Doula vs. Midwife: What's the Difference—and Can You Have Both?

Pregnancy and birth require decisions of you. So. Many. Decisions. One of the biggest things to consider: Who should be by my side during all of this? Doulas and midwives are key players in pregnancy and birth. But you’re not alone if you feel overwhelmed trying to figure out the differences in these two roles. When I was pregnant with my daughter I think I spent a whole day researching what they both actually do.

It’s simple, really. Doulas and midwives both support pregnancy and childbirth. But their responsibilities and training couldn’t be more different. One requires medical training and certifications, while the other doesn’t need to be licensed and is considered more of a support partner. So, which is which? Let’s break down the doula vs. midwife debate so you can feel confident in your decisions—because this is a big deal!

What Is a Doula?

A doula’s role is to provide emotional, physical and educational support to a pregnant person throughout their pregnancy, during birth and after. Think of a doula as a personalized support partner. And even if you already have a spouse or family member as your plus-one on appointments in the delivery room, “doulas know birth,” says Becky Ofrane, DrPH, a doula and assistant professor of public health at Montclair State University in New Jersey.

Doulas can also be broken down into different categories of specialization: antepartum doulas for support during pregnancy, birth doulas for labor support and postpartum doulas for care after birth. Some doulas even do it all and can be there for you every step of the way.

It’s really important to consider that doulas don’t technically require certifications or have national boards the way other professionals like ob-gyns and certified midwives do. “As a result, not all doulas choose to certify and some doulas are lay trained,” says Kristin Revere, a certified doula in birth, postpartum and infant care and owner of Gold Coast Doulas in Michigan. This means doulas aren’t medically trained. So, a doctor or midwife is also needed for prenatal care and the birthing experience.

What Is a Midwife?

A modern midwife functions as a medically trained healthcare provider. They offer preconception, prenatal and postpartum care, notes Tania Lopez, CNM, DNP, APRN, a certified nurse-midwife at Pediatrix Medical Group in Fort Worth, Texas. Additionally, they may provide other women’s health services, including family planning and menopause care. In any case, a midwife is the person who will actually be the provider at baby’s birth. “They’re the ‘baby catcher,’ per se,” says Lopez. “We don’t like to say we ‘deliver’ baby, as Mom is doing all of the delivering herself,” she adds.

Traditionally, midwives were trained throughout history by their mothers and grandmothers in community-based settings. They learned how to monitor the birthing person and baby by watching and helping with the live birth process. But with the introduction of modern medicine, midwifery was quickly considered “old-fashioned” and outdated. “As birth moved into hospital settings, it became a requirement for midwives to complete registered nurse training and subsequent obstetrical training specifically for labor and delivery,” says Lopez.

Today, all midwives are required to train and certify before practicing. There are a couple of certification paths midwives can choose from:

Certified nurse midwife (CNM)

These professionals have completed a graduate-level nurse-midwife program and are considered registered nurses. They are required to successfully pass a certification exam recognized by the American Midwifery Certification Board.

Certified midwife (CM)

Certified midwives have completed a graduate-level midwifery program without the additional nursing degree. They have also passed the American Midwifery Certification Board’s certification exam.

Certified professional midwife (CPM)

These midwives aren’t required to obtain a graduate or nursing degree. They do, however, need to complete an accredited midwifery program and pass a national certification exam recognized by the North American Registry of Midwives (NARM).

Certified nurse midwives and certified midwives can practice in hospitals, birth centers and home birth settings. Certified professional midwives are usually found in out-of-hospital settings. In any case, all midwives share the same responsibility: to work in partnership with women and provide the necessary support, care and advice during pregnancy, labor and postpartum.

Doula vs. Midwife: Key Differences

There’s no doubt both doulas and midwives do a lot for the pregnancy, birth and postpartum process. If you’re wondering what each one’s responsibilities are down to the nitty-gritty, here’s a breakdown, according to Lopez and Ofrane:

Doula:

• Helps develop a birth plan
• Provides prenatal education
• Plans for the logistics of labor, birth and postpartum
• Joins the birthing person during labor
• Use hands-on techniques to relieve pain during labor
• Suggests birthing positions and coping strategies
• Provides advocacy during labor and birth
• Supports the birthing partner
• Gives postpartum care
• Postpartum visits for basic newborn care
• Provides emotional postpartum support

Midwife:

• Provides prenatal care
• Tracks pregnant person’s health and orders tests
• Monitors and assesses the progress of labor
• Educates the pregnant person on labor, birth and newborn care
• Keeps an eye on any risks that require intervention during labor
• Pain management during labor
• Collaborates with a physician during labor
• Supports the pushing and delivery phase
• Cares for Mom immediately postpartum
• Provides immediate newborn care (suctioning, APGAR checks, etc.)
• Provides initial breastfeeding support

Can You Have a Doula and a Midwife?

