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Midwives and doulas: Your options explained

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Midwife and doula options
A midwife is a specialist who's qualified to care for a woman and her baby during pregnancy, labour and after the birth.

Doulas can often offer support, guidance and practical help throughout your birth and beyond, but although they may have some training, they are not medically qualified.

Some women choose solely to have a midwife, others a doula, or in many instances, they'll receive guidance from both. You'll be assigned a midwife on the NHS, but there are only a small number of NHS-employed doulas, so you'll often have to hire one independently.

Not sure which option is right for you? Here's what you need to know.

What to expect from your midwife

A midwife is a specialist who's qualified to care for a woman and her baby during pregnancy, labour and after the birth. She doesn't have to call in a doctor unless there's a problem that requires medical assistance. So a midwife can provide total care from early pregnancy onwards, throughout childbirth and for both the mum and her newborn until the baby is 28 days old.

Midwives are closely supervised and have rules and standards by which they must abide, otherwise they could potentially be struck off from practising.

You and your baby's needs are a midwife's primary focus. She should share information with you and help to empower you to make decisions about your own care. Women who feel involved in this process are more likely to feel in control of their pregnancy and birth, and have a more satisfying experience. A midwife should:
  • Work in partnership with the mum-to-be and her family.
  • Enable the pregnant woman to make any decisions about her care based on her individual needs, by discussing matters fully with her.
  • Respect the woman's right to refuse any advice given. (Midwives rules and standards, NMC 2004)

What to expect from your doula

Doulas provide a similar kind of support to midwives, but offer it in a different way, and usually work alongside medical professionals, as they are not medically qualified themselves. They are often seen as a 'birth companion', and one of the main benefits of a doula is that they can be very flexible and accomodating; as Doula UK explains, 'The services offered by a doula vary greatly according to the needs of the women, couple or family that she is working with.'

There are two main types of doula:
  • Birth doulas: support women and couples through pregnancy, labour, and birth and the immediate postnatal time. These doulas often assist with alternative births and pain relief techniques.
  • Postnatal doulas: support women and couples after the birth of their child in their own homes. Some doulas are able to fulfil both of these roles, whereas others specialise in a particular area.

Doulas are not regulated in the same way as midwives, and as such, cannot offer advice, only counsel and support.

How to contact your midwife

At the beginning of your pregnancy, when your midwife completes your notes, she should give you the number of a midwife you can contact. It might be her own mobile phone number, the number of another midwife in the team or an office where you can leave a message and ask for your call to be returned.

It's also useful to have the contact details of the labour ward, so if you need to speak to your midwife urgently and can't get in touch at least you know there'll always be one there you can talk to. If you have their mobile phone number, you can also text any non-urgent queries.

How to find your doula

Finding a doula is much more of a process than finding a midwife, as you'll have to search for and interview them yourself. Doula UK has a database of available doulas which you can search by postcode - most doulas work within a 25 mile radius, although some will be prepared to travel further.

Initially, you just need to know your doulas fees and availability, but once you've decided that they're right for you, you can go into more detail about your birth options and the type of support you'll need. Birth doulas will meet with you at least twice, then be available for phone and interview contact during your pregnancy, until at 38 week, they go 'on call', so that you can let them know when you're in labour.

Postnatal doulas will start working with you in the months after birth, and can do so for as long as you wish. They can help you with various tasks, from successful breastfeeding to help around the house, but as Doula UK notes, 'Unlike a maternity nurse, a doula is not there to take care of the baby for you. Instead, a postnatal doula supports you to be the parent you want to be.'

Can I change my midwife?

As, unlike in the case of doulas, your midwife is generally chosen for you, it's important that they be your advocate, supporting you in your choices and helping you have a positive birth experience. But not all women will get on with their midwife and may want to see someone else.

It's important to have a good relationship with your midwife. If you feel this isn't the case, then you can write or call the Head of Midwifery at your local maternity unit or call the switchboard and ask to speak to a Supervisor of Midwives and request a different midwife. You don't have to give a reason unless you really want to.

If you're on the labour ward and have a similar problem with the midwife caring for you, it's essential that you ask for a new midwife. It's so important that you feel supported in labour. If you're not happy with your care, then either you or your birth partner can ask to speak to the midwife in charge of the labour ward and firmly state that you'd prefer to have another midwife care for you.

Continued below...


Are there any other alternatives?

Some women choose to opt out of the NHS and employ an independent midwife. This way they know they're guaranteed the same carer throughout their pregnancy, birth and afterwards. Continuity of care has been shown to significantly increase the normal birth rate and reduce Caesarean delivery. The cost of this option varies, but is generally around £3,000. onemotheronemidwife.org.uk or independentmidwives.org.uk have more information on independent midwifery.

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