All About Midwifery & Doulas
Midwives and doulas play a critical role in reproductive health, ensuring that people have access to safe, respectful, and empowering healthcare experiences. Reproductive justice is about more than just the right to access healthcare services; it's also about ensuring that communities have the power, resources, and support they need to make informed decisions about their bodies and health.
What’s the difference between a midwife and a doula?
A midwife is a licensed healthcare professional who provides comprehensive prenatal, childbirth, and postpartum care. Midwives can provide a range of services, including performing physical exams, ordering and interpreting lab tests and ultrasounds, providing counseling and education on prenatal and postpartum care, and attending births. Midwives can work in hospitals, clinics, birth centers, and support home births. Midwives also provide primary care for people, including but not limited to contraceptive counseling, family planning, gender affirming, abortion, and gynecological care.
A doula, on the other hand, is a trained professional who provides emotional, physical, and information support to folk in transitions. Doulas do not provide medical care or interventions, but they can provide a range of supportive services. In birthwork they provide education on prenatal and postpartum care, helping to create a birth plan, providing massage and other comfort measures during labor, and supporting breastfeeding and newborn care. For example, in hospital settings, doulas can provide advocacy interventions to ensure that a provider is centering the pregnant person and their wants/needs. Doulas can work in hospitals, birth centers, or attend home births. Doulas also provide support to people in all types of transitions, including but not limited to abortion, fertility, death, and gender affirming care.
A Brief History of Midwives & Doulas in America
Historically, midwives and doulas have been important figures in the birthing process for centuries, especially in communities of color. Midwives, in particular, have been a staple of Indigenous African, Asian, and Native American communities, where they have provided essential support and care for pregnant people throughout the pregnancy process, including abortion, prenatal, labor/delivery, and postpartum support. In many cases, midwives were the only healthcare providers available to these communities and were often excluded from the formal medical establishment.
However, with the rise of western medicine, midwives and doulas have been marginalized and excluded from mainstream healthcare systems. In the United States, midwifery was effectively criminalized in the early 1900s, as medical professionals sought to standardize childbirth practices and eliminate traditional practices that they deemed unsafe or unscientific.
By 1980, midwives attended only 1.1% of births in the United States. In contrast, midwives attended almost 12% of births in 2020. Midwife-attended births became more common in the 1960’s and 1970’s as the second wave feminist movement uplifted midwives like Ina May Gaskin and began centering the pregnant person. It is important that people have access to culturally affirming individualized care. This is especially impactful for people outside of the established norms of white supremacy.
The effect of midwifery and doula care on birth outcomes
One of the key benefits of midwifery and doula care is the increased likelihood of positive birth outcomes. Research has shown that access to midwifery care can reduce the likelihood of preterm birth, low birth weight, and birthing parent and newborn mortality. Doulas provide emotional support, pain management techniques, and advocacy throughout pregnancy and during labor, resulting in shorter labor times and lower rates of interventions, such as cesarean sections.
However, midwifery and doula care can be inaccessible for many people, especially those from low-income backgrounds, rural areas, or communities of color. The lack of insurance coverage or Medicaid reimbursement for midwifery and doula care can make it cost-prohibitive for individuals who need it most. Additionally, there is a shortage of midwives and doulas in some areas, making it difficult for those who do have insurance coverage to find a provider.
Community-based birth workers have the unique capacity to challenge bias in the medicalized birth system and undo the exclusion of traditional, community-centered practices around pregnancy and birth.
For doulas and midwives, patient- and community-centered care is key to improving both outcomes and experiences for all birthing people, especially those at the center of the maternal health crisis. For people of color, especially Black and Indigenous people as well as LGBTQ people, many of whom have experienced discrimination and disenfranchisement in their birthing and broader health care experiences, the support of a community-based birth worker helps them to reclaim control over their pregnancy and birth experiences.