The Difference Between Using a Doula vs. Midwife vs. Doctor for Childbirth - Verily
This old-school approach might be a better option than you think.

When it comes to pregnancy today, it's hardly an exaggeration to say that the options are overwhelming. From pre-natal vitamins to optimal pregnancy diets and the never-ending debates on public breastfeeding, gestating and taking care of a baby requires a lot of decisions. Which is why more and more women are deciding to retain the services of a doula, according to the New York Times.

Technically, a doula can be any friend or partner who provides continuous non-medical support for mothers at all stages of pregnancy and postpartum. Before the introduction of the epidural in the 1920's, women relied less heavily on hospital practices and instead turned to a doula, which, in Ancient Greek, simply means "a woman who serves." Usually the doula is a sounding board for the mother's fears, someone who can offer sound and educated advice, a partner in creating a birth plan for the mom-to-be, and as physical and emotional support during labor, and even postpartum. What's more, research reveals that mothers who receive this kind of continuous support reported better natural births, less labor time, and higher APGAR scores (a test given directly after birth to determine a newborn’s physical condition).

While the need for medical intervention in emergency situations is undeniable, for many women who are considering childbirth, it's good news to learn that there are more options out there. We spoke with Dr. Ashley Greenwald-Tragash, a psychologist and behavior analyst who has been a certified doula for seven years, to clarify the most common myths and assumptions about what doulas are and what they do. 

Myth 01. Doulas are just glorified midwives.

Despite the common assumption that the titles of midwives and doulas are interchangeable, Dr. Greenwald-Tragash clarifies that while midwives and doulas may do similar work, “A midwife is a trained medical professional. Doulas are primarily for emotional and physical support.”

Unlike Midwives, doulas can not replace your regular OB. Doulas use a variety of supportive techniques during labor, alongside your doctor, but the care starts long before a mom gives birth. Dr. Greenwald-Tragash typically meets with her clients while they are anywhere from 15 to 20 weeks along in their pregnancy. 

The first meeting is an interview to allow parents and doula to get to know each other, and for the doula to provide them with resources. “That information is a really important part of being a doula, and just providing education,” Greenwald-Tragash says.

Dr. Greenwald-Tragash shares that she schedules several more prenatal visits to discuss the mother's birth plan which includes where and how she prefers to give birth, as well as the different techniques a doula might use during labor, and how husbands can help their wives. These prenatal meetings are crucial to building a trusting and open relationship with the parents, she notes. “We talk a lot about personal matters and preferences and fears and vulnerabilities,” she says. “So it’s really nice to have that opportunity.”

Myth 02. Doulas are there to replace your husband or mother.

Some women worry that the presence of a doula would undermine the role of the husband or mother. At first, it may seem like the doula is replacing them with her skills and expertise, but Dr. Greenwald-Tragash assures us that doulas are there to empower your husband. 

Once Dr. Greenwald-Tragash finds something that works for a mom during labor and delivery, such as an effective type of massage or a pressure point, she’ll usually replace her hand with the partner’s hand. As a trained professional, she can also remind partners of other techniques to try. 

She says partners usually underestimate just how emotional and overwhelming the delivery process can be. “Seeing the person you love be in pain, and not really feeling like you can take that pain away from her, or you’re doubting your ability to comfort her, or maybe you pressed on her back and she pushed you away really fast and you have no idea what to do because that’s the only thing you remember from your childbirth ed class—it can be really overwhelming for them.”

Myth 03. Doulas will try to convince you not to take drugs.

A big part of a doula's job is to empower women to make informed decisions in the moment, she says. Her goal is to allow women to have the birth they want, whether that be natural or induced.

In fact, many doulas like Dr. Greenwald-Tragash argue that modern birth processes take birth away from the mother. In a TEDx Talk, she opens with, "There is a difference between something that you do and something that is done for you." Her message to women is, "Take back your pregnancy." A doula helps empower a woman to reclaim agency and authority during all stages of pregnancy, labor and delivery.

“Being a doula is not about fulfilling your own desires or your wishes and projecting your own preferences on another woman’s birth,"Dr. Greenwald-Tragash says. "It’s about supporting the woman, meeting her where she’s at, helping her understand her options, and different risks and benefits of things that may come up.”

Myth 04. Doulas are expensive or not worth the money.

Healthcare and insurance costs for a doula vary from region to region. In expensive urban centers like New York City, a doula may cost upwards of $3,500, according to Parents Magazine. In less expensive regions, $500 is average. There is no standard insurance option for covering doulas, but some plans may approve reimbursements. 

If you think you might work with a doula, Dr. Greenwald-Tragash recommends reaching out around the 15- to 20-week mark of your pregnancy to an organization like DONA to find certified doulas. If the cost concerns you, it may also be helpful to consider that doula care may actually reduce hospital bills by decreasing the risk of cesarean and preterm births. The reason for this is not conclusive, but it may have something to do with reduced stress and greater advocacy during labor at the hospital. 

Every birth is unique, and each mother should feel affirmed in considering the path that is best suited to her needs, whether that be an at-home birth, in a hospital, or with a midwife. But remember that childbirth matters physically and emotionally, whether you doula or you don't.