As you’ve probably gathered, doulas and midwives do many different things. But their skills and responsibilities complement each other very well, too. “Having a doula in addition to a midwife is a wonderful and recommended way of being supported, even if you have a partner,” says Ofrane. Remember, a doula isn’t trained to help someone give birth alone. A clinician, such as a midwife or ob-gyn, should be present.

Most pregnant people find a midwife or provider as soon as they find out they are pregnant. On the other hand, doulas can be contacted at any time during pregnancy. It all depends on what kind of care you’re looking for. For example, hiring a doula in the first trimester would be very helpful if you feel like you need extra support throughout pregnancy. If not, perhaps just a birth doula would be best for you.

Here’s something else to think about: Midwives sometimes have multiple patients in labor simultaneously, especially in hospital settings. A doula will be dedicated to you throughout labor. Hiring both a midwife and a doula means you’ll always have one-on-one personalized support, making sure someone is always available, notes Lopez.

Benefits of Having a Doula and Midwife

Having both a doula and a midwife on your birth team can create the perfect balance of support and medical expertise. If you’re wondering if this duo is right for you, knowing the benefits of each professional is a great place to start.

Doula benefits

Pregnancy and birth is a natural process—it’s an instinct, really. But even with all that considered, it’s still hard to know what to do in certain situations. That’s where doulas come in. Here are some benefits of having a doula, according to Revere:

• Having a pro on speed dial. Doulas offer a wealth of resources and information throughout pregnancy, delivery and postpartum. Forgot to ask your midwife something during your prenatal appointment? Your doula is easily accessible and can probably help answer it for you!
• Services are flexible. Doulas can support you anywhere you choose to deliver, whether that’s in the hospital, birth center or at home. They are bound to you, not a specific place.
• Additional support for partners. The doula isn’t there for just you—they support anyone you have attend the birth. Whether that’s your spouse, parent or friend, doulas can give tips and show them how to offer you extra support during labor. They can help your partners on an emotional level, if needed. “Some doulas even offer sibling care at home births,” says Revere.
• Extra postpartum support. Care doesn’t just end when baby arrives. Sometimes you need extra help to process the entire experience. Doulas typically meet with the family within two weeks of delivery to give tips on feeding, recovery and newborn care.

Midwife benefits

Knowing you have a trained medical professional in your corner is reassuring. Midwives come backed with accredited certifications, but there’s much more to it. Lopez lists out some additional benefits of choosing a midwife:

• A personalized plan. Midwives generally spend more time with their patients. This closer relationship allows them to create a plan centered around your personal goals and values, giving you the pregnancy and birth experience you want.
• Better birth outcomes. Birthing with midwives may reflect improved maternal and baby outcomes. In fact, research shows that low-risk pregnant people who choose midwifery-led services have lower C-section rates.
• More natural approaches. Midwives often see pregnancy and birth as physiological events rather than medical conditions, says Lopez. That’s why midwifery care tends to allow alternative birthing positions compared to more medically driven techniques. They also use less medical interventions overall. Research shows that births attended by midwives have fewer inductions of labor.

Doula vs. Midwife: Cost Considerations

It would be entirely unrealistic to ignore the cost factors that come with pregnancy and birth. The whole process can be expensive and financially stressful. So here’s what you need to know: Typically, midwives who work in hospitals are covered by most commercial insurance and Medicaid programs. Self-pay often comes into play with home-birth and birth-center midwives—but it really depends on the state. “As evidence continues to show safe outcomes at lower costs for birth-center births, some insurance carriers also cover the costs of birth centers where either a nurse midwife (CNM) or certified professional midwife (CPM) may attend deliveries,” says Lopez.

Doulas are a little more tricky. Doulas are still typically a 100 percent out-of-pocket expense. In rare cases, some commercial and private insurance companies do cover doula services, but this is relatively new and not as common, notes Ofrane. And, of course, it depends on the area you’re in.

On average, midwife services can cost anywhere between $3,000 and $9,000 for prenatal, birth, postpartum and newborn care. Thankfully, it’s likely covered by insurance if in a hospital setting. For doulas, that average cost looks more like $300 to more than $1800 in some cases.

The bottom line? Doulas and midwives have one important thing in common: a goal to create a positive outcome for you and baby. Having a trained and board-certified midwife on your team can give you so much reassurance surrounding your prenatal and birth care. And a doula provides that extra support so you don’t feel like you need to do it all alone. Add them together, and you have a recipe for your dream pregnancy and birth experience.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

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