Doula or Midwife? What Each One Actually Does

Most of what people know about midwives and doulas, they learned from a screen.

On television the two blur into one warm woman in the corner of the room, and it is never clear who is holding the stethoscope and who is holding the hand. In a real birth room the difference is obvious within about a minute.

Midwives and doulas are on the same team. We are not interchangeable. Knowing which is which will save you a good deal of confusion later.

What a doula does

A doula is a walking, talking birth class.

She is the one holding the cue cards. She reminds you of what you said you wanted back when you were still thinking clearly. She redirects when things drift. She is an extension of what your family hoped for, carried into a room where you may be too far inside your own body to speak for yourself.

In practice that looks like comfort measures and counter pressure. Position changes. A steady voice at three in the morning. Someone reminding you to drink.

Here is what makes her role distinct: she never has to stop. She does not pause the counter pressure to chart. She does not step away from your back to take your blood pressure or listen to your baby’s heart tones. Her hands stay where they are. That uninterrupted quality is the whole point of her.

Doulas are also remarkably good with partners. They coach without taking over, showing him where to press and what to say, so that he can be the one holding you rather than standing at the edge of the room wondering what to do. A doula holds the experience so the family can be inside it.

A doula does not perform clinical assessments, monitor your baby, carry medications, or catch your baby. She is not a licensed medical provider.

Doulas are hired privately, by you. Your midwife may offer a few names, but the choosing is yours. Interview more than one, and pay attention to how each of them makes you feel. This is a woman who will be with you at your least guarded.

She also serves families in hospitals, in birth centers, and at home. That makes her one thread of continuity that holds no matter where your birth ends up taking place.

What a midwife does

A midwife is your clinical provider, and she carries responsibility for the safety of your care.

That includes prenatal care and physical assessment through your pregnancy, ordering and reviewing lab work, listening to your baby’s heart tones and taking your vitals through labor, carrying emergency medications and resuscitation equipment, catching your baby, examining your newborn, and caring for the two of you through the weeks that follow.

Midwives want to be loving and present, and most of us are. But when the two pull against each other, the clinical piece comes first. That is the work. Your midwife may stop mid-sentence to listen to your baby. She will step back to chart. She is not leaving you. Someone in the room has to be watching.

The letters

LM, Licensed Midwife. In Texas this is the state license, issued and regulated by the Texas Department of Licensing and Regulation. It is what a midwife must hold to practice legally here.

The pathway is built on apprenticeship and hands-on experience rather than one classroom route, which means it can look quite different from one midwife to the next. Some come through accredited midwifery schools. Some through years of supervised apprenticeship alongside an experienced midwife. Ask yours how she trained. It is a fair question, and the answer tells you a great deal.

Licensure requires an approved education pathway, the national NARM midwifery examination, a Texas jurisprudence exam on state law, current CPR and neonatal resuscitation certification, and training in newborn blood screening collection. It renews on a cycle with continuing education required.

CPM, Certified Professional Midwife. A national credential from the North American Registry of Midwives. Passing the NARM examination is what earns it, and because Texas licensure runs through that same examination, every licensed midwife in this state has come through it.

Keeping it current afterward is a separate renewal with NARM. Some midwives maintain it, some practice under the state license alone, and a midwife holding only an LM is not less trained.

The CPM does carry one thing the state license does not. It is what allows a midwife to precept students working toward certification. If the midwife you are considering is training the next generation of midwives, that is why she can.

CNM, Certified Nurse-Midwife. A registered nurse who has completed a graduate-level nurse-midwifery program. CNMs in Texas are licensed through the Texas Board of Nursing, and they may hold prescriptive authority through a collaborating physician. Their scope is broader than pregnancy and birth, including routine gynecological care, family planning, and primary care for women. CNMs practice in hospitals, clinics, birth centers, and homes.

Doula. There is no state license for doulas. Training and certification vary. Experience is typically the best teacher.

LMs and CNMs are not rivals

This is worth saying plainly, because the internet sometimes suggests otherwise.

Licensed Midwives and Certified Nurse-Midwives refer to one another, consult one another, and cover for one another. The credentials come from different pathways and carry different scopes, and they complement each other well. Many of us are glad to have colleagues on the other side of that line.

What matters when you are choosing is not which letters a woman holds. It is whether she is experienced in the kind of birth you are planning, in the place you want to have it.

So do you need a doula?

I recommend one, especially to first-time parents. I do not require it, and many families here do beautifully without one, but I love working alongside a good doula and the births where one is present have a particular ease to them. Some midwives do require a doula for certain clients, so if you are interviewing elsewhere, ask.

A doula adds something real if you want someone whose attention is entirely on your comfort while your midwife holds the clinical picture. If your partner would rather not be the only one supporting you. If this is your first baby and another experienced woman in the room sounds like a relief. If you want steady company through early labor, before your midwife arrives.

There is no wrong answer here. It is a good thing to talk through at a consultation rather than decide alone.

Where to start

Malta Midwifery is an exclusively homebirth practice in Lubbock. Shiane Archer is a Licensed Midwife, Certified Professional Midwife, and preceptor with over 400 out-of-hospital births attended.

If you are trying to sort out what kind of care fits your family, a consultation is a good place to do it. We meet face to face, review your health history, talk through your hopes for birth, and decide together whether this is a good fit.

Because we take around four births a month, availability can fill quickly.

To schedule, call or text 806-281-7725, visit our contact page, or email maltamidwifery@gmail.com.

A Few Doula Connections in Lubbock

There are wonderful doulas serving Lubbock families beyond this short list. These are simply a few we’ve had the privilege of knowing.

Bailee McDonald — @birthingwithbailee

Nurturing Dove Doula Services — @nurturingdovedoula

Magnolia Birth Doula Services — @magnoliabirths · magnoliabirths.com‍ ‍