Making the transition from pregnancy to motherhood can be challenging on many levels. The good news is that there are two types of birthing professionals that can help: doulas and midwives.
While they share a common goal of supporting mothers in childbirth, their support differs widely during pregnancy, birth, and postpartum based on their training, certifications, and duties. Adding to the confusion, midwives and doulas may work together in some cases. And some midwives also work as doulas.
So, what’s the difference between a doula and a midwife? Do you need one, both, or neither?
Doula vs. Midwife: The Short Version
Doulas and midwives each support women during pregnancy, birth, and postpartum, to varying degrees. In a nutshell, doulas provide non-clinical (emotional, practical) support while midwives provide clinical (medical) support.
Read on to learn more about their roles and the ways they can work together to deliver a safe and positive experience.
What Does a Doula Do?
Doula is the Greek word for “a woman who serves.” The doula is a specially trained birth companion whose focus is on the non-clinical aspects of giving birth. They offer emotional, physical, and practical support before, during, and after childbirth. (Yes, there are male doulas, too.)
Extensive, reliable research demonstrates that doula care is a high-value model that improves childbirth outcomes, increases care quality, and holds the potential to achieve cost savings by avoiding unnecessary medical procedures [*].
Doula support during pregnancy, birth, and the postpartum period reduces rates of cesarean deliveries, prematurity and illness in newborns, and the likelihood of postpartum depression. Doula care also improves the overall satisfaction with the experience of childbirth care and increases breastfeeding initiation and duration.
While the idea of having a companion to provide support to a woman in birth dates back to prehistoric times, the contemporary role of doula first emerged from the grassroots natural birth movement in the U.S. in the 1960s.
Back in the 1960s, there was a movement toward more involvement from the father in childbirth — an expectation that fathers would go from anxious pacing in the maternity ward’s waiting room to being intimately involved as birth advisors, coaches, and advocates for expecting mothers.
But in practice, most men could not navigate the thicket of medical decisions surrounding birth, and their distress over the mother’s pain made it even more difficult to provide the reassurance and nurturing that women need at this critical time. Enter the doula.
The first organization to train and support doulas, DONA International, was founded in 1992 by two physician researchers who conducted clinical trials on the medical outcomes of doula-attended births and coined the term “doula” as we use it today.
Do Doulas Deliver Babies?
In contrast to midwives, doulas do not have medical training and cannot perform exams, diagnose medical issues, administer medication, order tests, or deliver a baby. But they can and do advise women on their childbirth options to ensure a safe and positive experience. They provide comfort measures such as breathing, relaxation, movement, and positioning, as well as postpartum care.
Doulas also have a role in taking the pressure off the mother’s partner so they can participate at their own comfort level. Whether the birth partner is the father, a friend, a lover, or a family member, a doula will look to include them, not replace them.
Doulas divide into four categories: Birth; Postpartum; Fertility; Full-Spectrum.
The birth doula offers physical, emotional, and informational support to expectant mothers and their families before, during, and shortly after childbirth. They help women design and advocate for the healthiest, most satisfying birth experience, whether they opt to deliver at home, in a birth center, or at a hospital.
While the use of doulas arose out of the natural childbirth movement of the 1960s, note that you do not have to opt for natural childbirth to work with a doula — they unconditionally support women with whatever choices they make. A doula won't judge your decisions about pain relief — or anything else.
Most doula-client relationships begin 2-3 months before the baby is due. At that time, they’ll meet with you to discuss your birth plan, present options, offer support referrals (e.g., acupuncture, prenatal massage therapist, exercise programs), and generally learn how best to support you. They’ll introduce you to non-medical pain management techniques and be there to advocate for you to ensure your voice is heard and your preferences are honored by your medical team.
In the delivery room, roles are clearly delineated: Your OB/GYN or midwife oversees your medical care and the delivery of your baby while the doula offers emotional support throughout the labor to help you manage pain, ease stress, and get to the finish line like a champion.
Some doulas provide both birth and postpartum support, offering a continuous thread. The role of the postpartum doula is to provide educational and practical support in the home in the first weeks or months after childbirth. Their services may include infant care, breastfeeding support, information, advocacy and referral, partner support, sibling care, and household task organization. There is some evidence that postpartum doula support can increase breastfeeding and decrease postpartum depression [*].
A fertility doula can help during the conception process and may be especially beneficial for families who are struggling to get pregnant.
The term full-spectrum doula was coined in 2008 by the activists who began the Doula Project in New York City. Their goal was to expand the role of the doula to other reproductive experiences beyond birth, grounded in a reproductive justice framework. They used “full-spectrum doula” to describe one who supports all pregnancy experiences and outcomes, from conception, birth, and postpartum to pregnancy termination, miscarriage, and fetal loss.
