First Things First: What Kind of Support Are You Looking For?

Every birth is different - and the support you receive is different too.

Firstly, it helps to think about where you’re planning to give birth. Your options are: freebirth, homebirth with midwives, midwife-led unit (freestanding or an alongside unit on a hospital site), hospital labour ward or perhaps you’re having a planned caesarean birth? If you give birth in the NHS system you generally don’t get a choice about who will be looking after you during your birth. However, who you have supporting you during your birth can make a huge difference to your birth experience and even outcomes. Research shows that having continuity of care from a doula or midwife results in better outcomes for women, so if you have the option it makes sense to access professional birth support services - even if you’re planning on birthing with the NHS.

Beyond the NHS: Why Women Choose a Doula or an Independent Midwife

It’s well known that the NHS maternity system is struggling. Maternity has been chronically underfunded and understaffed for many years and this has directly impacted women and birthing people’s experiences and arguably even their birth outcomes. There are many fantastic healthcare professionals working within the NHS but it is incredibly difficult to provide truly personalised care in such a fragmented system. Too many women experience birth as traumatic - and we have to question what role our maternity system has to play in this. Research has shown that about 1:3 women experience birth as psychologically traumatic and 1:25 women develop post-traumatic stress disorder (PTSD) after giving birth, the effects of which can be far reaching for them and their families. For some women, hiring independent support that is outside of the NHS is a protective measure. 

Some women are looking for support completely outside of the NHS - perhaps they've had a negative past experience or just know in their bones that it’s not the path for them. Other women and birthing people still choose to access care in the NHS, but want support navigating the system and advocacy too. Some people want to guarantee access to homebirth - services locally and nationally are patchy (we wrote about that here!) and having a dedicated independent midwife makes that possible. For other women and birthing people, the place of birth may not be so important but they want to have a known and familiar face throughout their journey to support them and advocate for them if needed. Unfortunately, continuity of care isn’t standard for most women in the NHS system.

What Does a Doula Actually Do?

You might have heard of a doula, but be unclear about what one does. Often we find the term is confused with midwife, whilst there are similarities in the roles there are some key differences too.

Emotional and Practical Support Throughout Pregnancy, Birth and Beyond

Doulas provide non-clinical support throughout your pregnancy, birth and postnatal journey. History tells us that women have always sought support for their births. In the past that would have been from female friends and relatives, often other women who had given birth themselves, who brought lived experience, reassurance and a calm, knowing presence to the room.

The modern doula is a continuation of that tradition. They’re not there to provide medical care, but to provide consistent, compassionate, experienced human support at one of the most significant moments of your life. Research consistently shows that continuous support during labour leads to better outcomes, including shorter labours, lower rates of intervention and higher rates of satisfaction with the birth experience.

What to Expect from a Doula Relationship

In our experience, most doulas will offer some antenatal sessions, continuous support during your birth and then some postnatal support too. They will explain your options to you and signpost you to resources to help you make informed choices about your pregnancy and birth. Some offer practical support after birth such as meal cooking and help with household tasks.

They'll advocate for you if and when you need it, something which can be particularly valuable when navigating the NHS system and hospital birth, where you may meet different midwives at every appointment and feel like you're starting from scratch each time. Your doula already knows you - they know your wishes, your worries and what matters most to you, and they can help make sure your voice is heard.

Are Doulas Regulated? What You Need to Know

Doulas are not regulated, however most will have undertaken some form of training or may have worked as an apprentice to a more experienced doula. Before you book a doula it’s important to meet them, ask questions about their experience, check if your values align, read any reviews or testimonials they may have and most importantly - trust your instincts!

There are excellent directories where you can find doulas who have completed recognised training and are committed to ongoing professional development. Doula UK is one of the most established, while Abuela Doulas is particularly worth highlighting as the first Black owned, founded and created doula training organisation in the UK, which is an important and welcome addition in a world where Black women and People of Colour continue to face huge disparities in maternity care and outcomes.

What Does an Independent Midwife Do (and How Are They Different from an NHS Midwife)?

Continuity of care: knowing your midwife from booking to birth

When you hire an independent midwife they’re the person you’ll see throughout your pregnancy, during your labour and birth and into the postnatal period. This generally looks like having regular antenatal appointments during your pregnancy, continuous support during labour and birth (wherever you choose to birth) and then regular visits at home after your baby has been born. Continuity of care, as mentioned earlier, has been shown to improve outcomes. Certain NHS Trusts have tried to implement continuity of care models but as with most things in the NHS this is patchy. Some women may see the same midwife during pregnancy and then after birth, but will not know their midwife during labour. In the NHS it’s luck of the draw as to who you get on the day and you might get someone you really click with and who really supports your choices, or you might not. You can absolutely ask to change your midwife - either during pregnancy, birth or beyond - if you don’t feel they’re a good fit for you. The difference with an independent midwife is that you’ve specifically chosen them. You’ve probably had a call, done a vibe check, trawled their socials and decided that they’re the one for you. Having a known midwife means not having to repeat your story and developing a trusting relationship with someone who you know really has your back.

The clinical side: what independent midwives are qualified to provide

Independent midwives are registered with the Nursing and Midwifery Council (NMC) and have undertaken a degree at university to become qualified midwives. ‘Midwife’ is a legally protected title and only midwives and doctors are allowed to ‘attend’ women in childbirth - what this means is to provide clinical care to women giving birth. Midwives are trained to assess your wellbeing throughout pregnancy, birth and beyond. They can offer things like fetal heart rate monitoring, vaginal examinations and blood tests. We’re trained to recognise and be able to manage obstetric (childbirth) and neonatal (baby) emergencies. We are also able to give certain medications without a prescription.

