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What Is The Difference Between An Independent Midwife And A Doula?

You’ve probably heard about doulas and independent midwives, helpful and knowledgeable women that assist you through pregnancy. But what’s the real difference?

In actual fact, the roles are very distinct and if you’re considering employing a doula or independent midwife, it is absolutely essential to know why.

What's the differnece between a Midwife and a Doula?

Here at Private Pregnancy we’re here to help explain…

Midwives and the essential role they can play
An independent midwife’s work can encompass the medical care of women and babies throughout pregnancy, labour and your early weeks of motherhood. This is assuming you have a relatively straightforward pregnancy without complications – otherwise you may need to be referred to an obstetrician. An independent midwife should be able to recognise any warning signs and refer you.

You will meet with a midwife to check yours and baby’s progress and general health, and to have any of your medical questions answered.

Continuity in a midwife can add reassurance and comfort during pregnancy

For hundreds of years, the midwife has been a vital lifeline to pregnant women half the world over. Not only has the midwife been an essential fountain of medical information and good judgment, for many women she has been a source of consistency and support.

Many of today’s thirty-something women will have heard their mothers talking fondly about the old days of community midwives – when you saw the same professional consistently throughout your pregnancy. By the time the birth day came, you had developed a bond of trust.

NHS Midwives are now in short supply
These days, things are different. As birth rates rise midwives are in ever more short supply; the NHS is stretched and many women find themselves being forced to see a number of different professionals throughout their pregnancy, getting rushed through appointments, or perhaps having to repeat the same information over and over again.

Then at the birth, they have no way of knowing if they will be assigned a midwife they have met before. This can be incredibly disorientating at an already scary time, when a woman needs all the reassurance and comfort she can get.

Research has shown that many expectant mothers crave the continuity that was once so readily available. It is for this reason that increasing numbers of women are now opting to seek the services of a dedicated independent midwife.

What is an Independent Midwife?
An independent, or ‘private’, midwife is a fully qualified midwife who has chosen to practice their work on a self-employed basis outside the NHS. They can provide care either at home, or in a hospital setting as necessary.

Employing the services of an independent midwife does not in any way mean you have to forego NHS privileges or any extra care you may require as things develop.

Furthermore, independent midwives are subject to the same regulations as NHS midwives. They undergo regular checks, are fully qualified by law and are required to keep all their knowledge and training up to date.

Independent midwives may undergo training to compliment their services

Additionally, many independent midwives will undergo extra training (for example in complementary therapies) in order to more fully provide the spectrum of support that a woman may seek in this day and age.

Why employ an independent midwife?
Employing an independent midwife tends to give you more control – and not just over logistical concerns like scheduling. Most crucially, seeking the services of an independent midwife means you decide who will be your primary medical port of call throughout your entire pregnancy. You can meet and interview her. You can be sure that you are comfortable before you commit to undertaking the most important journey of your life with someone. And you can rest assured that, barring completely unforeseen circumstances, you will be with her on that all-important delivery day.

Things that a midwife does not do
Any midwife’s primary concern is the physical well-being of you and your baby. She can ask you how you’re feeling and provide compassion, but she can’t be expected to talk to you about your emotions in depth for long periods at a time, she needs to spend her time and energy making sure all is well with your body and baby. On the big day, she’ll be more concerned about the length of your contractions than holding your hand. If you’re looking for emotional or logistical support or a pregnancy companion, you may need to seek the services of a doula.

What is a doula?
Doula (pronounced ‘doola’) is a Greek word for ‘caregiver or woman servant’. These days, it is used to describe an experienced woman who provides practical and emotional support to a woman or couple prior to, during, and following childbirth.

Doula philosophy is about ‘mothering the mother’. She is there to support you in having the most satisfying time possible during pregnancy, labour, and those all-important early days of motherhood. The support of the right doula can help the whole family to relax into the experience.

Why might I need a doula?
Becoming a new mum can be a daunting prospect, and so can the birth of a second or even a third child. You may worry about how to juggle childcare and make sure the needs of your whole family get met.

A doula is an experienced woman that provides practical and emotional support

You may be confused amidst an overload of advice from friends, family members, or even books. If you are a busy career woman, you are probably used to feeling in control, and the birth of a baby may seem like one new venture you’re not ready for yet.

