Pregnancy journey is challenging throughout the months. Many pregnant women would ask a doctor what they can do to ensure things will go smoothly for them and their baby. However, have you ever wondered how mothers give birth in the old times where getting medical care was quite difficult? Here the midwife comes to the rescue and ensures both mothers with their baby are safe and healthy. In modern days, not only midwives are available for help for pregnancy issues as there is also doula. In this article, we will learn the differences between a doula and midwife.
In November 2020, the Health Minister reminded that doulas are not recognised as midwives in Malaysia. This alone shows that there are distinctive differences between the two professions. The reminders were placed after a case of baby death under supervision of a doula as highlighted in 2018. In Malaysia, practising doulas not trained as midwives can be taken against law under Subsection 14(1) of The Midwives Act 1966 (Act 436) that carries a maximum RM 2000 fine and one years’ jail. Furthermore, in Malaysia, doulas are not registered with any association in Malaysia.
Midwife provides medical care during pregnancy and birth. They can ask for tests and perform internal examinations, this means they can perform clinical tasks. They are trained to give advice to women during pregnancy, birth and after birth. They can handle birth delivery and ensure safety of both mothers with her child. Taking emergency measures in absence of medical help and providing medical assistance are part of their job. Beside these jobs, they can do preventative measures, and detection of abnormalities in both mother and child. They are allowed to carry out treatment as instructed by the doctor.
There is a midwifery educational program in Malaysia that has to be successfully completed before a person can be a midwife. They are also registered and legally licensed to practise as a midwife.
Midwives can be found working within hospitals and even in rural settings such as smaller healthcare facilities with maternity units or birth centres.
Doula provides emotional, physical and informational support for expectant mothers before, during and after birth. They focus on the mother’s needs so that the mother can have a great experience during delivery. Doula brings a spirit of connection which includes loved ones during the big day.
What doula can do is to provide clear communication between mother and with those delivering the baby such as midwife or doctor, improving breathing patterns or positions that ease delivery process and bringing support team that ease the mother’s feeling.
There are two kinds of doula which are antepartum doula and postpartum doula. Antepartum doula offers support and assistance for mothers before giving birth. Postpartum doula helps new mothers recover from the birth process such as caring for the baby and providing lactation support. They may also clean and cook meals or fill in the mother’s job at home when the mother needs rest.
In Malaysia, there is no certification recognising doula and only one Doula training centre. While there was an effort to create the Malaysian Association of Doulas and Childbirth Educator, those planning to become a doula have to get certified with certified international boards. The association ceased to exist as there were not enough doulas for such purposes. What is available now is combining doulas with childbirth educators.
In general, anyone can be a doula as long as they get training. However, due to the fact that in Malaysia it is still not recognised by the Health Ministry, doula must know that they have no power on attending pregnant mothers medically. Furthermore, many medical assistants staff have taken the role of doula in hospital. Doula should not be taking the place of the husband or family member supporting the pregnant mother.
It can be concluded that midwives and doula perform different jobs but midwives can perform a doula job as they are medically trained to handle pregnant women. Those who expect to receive support from doula, need to understand that doula could only provide non-medical support and if doula starts to present with toxic behaviour such as asking not to give birth in a healthcare facility, no vaccination and unusual birthing process, mother should not proceed with their advice.
Mother-to-be need to be clear and educated on ensuring their pregnancy and birth will be safe. The easiest way is to get themselves to a hospital and discuss with a healthcare provider. If they plan for a home birth, please double check with the healthcare provider first to ensure it is safe to do so. Home birth requires health personnel with midwifery skills and has been approved by the Ministry of Health. Community Health Nurse and Trained Staff Nurse are the one usually with midwifery skills to conduct home delivery. The discussion of place for delivery is best started in the first trimester and final decision should be decided during 36 weeks of pregnancy. Discussion should involve health staff and family.