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Doulas and midwives have been providing critical childbirth support for centuries, yet some confusion remains about their respective roles. In thinking about your birth plan, it's important to understand the difference between doulas and midwives so you can make an informed decision about the caregivers you would like to attend your birth. It's also important to remember that while doulas and midwives have different training, certification, and responsibilities, you don't necessarily need to choose one over the other. With their complimentary skill sets, doulas and midwives often work in partnership to support you through your prenatal care, your birthing experience and beyond.

Doulas play an important non-medical role in both birth and postpartum care. Their primary responsibility is to support you continuously through the birthing process, acting as a coach and offering non-medical interventions such as breathing techniques, massage, relaxation, and help with positioning. A doula's role supplements the nursing care provided by labor and delivery nurses, offering emotional and educational support, and advocating on your behalf with the rest of your medical team. Whether you decide to use medications or not, your doula is by your side to empower you throughout the entire birthing process. A doula may also play a role in recovery, offering support and guidance with breastfeeding, infant care, and other postpartum issues.


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Most doulas go through rigorous training, and many are certified by international organizations such as DONA (Doulas of North America) International or CAPPA (Childbirth and Postpartum Professional Association). Doulas may practice in home or hospital settings, and you may contract directly with a doula to provide you with support wherever you choose to give birth.

The benefits of receiving non-judgmental and continuous support throughout the birthing process have been studied extensively. A recent Cochrane Review, "Continuous Support for Women During Childbirth" showed that compared with women who had no continuous support, women with doula support were 28 percent less likely to have a cesarean section, 31 percent less likely to use synthetic oxytocin to speed up labor, 9 percent less likely to use any pain medication, and 34 percent less like to rate their childbirth experience negatively.

Certified Nurse-Midwives (CNMs) are medical providers who are Registered Nurses with an advanced degree from an accredited institution, as well as a certification from the American College of Nurse Midwives. In addition to delivering babies, CNMs can perform gynecological exams, provide prenatal care, offer contraceptive methods, prescribe pain medications, give labor-inducing drugs, monitor the fetus using electronic equipment, order epidurals, perform episiotomies if necessary, and stitch tears.

Many women receive all their prenatal care from a certified nurse midwife and choose to have a midwife attend to their labor and delivery. Midwives are trained to identify any potential medical complications that might warrant a higher level of intervention by an obstetrician, keeping the safety and well-being of birthing mothers and their babies as their highest priority. Often midwives and obstetricians work closely together to provide safe and comprehensive collaborative care.

Midwife-attended births have been increasing in popularity, with recent studies indicating that midwives tend to use fewer interventions such as epidurals, labor induction, and episiotomies. A review, published in the January 2012 issue of Women's Health Issues, also found a reduced incidence of perineal lacerations and a higher likelihood of breast-feeding in births attended by certified nurse midwives.

Even with the increased usage of midwives and doulas, the traditional services of obstetricians are still very much in demand, particularly for women with high-risk pregnancies or underlying health concerns. Some women, who have had unremarkable pregnancies may find themselves faced with complications during the birthing process, requiring the services of a physician.

Here at the BMH Birthing Center our team includes doulas, experienced labor and delivery nurses, certified nurse midwives, and board-certified obstetricians, so expecting parents can choose the birth experience and the type of provider that best meets their needs. You may request the services of a doula as you plan for your birth and get to know them ahead of labor, or when you arrive at the Birthing Center we can contact the doula on call. BMH doulas are familiar with the Birthing Center resources and staff, allowing them to be better equipped to provide support to expecting parents and their families. Doula services at BMH are provided at no cost, and all of our doulas are volunteers.

No matter what type of birthing support you choose, we are committed to supporting expecting parents in creating a personalized birthing experience that reflects your wishes and priorities. We welcome the opportunity to discuss your birthing plan and review all the options available to you.

Erinna Cooper, RN is the Director of the Birthing Center at Brattleboro Memorial Hospital. She can be reached at 802-257-0341.