Why I Am A Doula And Not A Midwife

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  • November 20, 2014
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Why I Am A Doula And Not A Midwife

Last year, while supporting a first time mother and her partner through a particularly intense (aren’t they all really?) and precipitous labor, I had a very illuminating experience as her doula. Upon our arrival at the hospital, my client was clearly in active labor and after routine monitoring, baby was doing fine. When the nurse midwife entered the room, she could see that all was well albeit in a heightened phase of intensity, She very sensitively let the mother and her partner and myself continue the groove that we had established, with the partner supporting her from behind and she and I communicating more through eye contact and occasional but clearly needed words of encouragement: “you’ve got this”, “you are doing a phenomenal job”, ‘stay with your breathe and look at me”, ‘only one contraction at a time’… At one point the midwife brought in two medical students and asked me to share with them what I was doing and why.

I was honestly taken aback and surprised by her unspoken acknowledgment of my role by not ‘taking over’ and instead ‘reading’ the dynamic of the room and choosing her role and presence with consideration. While nurse midwives are far more likely to do this than OB’s, there is still a ‘power’ dynamic in the room. As a result I felt very clear and confident in my role as ‘the doula.’ The midwife and I worked seamlessly together with her focus on fetal heart tones, cervical dilation and a smooth delivery and my focus on staying connected to and supporting the women doing all this incredible work! That she also included me in her student’s learning process, was both unexpected and incredibly validating. Less than 3 hours after our arrival, my client delivered her baby boy, with the wild shock and disbelief that she actually made it through the unmedicated birth she had hoped for. She did have a very normal vaginal tear and while the midwife was suturing her she tuned to me as said, “so, are you planning to be a CNM or an LM?” I was, for a moment, insulted by her incredible assumption. After a few moments of pause, I responded, “do you see what you are doing right now? That is not for me.”

That I have no desire to include sewing up vaginas on my professional list of skills is but one of many reasons why I am very happy with my role as a doula and am not simply ‘getting birth experience’ before I move on to my inevitable goal of becoming a midwife.

Don’t get me wrong, midwifery is an essential and amazing skill and the world needs more midwives and less OB’s!! However, I am not one.

I am a doula and I love the role and relationship that affords with my clients. There have been numerous occasions where I have been part of the birth team in a hospital setting: the labor and delivery nurses and OB’s who come and go with their shift changes, the medical students, residents and attending’s who presence are ephemeral and brief, only memorable should complications arise. I couldn’t help but concluding, in spite of my regular questioning of my own role and professional potential, that I truly had the best job in the room.

I am all too aware of the ‘status’ we grant to various medical professionals usually depending on the difficulty and intensity (not to mention cost) of the training involved. The single factor that differentiated my role from theirs, aside from the obvious non clinical role of a doula, was my relationship and connection to the most relevant and significant person in the room: the mother. I am often, along with the mother’s partner, the only person in the room that is chosen to be there specifically by the mother. I work for her and not the hospital. While that does set the stage for some difficult situations and can require a great deal of sensitive diplomacy when questioning possibly unwanted interventions, it also allows me incredible clarity and freedom as to my role and my priorities. In other words, I have the privilege of having a single client to focus on, offering continuous care and unconditional support, in no way beholden to hospital policy or fear or litigation.

I am also a qualified acupuncturist who studied and practiced in the UK for 8 years prior to returning to the US and choosing doula work over the administrative, costly and frankly daunting task of translating my UK license to both California and now Seattle where I currently live. I loved my work and relationship with clients as an acupuncturist and I did relish the more clinical nature of my role as well as the ‘status’ of being a licensed healthcare provider. After my own experience of birth, however, I knew that I wanted ‘birth’ to be my work and welcomed the focus on birth work that doula support required. It is also very likely that my success as a doula is very much buttressed by my experience and training as an acupuncturist. What I have learned along the way is that there is a great deal of satisfaction, freedom and self-determination that comes from working closely with women outside of the restraints and limitation of clinical licensure.

More importantly, so much of what birth is ultimately about and certainly what draws me towards it is not clinical. It is deeply emotional, mental and physical not to mention the mountain of ‘information’ and ‘decisions’ that face every expectant family. To provide a container of support for this entire journey and help women and their partners find their own path forward, nourishing their self-confidence and innate intelligence along the way, is profoundly gratifying work.

A colleague of mine once said, “midwives catch babies. As doulas, we catch parents.”


Kara Kaikini

Kara Kaikini

Kara Kaikini is the Course Developer and Educator at Doula Spot as well as an International Board Certified Lactation Consultant (IBCLC). Besides being a mom, Kara’s main gig is the Parent Education Program Coordinator at Maine Medical Center’s Family Birth Center where she immerses herself in everything pregnancy, birth, postpartum, babies, and breastfeeding. Having spent time as a postpartum doula Kara loves providing education and support to new parents and babies as they embark on this new adventure of parenthood. She spends her “free time” on the beautiful coast of Maine on her dad’s boat or at her family’s home, and daydreaming about future family adventures. Kara lives in Freeport, Maine with her husband and her young sons Bode and Eli.

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