The difference between a doula and midwife

Doulas and midwives play distinct roles in supporting women through pregnancy, childbirth, and the postpartum period, yet they differ in terms of their responsibilities and the legislative framework governing their practice. A doula primarily offers emotional, informational, and physical support to the mother before, during, and after childbirth, focusing on comfort, encouragement, and advocacy without performing clinical tasks. In contrast, midwives are healthcare professionals who provide medical care, conduct prenatal visits, manage deliveries, and offer postpartum care. 

Role and responsibilities

Doulas 

Doulas serve as a source of emotional, informational, and physical support for women throughout the pregnancy, childbirth, and postpartum period, without engaging in medical tasks. Their responsibilities include providing comfort through pain relief techniques, offering emotional reassurance, facilitating communication between the laboring woman and healthcare professionals, and supporting the family with the transition into parenthood. Doulas are instrumental in reducing anxiety and stress during labor, contributing to a more positive childbirth experience. Research shows that women with doula support experience a 50% reduction in premature deliveries, a 36% decrease in the likelihood of birthing low birthweight babies, and a 33% increase in the initiation of breastfeeding.

See also: The role of a doula

Midwives 

Midwives, on the other hand, are healthcare professionals who provide comprehensive medical care to women during pregnancy, labor, delivery, and the postpartum period. In 2021, midwives attended 12% of births in the US, reflecting their role in maternal and infant health care. They conduct prenatal exams, manage deliveries, offer nutritional counseling, and handle minor complications. Certified Nurse-Midwives and Certified Midwives primarily work in hospital settings, while Certified Professional Midwives often provide care in birth centers and homes. The scope of practice for midwives varies by state, affecting their ability to offer services independently or requiring supervision by physicians. Despite challenges related to insurance coverage and legislative restrictions, the number of midwives and midwifery students has been increasing. 

See also: How HIPAA applies to midwifery

Data privacy

Doulas 

Doulas collect, store, and transmit data aligning with their role in providing non-medical support during pregnancy, childbirth, and the postpartum period. The process begins with the collection of personal and occasionally sensitive information from clients, aimed at offering customized support services. Doulas are responsible for securely storing this data, but are not subject to specific legislation like HIPAA. 

Midwives  

Midwives collect, store, and transmit data such as comprehensive health records that include medical histories, details of pregnancy progression, birth plans, and postpartum outcomes. This information is necessary for midwives to provide informed and personalized care. Once collected, the data is documented either in physical client files or within electronic health record systems, following standardized documentation practices to maintain accuracy and consistency. All data handling practices related to patient data are subject to legal standards such as HIPAA.

See also: HIPAA Compliant Email: The Definitive Guide

Training and certification

Doulas 

Doulas undergo training that focuses on providing emotional, physical, and informational support to women during pregnancy, childbirth, and the postpartum period. This training typically involves completing a workshop or course from a recognized doula certification organization, such as DONA International or CAPPA, which can vary in length from a few days to several months. Following the completion of their training, doulas must often attend a certain number of births and sometimes complete additional coursework in related areas, such as breastfeeding support, to obtain certification. Continuous education is encouraged to maintain certification and stay updated on best practices.

Midwives  

Midwives, on the other hand, must complete a more rigorous and formalized education and training pathway to practice. The requirements for midwives vary depending on the type of midwife—Certified Nurse-Midwives and Certified Midwives generally need to complete a graduate-level program in midwifery accredited by the Accreditation Commission for Midwifery Education and pass a national certification exam offered by the American Midwifery Certification Board. Certified Professional Midwives must meet the standards set by the North American Registry of Midwives (NARM) , which includes passing the NARM Written Examination and completing a specific number of clinical experiences. Midwives are also required to obtain licensure in the state where they practice, with the criteria varying by state.

Legal requirements

Doulas

The legal requirements for doulas generally involve adherence to privacy and confidentiality standards, but they do not include medical licensing or certification by law. Doulas focus on providing emotional, informational, and physical support to women throughout the childbirth process, and their role is non-medical. While there is no legal mandate for doulas to obtain certification, many choose to become certified through reputable organizations such as DONA International or CAPPA. Doulas must be aware of and comply with any local regulations regarding business practices, such as registering as a business if required, but their practice is not regulated by medical or health care laws.

Midwives

In contrast, midwives have specific legal requirements that vary by jurisdiction. In the United States, for example, midwives are classified into several categories, including Certified Nurse-Midwives, Certified Midwives, and Certified Professional Midwives, each with different legal requirements:

• Certified Nurse-Midwives are required to have a nursing background, complete a graduate-level program accredited by the Accreditation Commission for Midwifery Education (ACME), and pass a national certification exam administered by the American Midwifery Certification Board (AMCB). They are licensed to practice in all 50 states and the District of Columbia.
• Certified Midwives have similar educational requirements to CNMs but do not require a nursing background. They must also complete an ACME-accredited graduate-level midwifery program and pass the AMCB certification exam. CMs are legally recognized to practice in fewer states compared to Certified Nurse-Midwives.
• Certified Professional Midwives focus on out-of-hospital births and are certified through the North American Registry of Midwives (NARM) based on their completion of a midwifery education program and/or an apprenticeship, as well as passing the NARM exam. The legal recognition varies by state.

The primary difference between doulas and midwives lies in their scope of practice: doulas provide non-medical support to enhance the birthing experience, while midwives offer comprehensive medical care throughout the maternity cycle. Both play vital roles in supporting expectant mothers, but they do so from different professional standpoints and with different objectives.

FAQs

What is a doula?

A doula is a professional trained to provide emotional, informational, and physical support to a woman before, during, and after childbirth, without performing medical tasks.

What is a midwife?

A midwife is a healthcare professional who provides medical care and guidance to women during pregnancy, labor, and the postnatal period, including delivering babies.

How does HIPAA govern midwives?

HIPAA governs midwives by requiring them to protect the privacy and security of their patients' health information, just like any other healthcare provider.