Independent midwifery vs NHS midwifery: the key differences

One of the key differences between independent midwives and NHS midwives is that due to the nature of being independent, we’re not bound to offer hospital policies or protocols (which sometimes are not based on good or any evidence). Another huge difference is time. We take on micro-caseloads of women which means we have an abundance of time to dedicate to you and your baby. There’s no rushing to see the next person and no rushed decisions, there’s always time to fully discuss and explore your options. We're able to do this as independent midwives in a psychologically safe space where time for lengthy discussions with a midwife you know allows for your choices to be respected. We see all our clients at home for their pregnancy and postnatal visits, and of course if you’re planning a homebirth we’ll be there too!

The Key Difference: Clinical Care vs Emotional Support

Understanding scope of practice

Midwives have a specific scope of practice within which we can provide clinical care. When you are able to develop a relationship with an independent midwife they get to know you, the whole you. Not your clinical bio markers, but you. That time spent discussing your care allows us to understand what makes you you. The things you've embraced but also the hard bits that worry you. All this can impact your labour and birth in positive and negative ways. Having an independent midwife by your side means they know when to simply be and hold your hand or when to apply clinical skills needed to keep you and your birth on the right path.

Doulas do not have a formal scope of practice. Because midwives are regulated, we must abide by the NMC Code of Conduct and there are certain conditions that we must meet in order to maintain our registration. Doulas do not have any obligation to have undertaken any training, but most will have.

Who is responsible for what during your birth?

Midwives are responsible for the clinical wellbeing of you and your baby (or babies!). They have an obligation to offer you care as per standard practice and UK guidelines. It’s important to note however that you do not have any obligation to accept these offers of care and your decision should always be respected. Doulas do not have any clinical responsibility at a birth. They are there to provide emotional and practical support.

What an Independent Midwife Can Do That a Doula Can't (and Vice Versa)

What only a midwife can provide

A midwife - and particularly an independent midwife - can offer all the things a doula can as well as clinical care, if you want it. This means that as well as being there for you emotionally, your independent midwife is also monitoring you and your baby throughout pregnancy, labour and birth - assessing you, making clinical decisions and acting on them if needed.

Specifically, an independent midwife can:

• Carry out all routine antenatal appointments and checks
• Monitor your baby's position, growth and wellbeing throughout pregnancy
• Assess you and your baby continuously during labour (e.g. offer you fetal heart rate monitoring, blood pressure checks)
• Administer certain medications, including those used in labour
• Offer vaginal examinations and an assessment of your cervix in labour
• Manage complications and emergencies should they arise
• Provide postnatal care for you and your newborn, including newborn checks

This clinical accountability is something a doula cannot and does not provide and that distinction is really important when it comes to planning your birth. You have to decide if that’s important to you or not.

What a Doula Brings That a Midwife May Not

Because a doula is not providing clinical care, they are under no obligation to offer this and can be fully present to provide you with emotional and practical support for your birth. Their entire focus is on you - your comfort, your confidence and your experience.

A doula can offer:

• Continuous, undivided emotional support throughout labour
• Practical comfort measures such as massage, breathing techniques and positioning
• Help communicating your wishes to clinical staff
• A reassuring, consistent presence if plans change or things feel overwhelming
• Support for your birth partner, helping them feel confident in their role
• Postnatal support, including feeding support and emotional debrief after birth

Where a midwife's attention will naturally move between the clinical and the emotional, a doula's focus never has to shift.

Questions to Ask Yourself Before You Decide

It can help to sit with a few questions before making any decisions about whether to book a doula or an independent midwife…or both!

• Do you want someone who can take clinical responsibility for your care, or are you happy with NHS oversight alongside dedicated personal support?
• Is continuity of care (knowing exactly who will be with you at your birth) important to you?
• Are you planning a homebirth, and if so, do you want a midwife who specialises in that?
• Do you feel you need clinical reassurance throughout pregnancy, or is your main priority having emotional and practical support during labour itself?
• Could you benefit from having both - a midwife for clinical care and a doula for continuous emotional support?

There are no right or wrong answers. But being honest with yourself about what you're looking for makes it much easier to find the right fit.

The Roles That Can Work Beautifully Together

Choosing between a midwife and a doula doesn't always have to be a choice at all. For many women, having both is what makes their birth experience everything they hoped it would be - you get the reassurance of clinical support AND emotional and practical support.

How Midwives and Doulas Complement Each Other

Midwives and doulas can work together beautifully. Your midwife can provide the clinical care and your doula isn’t out of their depth if something does need medical attention. Everyone is doing exactly what they're best placed to do, with you at the centre.

Good midwives and doulas are used to working alongside each other and will communicate openly as a team. If you're considering both, it's worth mentioning this when you first speak to either of them. Independent midwives may already have doula colleagues they work closely with and vice versa. We’ve had experiences when working in hospitals where a woman has a doula and it’s clear that hospital staff feel threatened by this. We believe this is incredibly short-sighted and believe that doulas are a real asset to any birth and particularly if you’re birthing in hospital, they are able to provide the continuous emotional support and advocacy that, if we’re being really honest, most midwives within the NHS just can’t provide due to the nature of the system.

Finding Independent Midwifery Care or Doula Support in Kent

Homebirth support across Kent - from Folkestone to the wider county

There is a growing network of independent midwives across the country, with several options in Kent and the surrounding counties! Zest has an independent midwife directory where you can search for a midwife local to you. Doula UK and Abuela midwives both have directories to find doula support. We’d encourage you to find out if there are any birth circles run near you as these can provide a wealth of information about homebirth, and many are doula run.

How to get in touch with us, Juno Midwives!

If you’d like to find out more about how we can support you during pregnancy, birth and postpartum - book a free intro chat. We’re also on the gram @junomidwives