(TL;DR : Yes, yes you do need a Postpartum Doula and a Midwife. They are different.)

I get it: the birth & new parenthood world can feel like a completely different universe. It can be new and confusing. SO MANY NEW WORDS!! There is lots to learn. I hear you. So if I can help clear something up for you then that makes me very happy.

If you’re here, I’ll assume for now that the terms ‘Doula’ (in this case, Postpartum Doula) and ‘Midwife’ are causing some confusion. THAT’S PERFECTLY OKAY! In fact, I’ll discuss below why it may be COMMON to mix the two up.

Luckily, I have experience as both a Student Midwife and as a Postpartum Doula! Both professionals are wonderful, complementary, and are well worth your time learning about and considering.

I’ve also invited a great friend of mine, Vishali, who is a new Registered Midwife (RM) as a guest on this post, to also share her expertise on the subject. Welcome, Vishali!

Disclaimer: this is not a definitive or exhaustive comparison of the two professions. Just some main points we’ve come up with.

Why do a Postpartum Doula and a Midwife Sometimes get Mixed Up?

Great question. There are a few similarities, along with history, that Doulas and Midwives share.

• Doulas and Midwives tend to be natural-focused. Meaning, they view birth and the postpartum as natural, normal processes that ought to be complemented with holistic, nature-based and gentle approaches whenever possible.  *This is trend, not a rule*

• Doulas and Midwives are experts in NORMAL.

• Doulas and Midwives have been around for centuries! H(er)storically, A woman well-versed in perinatal health and wellness would typically support the women of their community in the perinatal year and in female sexual health matters. Generally, the female elders and relatives would typically tend to the mother in similar capacities in which a Postpartum Doula does today (with exceptions). Often the Midwife would embody the work/care of a Postpartum Doula as well. 

See? You’re not alone or crazy for getting the two mixed up. In fact, it shows that the herstory of caring for perinatal persons isn’t forgotten! Yay. Now, let’s come back to the present and explore what makes them different professions nowadays (in the Ontario, Canada context!)

What Does a Midwife do that a Postpartum Doula does Not?

Vishali:

Thank you for asking me to talk about midwifery in your blog post! Midwives are primary health care providers specialized in low-risk pregnancy and birth. We have four years of university education during which 2.5 years is focused on rigorous clinical training, almost like a medical residency. We are publicly funded through OHIP and are regulated by the College of Midwives of Ontario. Midwives provide care to pregnant people in antepartum, intrapartum and 6 weeks postpartum.

Antepartum:

• We see people in clinic for the regular pregnancy check-ups.
• Order blood work and ultrasound necessary to monitoring both the mother’s and the fetal wellbeing.
• Have informed choice discussions with the parents so they are able to make the right decision about the care in pregnancy and their birth plan.
• Prescribe medications for urinary or vaginal infections and nausea/vomiting.
• Consult with obstetricians if any complications arise in pregnancy.

Intrapartum:

• Assess the women either at home or at hospital in early labour
• Deliver baby either at the hospital we have privileges in or at the comfort of their own home (We always carry all the necessary birth equipment and emergency medication in our car )
• We are certified in Neonatal resuscitation (NRP) in case a baby is born with difficulties breathing.
• We consult with obstetrician if the woman requires assistance with delivery through vacuum, forceps or c-section. 

Postpartum:

• We see mom and baby 2-3 times at home within the first week of delivery to ensure the dyad are stable, healing well, support with breastfeeding and monitor newborn for issues like dehydration, jaundice and extreme weight loss.
• We then see mom and baby at the clinic at 2, 4 and 6 weeks from delivery to ensure mom is recovering and coping well emotionally, baby is gaining well and answer any concerns parents might have.
• Monitor moms for postpartum depression and connect them to the right resources.
• Prescribe medication for nipple pain, breast infection, milk supply and oral thrush
• We consult appropriately with either lactation consultants or paediatricians if there are any concerns with baby’s weight gain or health.

