If you’re pregnant, one of the many things you’ll be deciding over the next months is who you want on the team that will support you during your labor and birth. Midwives and doulas both have valuable skills to offer birthing parents. But while there is some overlap, the two types of birth professionals differ in some important ways. Here, we’ll be discussing birth doulas only, and not other types, such as postpartum doulas.)
One major distinguishing factor is that a midwife is a healthcare professional, while a doula is not. For example, a midwife can perform certain medical procedures and deliver babies. A doula is more like a non-medical labor support person or coach. That means that a doula can’t replace a midwife, so it’s important for you to know how they’re different.
So let’s dig deeper into what each of these types of birth professionals do. We’ll also explain why you might want to have either—or both—care for you during your labor and birth.
Similarities between a midwife and a doula
Let’s start with what midwives and doulas share.
Philosophy about pregnancy and birth
Generally speaking, midwives and doulas see childbirth as a normal process, and a profound event in a person’s life.
Hands-on physical support skills
Doulas and midwives are knowledgeable about the normal process of labor and birth, and strategies to keep labor from stalling. Both types of professionals have learned techniques that can offer pain relief during labor and birth, as well. These include things like massage, and relaxation breathing exercises.
Emotional comfort and support
Compared to obstetricians, midwives and doulas spend more time getting to know the pregnant person and partner. This can help build a deep sense of trust. Then, when labor starts, the birthing person may feel more confident and less anxious. This in turn can help reduce pain.
Continued presence
Midwives and doulas also provide more continuity of care during labor and birth. For instance, in the case of a hospital birth, obstetricians and nurses usually pop in and out of the room while you’re laboring. A midwife or a doula will typically stay with you most of the time. And after the baby is born, midwives and doulas can help establish breast- or chest-feeding, and offer guidance on newborn care.
Fewer interventions, high satisfaction
Finally, research has linked both doula and midwifery care with outcomes that many expectant mothers may hope to achieve. These include less use of pain medications, and a lower likelihood of interventions such as C-section. What’s more, birthing parents who are cared for by a doula or midwife tend to report more positive feelings about their birth experience.
Differences between a midwife and a doula
Training and qualifications
Doulas are not medical professionals, meaning they have no medical training and can’t offer medical advice. In fact, since ‘doula’ is not a regulated title, someone can legally use it without having undergone any training at all.
That said, many doulas do choose to undergo training through an organization such as DONA International. These programs don’t require that you meet a minimum education level for acceptance. They vary in length—taking anywhere from a few months to a year or two to complete. (You can read more about some of the different programs here.)
Doula training typically involves a combination of a workshop, plus required readings. Often, trainees must also attend both a childbirth education class, and a breastfeeding/lactation class.
Doulas can choose to take the extra step of getting certified through a training organization like DONA International or ICEA. Specifics vary, but common elements include passing a written exam, and attending a certain number of births.
By contrast, midwives are health professionals who are experts in low-risk pregnancy and the normal birth process. They provide primary care to pregnant and birthing people and their newborns.
The education and training required to become a midwife usually takes several years. For example, in the US, certified nurse midwives (CNMs) are advanced practice registered nurses. A CNM holds a bachelor’s degree (usually in nursing), plus a master’s or graduate degree that takes a minimum of 24 months to complete. CNMs also have to pass a national qualifying exam and be certified by the American College of Nurse-Midwives. You can learn more about the different types of midwives in the US, such as certified professional midwives (CPMs), here.
Scope of Practice
Doulas provide non-medical informational, physical and emotional support and advocacy for pregnant and birthing people. According to ICEA, an organization that trains and certifies doulas, a birth doula ‘provides continuous care in a variety of locations and situations: at home, in birth centers and in hospitals; during medicated and unmedicated vaginal births, and in the operating room for Cesarean births.’ The doula’s first priority is the physical and emotional comfort of the birthing individual.
A midwife’s primary responsibility is the health and safety of the birthing person and infant. Midwives provide comprehensive care during a woman’s pregnancy, labor, and childbirth. They care for both the birthing person and newborn for the first several weeks after birth, as well. As regulated health professionals, midwives are qualified to perform certain medical tasks, too. For example, they can carry out physical exams, order tests (such as ultrasounds), prescribe some medications, deliver babies, and stitch up tears.
