birth. The average training for a CPM is approximately 3-4 years; this time is used to finish any additional schooling, gaining hands on birth experience, and fine tuning their overall skills used in a birthing space. Similar to LM’s, the CPM's privileges will vary by individual States. some states recognize CPMs and some don't. In a state where a CPM is not recognized--they are technically practicing without a license.)


Certified Nurse Midwife or a, CNM. A CNM must hold a state AND national licenser typically issued through their 'state board of nursing', and therefore is is recognized, and permitted to practice in all 50 states of the U.S. A CNM is a registered nurse first that receives additional training in pregnancy and childbirth, and has at least a master's degree in nurse-midwifery. CNMs have high levels of formal education and practical hands-on knowledge. In most states with stricter midwifery laws the majority of midwives that you'll meet, (in a hospital, or birth center) are CNM’s. Because CNM's are also trained in medical management of pregnancy in a hospital i.e. inductions, ect, and also have prescriptive privileges in all 50 states, most do work in hospital settings and collaborate with OB/GYNs'. Though many do out of hospital births as well. A CNM is a GREAT option for someone who isn't considered "low risk" but still wants Midwife care. Because of their extensive knowledge in nursing and midwifery, CNMs are qualified to provide woman's health care not just during the childbearing years, but during someones' entire life.


Certified Midwife or a, CM. A CM and a CNM have a lot of similarities, the biggest common denominator being the levels of a formal education, both a CNM and a CM are required to have at least a masters degree, typically in Midwifery. However a CM doesn't necessarily have a bachelors in nursing like a CNM does. CM's primarily work in a hospital setting and have prescriptive privileges in New York, Rhode Island, Maine. CM's are only in licensed to practice in Delaware, Maine, New Jersey, New York, and Rhode Island.

A doula is a non-medical professional, whose focus is primarily on the emotional, mental and physical comfort of labor and birth. Doula certification will vary, and not all doulas choose to be certified. A certified doula typically takes a three-day training course, roughly 36+ hours, a breastfeeding support class, a childbirth education class, and a business training course, adding 20+ hours to the initial training. They will then attend 3-6 “certifying births” which constitutes an additional 15+ hours of of training. This gives the doula valuable hands-on practical knowledge. There is not a formal degree available for doulas. However, many do have college degrees.


Doulas and midwives work synergistically in a birth space, due to their individual training, and unique roles.

The benefit of having a doula is that they have no medical responsibilities, because your doula is able to give you their complete and undivided attention. They are able to focus solely on your emotional and mental wellbeing. Also, a doula is able to come and support you regardless of where you may be in the labor process, and is able to stay with you the entire duration of your labor and birth, as opposed to a midwife, who will typically only attend to a patient in active labor. In addition, a midwife or OB may have multiple births occurring at the same time and may only be present during the final stages of birth. While these medical professionals find themselves in and out of the birthing space, doula’s are a constant presence and support.


In my experience, I have heard that clients express a huge sense of relief knowing that someone with an intimate knowledge of birth is present 100% of the time, even though they are not receiving medical advice. Continual support and encouragement during birth is both vital and reassuring.


As a doula, I have enjoyed working alongside many Doctors, Nurses and Midwives. I know that it takes a tribe to bring a baby into this world. Working together as a team is such a wonderful thing to be able to see. I have gotten to know many providers here in my old city of Charlotte, North Carolina, and it is a privilege to work among such incredible people who are all passionate about happy, healthy births.We live in a remarkable time when medical professionals and non-medical professionals join together in creating the best support team possible in making the “birth experience” a memory to cherish.



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Resources:

Graduate Nursing Education-https://www.graduatenursingedu.org/careers/certified-nurse-midwife/what-is-a-midwife/

American Pregnancy-http://americanpregnancy.org/labor-and-birth/midwives/

North American Registry of Midwives-http://narm.org/

American College of Nurse-Midwives-http://www.midwife.org/

Midwife Schooling-https://www.midwifeschooling.com/midwifery-roles-and-credentials/


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