Lifestyle & Parenting

Doula Or Midwife? An Expert Tells Us The Difference

June 25, 2024

With World Wellbeing Week happening June 24 to 30, we chatted with Dr. Paul Quinn, one of the only male midwives in the U.S., about the key differences between doulas and midwives, and some other matters related to prenatal health and wellbeing. —Vita Daily

Dr. Quinn, as one of the few male midwives in the U.S., can you share what initially inspired you to pursue this career and how your upbringing influenced your passion for women’s health?

I knew very early on that I wanted to do something in health care. My mother was a nurse and retired after a 40-year career, so I grew up watching her go into work each night and remember being intrigued by her stories of the different patients she encountered. Later on I learned from researching my ancestry that I am actually the great grandson of a midwife in Ireland, my grandmother took care of babies at a hospital in Brooklyn, New York, my mother’s first role was in the nursery right after she graduated nursing school, and now my cousin’s daughter is following in our footsteps and will enter college this fall to pursue nursing with a dream to work in Labor and Delivery!

When I was old enough to be a hospital volunteer, I jumped on the opportunity. Originally, I was assigned to the Emergency Room and saw so much interesting stuff as a teenager. Then there was an opportunity for me to work in the Newborn Nursery and I was hooked. I saw women come into Labor and Delivery in various stages of labor and shortly after I would have a new baby in the nursery. I was mystified by what happened in the birth process but still had not seen an actual delivery. The Labor and Delivery nurses taught me so much about the birth process, and one nurse in particular was leaving the hospital to pursue becoming a midwife in England. She kept in touch with me and shared with me all the stories of her clinicals, the patients she cared for and the home visits she was making and, above all, the deliveries she was doing in some of the roughest neighborhoods in London. I knew then that I wanted to do what she was doing but wasn’t exactly sure how to go about it. I decided in my junior year of high school that I wanted to be nurse and not a physician and that obstetrics was where I wanted to be. However, in the early 90s when I was in nursing school the doors to obstetrics were still sealed shut to male nurses, so I had to get to OB by a long route, gaining experience in critical care and the emergency room then nursing leadership before landing in obstetrics. My career has taken many different turns over my three decades as a nurse and two decades as a midwife, but I have had the fortune to care for women and families across the lifespan, from the most affluent to most impoverished. Women inspire me and I am humbled by the strength and resilience they possess to withstand pregnancy and the birth process and to be mothers. I am passionate about caring for women and humbled to be in their presence. They keep my passion for what I’m doing alive.

Many people often confuse the roles of doulas and midwives. Could you explain the key differences between the two and how each contributes to the birthing process?

Midwives and doulas are two different roles, but we often work in partnership for the same outcome. A midwife is often a nurse (but can also be a lay professional) who has completed nursing school and usually a master’s degree as an advanced practice nurse in midwifery. Midwives attend a formal education program with specific requirements for didactic education, hands-on clinical practice hours and sometimes a specific number of deliveries or types of patients to care for (for example, antepartum or postpartum patients, gynecology patients, or babies). We take a comprehensive certification exam that allows us to be licensed in the state we practice in. Midwives provide primary care for women across the lifespan and can prescribe medications to manage most medical conditions. Midwives had specific continuing education requirements to maintain licensure. Midwives can independently manage a woman throughout all stages of the birth process and can often perform additional procedures in the office or outpatient setting or within a hospital. Doulas, in contrast, do not need to be nurses and are often women who have experience with, and passion for, the birth process. Doulas, like midwives, complete a rigorous education program with specific hands-on clinical hours with a mentor or preceptor and then successfully pass a certification exam. Doulas provide support and education to women and families during all phases of pregnancy and are a tremendous support to women after delivery to help promote breastfeeding, bonding and a woman or family’s transition to parenthood. Doulas and midwives work together to promote physiologic birth, often collaborating to make labor more effective and to promote a mother’s comfort and maximize her body’s ability to deliver a baby safely.

You’ve been a midwife for 20 years and have seen the profession evolve significantly. Can you give us an overview of the history of midwifery and how it has changed over the decades?