There is no law requiring doulas to become certified, but there are many organizations that provide training and certification, including Birth Arts International, Birth Works, Birthing from Within, Childbirth and Postpartum Professional Association (CAPPA), DONA International, Hypnobirthing, International Childbirth Education Association (ICEA), and ProDoula.
Typically, a birth doula needs to finish 7 to 12 hours of childbirth education, 16 hours of birth doula training, and attend 2-5 births.
A postpartum doula usually attends about 27 hours of postpartum doula education and assists two or more women with postpartum support.
Studies show that women who use a birth doula are:
- Less likely to need Pitocin to induce labor.
- Less likely to have a cesarean birth.
- Less likely to use any pain medication.
- More likely to rate their childbirth experience positively.
These widely accepted claims are based on the largest systematic review of continuous labor support, published in 2011, which reported the combined findings from 21 randomized controlled trials including more than 15,000 women [*].
Doula Options and Costs
You can engage a doula through an independent doula practice, a hospital or agency doula program, or a community-based doula program.
Although some health insurance and flex pay plans pay for doulas, at present, private doula care is usually paid for directly by the client. Costs vary widely, from around $800 for a private doula to $2,500 or more, depending on the provider, location, and services rendered. Some offer a flat fee while others charge by the hour.
Insurance companies are increasingly offering coverage for doulas, either as a listed service, through a flexible spending account, or as part of their universal health care coverage. Call your provider and ask for their policies on labor support, childbirth education, and lactation support.
Grant funding for doula services is also sometimes available, and, in the US, some Medicaid-funded health agencies have contracts with doula organizations to support women in poverty and women with special needs.
Community-based programs typically provide more home visits and a wider array of services and referrals for individuals who need more comprehensive support than would be provided by a traditional doula. The support provided is low or at no cost and focuses on ensuring safe, dignified, and respectful care. Most community-based doulas are members of the community they serve.
Use a resource like Doula Match to find someone who works within your price range—you may even be able to find someone who will provide free services while undergoing the training process to become fully certified.
What Does a Midwife Do?
A midwife is a trained medical professional who can deliver a baby as well as provide certain pre- and post-natal care. Midwives focus on encouraging vaginal birth and providing holistic care for pregnancy and the postpartum period.
Evidence has shown that using a midwife for pregnancy and birth can include benefits such as:
- Reduced infant mortality rates.
- Reduced need for interventions and inductions.
- Lower rates of induced labor and anesthesia.
- Higher satisfaction rates with quality of care.
- Reduced risk of preterm births.
- Reduced risk of having a cesarean delivery.
In many practices, midwives work collaboratively with OB/GYN doctors and do many of the same things, from providing prenatal care and exams to ordering an epidural, resuscitating a baby or stitching tears.
In fact, midwives can manage more complications than a labor and delivery nurse, but they are prohibited from performing C-sections or using forceps and vacuums during the delivery. And while they are trained to recognize a situation that requires medical care from a doctor and will seek intervention should the need arise, their philosophy is to reduce the birth mother’s reliance on medical interventions unless it’s absolutely necessary.
Midwife Types and Certifications
Some midwives are registered nurses (CNM, or certified nurse-midwife) certified by the American College of Nurse-Midwives, while others have a bachelor’s degree with specialized training in midwifery (CM, certified midwife). In the United States, CMs are certified through the North American Registry of Midwives and the American Midwifery Certification Board. CNMs are by far the most common and have the most education.
Both CNMs and CMs are trained to handle low-risk pregnancies. They can perform exams, order tests, prescribe medication, and perform deliveries without complications. A credentialed midwife is authorized to work in any setting, including health clinics, hospitals, or the home.
Midwife fees also vary by location, averaging around $2,000. Fees typically cover all prenatal visits, birth, and postpartum visits. Midwife fees may be more likely to be covered by some insurance providers because their services are often billed under a consulting physician.
Can I Have a Midwife and a Doula?
Yes, absolutely! Midwives and doulas often work collaboratively. If you’re keen to have the emotional support and advocacy a doula brings as well as the clinical expertise and holistic approach to birth from a midwife, then by all means, team them up.
The Bottom Line
Studies show that continuous birth support from both doulas and midwives contributes to positive health outcomes for mothers and their babies, with lasting effects into adulthood [*].
Like MiracleCord’s cord blood banking services, employing a doula, midwife, or both can offer an added layer of security for your family in these uncertain times.