When people hear the word doula, they often respond with "Oh, I have heard of those. They are like midwives?"
Doulas are like midwives as far as working with expecting and new families but their roles are very different. Choosing to have a midwife or to have a doula, is not a one or the other, like it would be when choosing a midwife or a doctor. A midwife is a primary care provider, just like a doctor. Expecting mothers need a primary care provider, either a midwife or doctor. Doulas on the other hand work with families who have midwives or doctors.
Midwives are experts in normal, low-risk health pregnancy, birth and early postpartum (6 weeks). They care for healthy women throughout pregnancy, attend to them in birth and check in often during the first 6 weeks as the primary care for the mother and the baby. Midwives are paid for by the provincial government. They offer, order and interpret all prenatal tests and screening, just as a physician would.
Midwives can prescribe medications and recommend supplements in pregnancy, if needed. This includes pain management options in labour. (Yes, you can have an epidural if you have a midwife!) They can attend home births and hospital births, where they will monitor mothers and baby (babies), assess the labour and do all vital checks and exams. If concerns arise at home, they know when transfers to hospital should be recommended and made, and they continue the care once at the hospital. They are in charge of all clinical tasks and procedures. They can collaborate care with obstetricians if and when needed, to ensure the best care of everyone. Midwives have a very defined scope of practice in each province they practice in. You can see more info on midwives on the Saskatchewan College of Midwives website.
If that is what midwives are all about, what are doulas all about?
In contrast doulas are not the primary care providers but rather focus on non-medical, no clinical topics. Doulas focus on the emotional, physical & information pieces of pregnancy, birth & postpartum period. While doulas are accepted in the medical community and the evidence for improved outcomes exists, the fee of a doula is not paid for through provincial health. The fee is paid for by the family. There are some extended health plans that cover the fee. There are also some programs for financial supports for families if the cost of a doula is prohibitive. In Regina, the Doulas of Regina, have a relief fund. A doula is going to get to know their clients on a different level and help them plan for their birth and postpartum that matches their desires, needs and ideas. Doulas will direct all medical concerns and questions back to the primary care provider. If a client is concerned with something the primary care provider has suggested or misunderstands, a doula will help the client communicate more effectively with the care provider, but not on behalf of the client. Doulas are often in the know about other resources families would benefit from so they will guide clients to resources as needed. Doulas focus all their energy into the emotional and physical supports during labour without the distractions of clinical care needs. They also ensure the partner is supported and taken care of in the process. Doulas want to ensure mothers feel confident, informed, supported and comfortable during all aspects of pregnancy, birth and postpartum.