Midwives have been in existence for centuries and are even mentioned in the Bible!  We have, literally, been delivering babies for centuries. At some point in history the rise of obstetrics as a medical profession, and the shifting focus in society that health care by a physician was more preferable and respectable rose. Many midwives learned their craft from other midwives and apprenticed under more experienced midwives until they could deliver babies on their own. At certain points in history maternal and infant mortality began to rise and the midwives became an easy target of blame. This led medicine to take over birth and the notion that delivering in hospitals was preferable than the home. However, many women could not afford health care, the hospital was too far from their home, and charity care was sparsely provided. Religious communities would later take over creating hospitals and helping women for labor and delivery. However, women continued to deliver in their homes and be supported by midwives. As women emigrated to other countries, they often sought the local midwife who spoke their language and were part of their community. In the U.S., midwives continued to flourish in cities until their practice became over-regulated by the medical establishment and the profession of midwifery was almost wiped out. However, there was a resurgence in the 1960s for a return to natural childbirth without medical intervention and to return choices to women. Midwives returned and out education was more formalized and extensive to keep us on par with our physician colleagues. Today, most midwives are advanced practice providers who have prescriptive authority in most states to care for women (and men) across the lifespan. Midwifery care was recognized as an important component to minimize maternal mortality and morbidity in the most underserved or health disparate areas and we are often the only source of primary health care a woman has. We have also expanded our practice to now include rigorous research into women’s health care and health care delivery to try to minimize the ongoing health disparities for women and families.

In your experience, what roles do men typically play during pregnancy and childbirth, and how can they best support their partners throughout this journey?

Men can be a vital part of the entire pregnancy journey!  I think men are equally as excited about the prospect of being a parent and want to be as involved as they can be in the process. Obviously, it’s the woman who bears the brunt of the workload from pregnancy through delivery, but men can be significantly involved in the experience. For example, men can be present for doctor’s or diagnostic testing appointments, Men can learn comfort measures like massage or reflexology to help minimize the frequent body aches or discomforts. Men can prepare healthy meals and take on the daily household activities to promote rest for the mother or let her have a time out to recharge. Men can learn how to promote physiologic labor and learn how to support the woman during labor in various positions to promote comfort and make labor more efficient. Men can learn how do perform infant care and allow the mother time to rest and heal. Above all, men can be present and be someone for the woman to lean on, vent her frustrations or fears to confide in and feel secure with. The love a man has for his partner and baby is powerful and transcendent and is often the most motivating force a woman needs to complete this journey.

With your extensive experience and research in obstetrical nursing, what are some of the current trends in prenatal care that expectant mothers should be aware of?

There have been incredible advances in obstetrics in the past 20-30 years. Most importantly, we have learned to diagnose issues earlier in pregnancy with more sophisticated antenatal testing. Women can anticipate being offered multiple screening tests at specific weeks of pregnancy, either through laboratory blood work or more commonly with the use of ultrasonography, to assess fetal development and the uterine environment throughout all stages of pregnancy. Of course, with this advanced screening women can also anticipate the possibility of the need for intervention, whether that be referral to a medical specialist to manage a condition in the mother or to a team of specialist to manage any special needs the baby may have. We now rely heavily on technology to monitor women through pregnancy, whether in the home with special services or admitted as an inpatient to the hospital for the duration of pregnancy. There has been incredible work done on investigating drugs that treat many maternal conditions during pregnancy that are now safer to use during pregnancy with careful monitoring. Women can also expect high quality obstetrical care in Labor and Delivery units with most taking on a more family-friendly approach to ease the process, keep families together, and still have emergency equipment or procedures available at a moment’s notice. There is also a renewed emphasis on promoting physiologic vaginal birth and, fortunately for my colleagues and myself, a return to the popularity of midwives and doulas as partners in the birth process. Significant research has been completed that demonstrates the superiority of breast milk feeding to promote infant health and to avoid many chronic conditions later in life for children. Women will likely see additional education, support and promotion of breast milk feeding. There is now an increased focus on women’s primary care after delivery to intervene sooner in chronic conditions (for example hypertension, obesity, diabetes) that can affect women across the lifespan so more comprehensive follow up post delivery is likely. There is finally a focus on women’s mental health to minimize the stigma of mental health conditions and thankfully new programs to provide experts like social workers, therapists, counselors or psychiatrists to assist women with their mental health needs. Women can anticipate a more targeted assessment of their mental health needs and mood throughout pregnancy, after delivery, and throughout her lifespan.


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