What's the Use of Midwives and Doulas?

Note: First author is Elizabeth Ledden

Doulas have been assisting childbirth since time immemorial. A doula is a support to the mother throughout the perinatal period (see more about doulas here).

A doula is a professionally trained birth coach, who accompanies the mother during the birth and the next few days afterwards. A doula doesn't replace a doctor, but is present during the birth, along with the doctor, to support the new mother.

A midwife is professionally trained to help give birth to the child and serves as a replacement for the doctor during the birth.

Although decreasing, there is currently a stigma in popular culture against the use of a doula or midwife in the birthing process. Many criticisms stem from the concern for the safety of both mother and baby, with the thought that doctors can provide a better quality of care during the birth.

However, studies have determined that expectant mothers assisted by either doulas or midwives are significantly more pleased with the birth process than are mothers assisted by doctors^1,2. Women assisted by midwives have had a more positive attitude about their birth experience and are more satisfied with the care they received¹. Women assisted by doulas find an increased communication and empowerment during the birth process, as well as a more positive attitude about their role in giving birth to their child².

Are doulas and midwives safe?

A doula acts as a birth coach in the birthing room and does not replace the presence of the doctor. Having a doula present does not serve as a type of safety hazard for the mother or the baby. A midwife is professionally trained to help the mother give birth, and thus is qualified to replace a doctor in the birth process. Women assisted by a midwife as opposed to a doctor in a hospital setting had similar maternal and infant outcomes concerning the birthing process³.

What role does a doula play?

Doulas serve as advocates for the expectant mother during the birth process. Doulas offer physical comfort, physical assistance, and emotional, social, and verbal support⁴. Doulas offer support through praise, reassurances, acts that improve the comfort of the mother, such as holding her hands and rubbing her back, and explanations of what is happening during the labor and delivery process. The use of doulas is comparable to longstanding traditions of having experienced women help the expectant mother through the birth process⁴. Overall, the presence of a doula leaves women feeling more supported and informed during the birth².

What are the influences of using midwives or doulas on the birthing process?

The use of doulas and midwives is associated with a more natural birth experience and fewer, often-unnecessary medical interventions. C-sections, episiometry, epidurals, and admission to the NICU occurred more frequently in doctor-assisted deliveries than in midwife-assisted deliveries¹. Women attended to by doulas find the overall pain more bearable², and women assisted by midwives experience lower rates of obstetric interventions, narcotic analgesia, electronic fetal monitoring, and use of amniotomy³. Babies delivered by midwives as opposed to doctors are less likely to receive drugs for resuscitation, but show similar Apgar scores and outcomes as babies delivered by doctors³.

Do doulas improve outcomes?

Yes, they do. In a meta-analysis (a study of studies) by Scott and colleagues, continuous support from a doula, when compared with no doula support, was significantly associated with less need for painkillers, artificial oxytocin, forceps, and c-section. Continuous support was also significantly related to shorter labor. Intermittent support did not have these positive outcomes. In one study, friends of expectant mothers (randomly assigned to condition) were trained to be doulas in two 2-hour sessions. Their presence decreased the length of labor, and the babies had higher Apgar scores at both one and five minutes. So doulas can help mothers and babies.