Having a doula to help can take the pressure off somewhat, enabling you to concentrate on relaxing and bonding with your baby.

For example, research has indicated that employing a doula could:

  • Increase your chances of successful breastfeeding,
  • Help fathers to be involved in a more confident way and
  • Decrease pain medication requirements.

What sorts of things does a doula do?
All sorts of things. In fact, often the mark of a good doula is her flexibility. During pregnancy, a doula may help you get to appointments or ensure you are well looked after and getting enough rest. In labour, a doula can be on hand to listen if you have concerns, and help support you in any decisions you may need to make about the best way to proceed.

Some doulas only offer pre-birth or labour assistance; some only post-birth services. Many offer all three. If you decide to opt for doula help in your early days as a new mum, your doula may perform a myriad of tasks – from washing up to taking care of your new arrival while you get some sleep, or picking up your other children from school. It depends on you and what you need.

What a doula does NOT do
These days, most doulas do undergo some training. Birth doulas will be experienced in childbirth, and many are mothers themselves (although not all are). Generally speaking, they possess a fair amount of knowledge about female physiology.

But a doula is not a trained medical professional.

Even if she is a qualified health professional, as far as her role as your doula is concerned, she cannot give medical advice or diagnose problems. It is the job of your midwife or obstetrician to do that.

A doula is not a midwife replacement.

If you decide to opt for a doula, you need to be clear what her role is. Be sure to remember that a doula is there to support you throughout your decision-making process, without advising you or influencing your choices in any way. This is your baby and your birth.

You also need to bear in mind that unlike in the case of midwives, there is no statutory regulatory body for doulas. There are a number non-profit associations of doulas in the UK, for example Doula UK and The Doula Council. They approve courses for doula training, provide advice to mothers-to-be who are considering employing a doula, and they are working to improve awareness and recognition of doulas in the UK. Check out their websites for advice on interview questions for doulas and written codes of conduct. But do remember they are not government bodies.

Employing a doula could be amazingly helpful – as long as you are clear about what her role is.

To help make things easier, we’ve broken down some examples in a handy little table…

A doula can be there toA midwife is there to
Enable you to feel supported and empowered when asking questions of medical staff.Give medical advice and diagnose conditions. For example telling you that you’re showing signs of pre-eclampsia and sending you for further tests.
Help to encourage you in labour. For example supporting you in your breathing techniques.Answer medical questions you may have about how your pregnancy and/or birth is progressing. For example: ‘Is my level of morning sickness okay?’
Enable the smooth running of your home in the weeks after birth. For example many post-birth doulas will undertake some housework duties as needed.Visit you in the weeks after birth to make sure you and baby are both fit and healthy.
Support you in your general well-being. For example by looking after the baby while you get some sleep.Perform tests to check your baby’s vital signs.

So the question is – what do you need? A compassionate, knowledgeable pregnancy companion, or dedicated, consistent medical care with the same health professional throughout your pregnancy?

Or – perhaps both?

When a midwife and a doula work well together
If you want to try for a home birth, then an independent midwife can be priceless. In fact, often doula associations will not support doulas who attend unassisted home births – which says much about the medical importance attached to midwives.

During your labour both an independent midwife and doula can work together towards a happy birth

But while a midwife is checking your heart rate and dilation, a doula can be looking after your other children, reassuring your husband, helping to support you while you make pain relief decisions, and encouraging you with your breathing exercises.

In many cases, women decide to opt for both. As long as you are clear about their distinct roles, and make sure you are comfortable with both women, this arrangement can work very well.

How much do they cost?
Birth doulas may cost anywhere between £350 and £1000. This is likely to include a couple of pre-birth visits, the labour and birth, and at least one follow up visit. Trainees or newly-trained doulas sometimes charge less.

Post-birth doulas may charge anywhere between £10 and £20 per hour. Usually they are self-employed and pay their own taxes. Sometimes doulas will also charge mileage. Often they will not charge for an initial meeting or interview.

Independent midwives will most often charge between £2000 and £4500 for a complete package of care, including prenatal appointments, the birth itself, and follow-up appointments in your early motherhood.

(Estimated prices correct as of January 2013).

We have put together a list of reputable Midwives and Doulas for you to refer to if you’re looking for support in this area.

Related Video: Who Is A Birth Doula?

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