Midwives also have the training to assess whether a pregnant person is no longer considered low-risk, and thus needs more specialized care. In such situations, a midwife may continue to provide care in collaboration with an obstetrician.
It’s also worth noting that midwives aren’t limited to caring for pregnant women. They may also provide other types of reproductive healthcare, such as screening tests for cervical cancer, and family planning services.
Services Provided
Many doulas offer prenatal support in the form of personal visits, and availability by text, phone, or email to answer questions. Some doulas will come to your home when you’re in early labor and suggest ways of coping with contractions, and help you decide when to leave for the hospital or birthing center.
Doulas will typically remain with a birthing person throughout labour and birth, using techniques such as massage and breathing exercises to help manage pain. Even if you choose to have an epidural, a doula can provide invaluable support. For example, your doula can communicate the wishes in your birth plan to your care team. She can also keep your labor progressing by using tools like a peanut ball, and physically helping you move into different positions.
A doula can act as a resource for the birthing person’s partner, too—by providing reassurance about what is normal, for instance. And whether you’re planning a hospital or home birth, your doula can act as a spare set of hands, as well, for jobs like taking photographs.
A doula may also provide assistance in the hours after birth, by helping to get breast- or chest-feeding established and offering guidance on newborn care. Some birth doulas offer support and assistance in the postpartum period, too. You can find a more in-depth look at the services doulas offer here.
Midwives have the knowledge and expertise to provide many of the same services offered by doulas, but may not always have the time or opportunity to do so. For example, when a midwife is busy with medical tasks, she may be unable to provide comfort measures such as massage.
Choosing Between a Midwife and Doula
First of all, you don’t necessarily have to choose! You can opt to have a midwife to provide your prenatal care, and deliver your baby, and still hire a doula to offer emotional support, encouragement, and comfort measures throughout your labor and birth.
So what are some of the factors to consider when you’re deciding whether you want one or the other or both on your care team?
Personal preferences
If you’re a very private person, you may want to have the fewest people possible present when you’re feeling exposed or vulnerable. This could mean you’d prefer not to have a doula. On the other hand, because you can build a relationship with a doula before the big day, you and your partner may find her presence calming. Or perhaps you’d feel most secure with a physician as your primary provider. In that case, you’d probably want to choose a doula over a midwife.
If you’re the birthing person, would your partner welcome having someone to ask for guidance on how best to support you? Is there the possibility you might be left alone if your partner needs a rest or meal break? A doula can focus her full attention on meeting such needs, since her only responsibility is to help you have the best birth experience possible.
Health and medical history
If your pregnancy is considered high-risk, you may not have the option of having a midwife, but you can typically have a doula present to support you during labor and birth. The place where you think you’ll feel most safest and most comfortable giving birth may factor into the equation as well. For instance, say giving birth at a specific hospital is at the top of your must-have list, but the only midwife in your area who’s taking new clients doesn’t have privileges there. Then you might want to opt for a doula.
Budget
Unfortunately, your bank balance and insurance coverage will figure into your calculations, too. Many major insurance companies will cover midwifery services, although you should call your insurance provider’s customer service department to ask about your specific plan.
It’s less common for insurers to cover doula services, although a growing number have begun to offer at least partial reimbursement. And some states permit Medicaid coverage for doula services, although they may reimburse at much lower rate than the actual cost. If you have to pay entirely out-of-pocket, the cost can range anywhere from $500 to $3,500, although some doulas do offer sliding scale pricing based on your income.
In short, while doulas and midwives fill different roles, both types of care providers have a lot to offer. Both practice a ‘high-touch, low-tech’ style of care, including longer, more frequent visits, and thus a greater opportunity to build trust and familiarity. They can also reduce your need for pain medication, and lower your chances of undergoing medical interventions. (You can read more about how to find a doula here.) Ultimately, you and your partner are the best judges whether a doula or a midwife or both best suit your individual needs.
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