Closing Comparisons:

Unfortunately, midwifery care ends after 6 weeks postpartum and our clients are discharged back to their family physicians and paediatricians. However, you can choose how long you would like support from your postpartum doula.

Although midwives come to your house few times within the first week of delivery, we are unable to spend more then an hour since we are providing care for about 120 clients per year who all need our time to either attend their labour or antepartum concerns. So we prioritize this hour to ensure you and baby are clinically stable. Postpartum doulas are experts in providing support for new moms who are transitioning into motherhood and learning to keep up with the demands of feeding their newborns every 2-3hrs while lacking sleep. They can especially be helpful on days where baby will be cluster feeding (constantly latched on to mom) when they are going through growth spurt (this can happen every 3-4days in the first 2 weeks).

Thank you so much for sharing your valuable insights, Vishali! My dearest reader, if you have any questions for Vishali please pop them in the comments at the end of the post!

What a Postpartum Doula Has that a Midwife Does Not

Postpartum Doulas are set up to have more time with you

The biggest difference, in my opinion, is TIME. Postpartum Doulas work with their clients to determine exactly what the client wants and needs, and what kind of support will work for the family. The client dictates the time committment. The Postpartum Doula’s scope and number of clients are smaller than a midwife’s, thus we are able to commit more time to each client.

And that’s an intentional difference! Remember, Midwives are health care providers. They make sure you and babe are healthy. Doulas want to make sure you feel supported. That typically takes more time!

For example, Postpartum Doulas can do light chores around the house. You will probably have a list ready of ways we can support you, and it’ll take some time to get that done for you, and we are MORE THAN HAPPY to. Please do not expect this from your midwife at their postpartum visits!!!!

Postpartum Doulas are hired to make space for you and your family to do the things that will make you feel good. Space and time are one in the same.

Postpartum Doulas have more freedom in what they offer and how

In Ontario, Postpartum Doulas are not regulated, and are privately funded. (Sometimes Postpartum Doulas are available through charitable and community organizations.) Thus, our scope extends beyond the 6 weeks postpartum of midwives. And each Postpartum Doula’s time scope may be different. At The Postpartum Nest, our time scope is 6 months postpartum. But if you need support and you are more than 6 months postpartum, feel free to contact us and we can still connect you.

Also, since Postpartum Doulas aren’t regulated by the government of Ontario (yet), there is more liberty in the services each Postpartum Doula can offer their clients. Each Postpartum Doula has complete autonomy over their business and services! Thus, it makes it easier for you, the client, to find a Postpartum Doula that meets you and your family’s needs. Yay!

Postpartum Doulas are an addition to your support circle

Postpartum Doulas are not an either/or professional; they are an AND. Meaning, they are an addition to your support team/circle for the postpartum, and it does not exclude you from being able to access any other service. (Remember when I/Vishali explained that you can either have a Midwife OR an MD as your/baby’s health care during the first 6 weeks (unless it’s a consultation).)

In Sum, You Should Have a Postpartum Doula AND a Midwife

In sum, the KEY takeaway I want you to have here is: Midwives are great. Postpartum Doulas are great. They are different professionals. The best case scenario is having BOTH! You can do that! And, I’ll argue till the end of my days, you should (and I DON’T usually use that ‘s’ word).

Midwives and Postpartum Doulas are complementary to each other.  Both will hopefully and probably be fierce advocates for you. Happily, Midwives are covered by the Ministry of Health (Ontario). However, Doulas are not, but maybe one day? Who knows. It would definitely improve maternal mental health outcomes in Ontario, even Canada, but that’s a discussion for another day!

Next Steps:

Look into midwives in your area and see if they might be a good fit as your perinatal primary health care provider. They are experts in normal pregnancy, birth, and postpartum health for you and your growing babe(s). If you need help finding a midwife, I might be able to help! Let me know.

And do yourself and your family a massive favour and invest in a Postpartum Doula! Ready? Book an appointment for a free discovery call with us today to continue the conversation. And share this blog post with someone else who you think should know about Midwives and Postpartum Doulas!

Thanks so much for reading!

Xo Naomi

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