Doula vs. Midwife

Doulas and midwives both assist with childbirth and provide support to a pregnant mother.

Doulas and midwives are both professionals who assist with childbirth and women’s reproductive health. A doula provides support to the mother before, during, and shortly after childbirth, but does not deliver the baby. A midwife may offer gynecological examinations, birth control counseling, prescriptions, and labor and delivery care.

The laws of each state regarding certification and licensing affect the exact types of services that a midwife can perform.

A doula provides physical, emotional, and informational support to an expectant mother before, during, and after childbirth. A doula focuses on an expectant mother’s own needs, which enables her to have a memorable and empowering experience while giving birth. While in most cases the term “doula,” implies a professional who is present during the birth, there also are doulas who specialize in antepartum (before birth) care and postpartum care. A doula typically helps a woman prepare a birth plan.

A birth doula remains with the mother during birth, offering relaxation and breathing technique support, as well as comforting services like massage, and assistance with labor positions; however, doulas are not medically trained, and cannot deliver babies. A doula is not a substitute for having a woman’s partner at the birth. Doulas encourage participation from the partner, and offer support and reassurance to the partner as well.

A midwife is a health care professional. Depending upon the laws of the US state in which the midwife practices, a midwife may perform gynecological examinations (for example, Pap smears, pelvic exams, and breast exams), write prescriptions, care for a woman during labor and delivery, perform fetal monitoring, and provide information about contraception. A midwife usually seeks to eliminate or minimize unnecessary technological interventions, believing that pregnancy and birth are normal life processes. However, a midwife also is skilled at identifying and referring women who need the services of an obstetrician during the birth. A midwife is medically trained and qualified to deliver babies.

Some midwives also are trained as nurses. A nurse-midwife usually can offer the greatest variety of health-care services to women.

The American Midwifery Certification Board (AMCB) is the US national certifying body for certified nurse-midwives (CNMs) and certified midwives (CMs). Midwifery education programs involve graduate study and usually require a Bachelor's Degree for entry. Some programs will accept applicants with a Bachelor’s degree in a field other than nursing, while others require a Bachelor’s degree in nursing. Midwifery education programs in the United States are accredited by the Accreditation Commission for Midwifery Education (ACME). According to the AMCB, legal recognition for CNMs and CMs varies among states.

A doula does not necessarily have medical training, and there is no formal licensing required. However, many doulas choose training and certification by organizations that oversee doula training programs, such as DONA International™ and the Childbirth and Postpartum Professional Association (CAPPA).

A doula and a midwife offer different types of services, even though both may support the childbirth experience.

Midwives have medical training and during the birth process, focus on delivering a healthy baby.

Doulas, on the other hand, focus on the needs of the mother, offering mental, physical, and emotional support. Doulas do not have medical training or experience and cannot be used a substitute for a midwife or doctor.

Yes, many women opt to use both a doula and midwife, although it is not required that a woman use both if using one or the other.

A midwife is trained to recognize an emergency or situation that requires medical care from a doctor. Midwives are trained to handle normal pregnancies, but obstetrical care is required for certain situations, and for pregnancies deemed to be at high risk. Many doctors have nurse-midwives in their practices that work alongside your doctor’s team and may manage normal pregnancies if the woman wishes.

Obstetricians (ob-gyn physicians) can manage high-risk pregnancies and can perform surgeries, including C-sections, when necessary. Midwives are prohibited from performing C-sections or using forceps and vacuums during the delivery process. The midwife will seek obstetrical care from a doctor should a birth complication arise that requires one of these interventions or an emergency that threatens the mother or baby.

The costs for doulas and midwives, as for any health-care service, vary according to the specific provider and the geographic location. A doula typically charges a flat fee for service, meaning an agreed-upon number of prenatal visits, being on-call for support during your pregnancy, support during your labor and birth, and at least one postpartum visit. Other services may be included in the package. The costs for a doula can be $1,000 or more in major cities and substantially less in other areas.

For a midwife, the cost also varies by location. An average cost of a midwife is around $2,000, but midwives’ fees may be covered by some insurance policies. These fees typically cover all prenatal visits, the birth, and postpartum visits. Some midwives may offer sliding scales, reduced fees, or payment plans for some women.