Doula vs. Midwife: How to Choose the One I Need?

Labor is an intense and emotional event for expectant mothers and their families, but it can also be a positive and empowering experience. Both doulas and midwives have a unique set of skills to help guide the birthing person through the process.

So which one is right for you? Do you have to choose between the two? Let’s dive in and find out!

A doula is a part of the birth team. They are not a medically trained healthcare provider, nor are they a replacement for your spouse or other birth partner. A doula will help support you and your partner through labor, breastfeeding, and the postpartum period. 

A doula’s role is to provide knowledgeable guidance and support throughout labor. You may also work with a doula during the postpartum period. There are different types of doulas, but regardless of whether you choose to have one for your birth or for your postpartum period, your doula will get to know you and your family in order to best support you. Let's take a look at each type:

A birth doula, or a labor doula, is responsible for supporting you through the nonmedical aspects of your birth. They will offer techniques for relaxation and positioning. Doulas may use breathing, massage, counterpressure, or other methods to assist you during labor. 

If you have a hospital birth, they will advocate for you and communicate your desires with the medical staff. A doula can help you develop your birth plan and will assure that your wishes are respected as much as is medically feasible, to ensure you feel confident and empowered during the birthing process. 

The benefits of hiring a birth doula have been proven through reduced c-section risk, decreased need for medical interventions, and increased reports of positive birth experiences. 

If there is a medical reason to deviate from your birth plan, your doula will provide you with emotional support and comfort techniques. If you are delivering at a hospital and concerned about medical interventions or having enough support during labor, consider adding a birth doula to your team. 

A postpartum doula’s role is to assist with your recovery after birth. They are available to help the entire family with transitioning to welcome the new baby, as well as help care for your newborn. They may help with light houseworking tasks like dishes or laundry, help prepare meals, or care for siblings while you rest or bond with your baby. 

A postpartum doula can be especially helpful after a c-section or other difficult birth where your mobility is limited shortly after. Both a postpartum doula and a birth doula can provide breastfeeding support.  

Doulas do not need to be certified. However, they may choose to become certified through organizations like Doulas of North America (DONA) and International Childbirth Education Association (ICEA). 

Doulas should receive training in childbirth, breastfeeding, and attend a number of births before providing services, regardless of certification status. 

The cost of a doula can vary greatly depending on where you live and the services provided.  A birth doula can cost between $500 and $2000. A postpartum doula may charge hourly for breastfeeding and in-home support. Some doulas may offer a sliding scale based on income or a payment plan. Insurance will not cover the cost of a doula. 

A midwife is a medical professional who is involved in prenatal, birth, newborn care, and postpartum care. There are varying levels of certification and training for midwives, leading to different professional titles. 

Midwives deliver at home births and birthing centers, and may work alongside OBGYNs at hospitals. Midwifery care is suitable for low risk pregnancies or minor complications. 

Certified nurse midwives are the highest level of certification for midwifery. They begin as a registered nurse or a nurse practitioner, and then go on to complete further formal training at the graduate or doctoral level in midwifery. A certified nurse midwife may be your primary prenatal and postnatal care provider, and they’re able to complete many of the same tasks as your obstetrician. 

They are trained in aspects of medical care related to vaginal births, and can prescribe medications. In some states and circumstances, certified nurse midwives will need to work alongside a doctor. They cannot perform cesarean births without a doctor.   

Certified midwives complete the same midwifery training as certified nurse midwives, but they do not have nursing degrees. They will complete a midwifery program and work under an apprenticeship. Not all states recognize certified midwives credentials, and they cannot prescribe medications in most states. They may complete similar tasks to an OBGYN for routine prenatal and postnatal care. 

Certified Professional Midwives differ from the previous two because they do not deliver in hospital settings; the majority of their deliveries occur at home births or birthing centers. They’re also the only certification level that requires apprenticeship and education in homes and birthing centers, instead of hospitals. 

Certified Professional Midwives receive their certification through the North American Registry of Midwives. 

A traditional midwife does not receive formal training or education, but rather has learned through experience or informal training measures. They are not regulated or certified by any organization, and may be referred to by other terms, like community-based or lay midwives. All three of these titles mean the same thing, and they will have similar qualifications. These midwives’ skills may be rooted in traditions and folk medicine passed down for generations. 

Certified nurse midwives (CNMs) have a graduate-level education in midwifery from an accredited program, pass national certification exams, and are registered nurses. 

Certified Midwives (CMs) only differ from CNMs in that they are not registered nurses or nurse practitioners. 

Certified Professional Midwives are not required to complete an academic degree beyond high school, and are certified through demonstrated competency in the field of midwifery. 

Traditional Midwives do not hold any formal certifications. 

You can look at the American College of Nurse-Midwives website for more information on certification. 

A midwife can cost between $2000 and $9000 for a home birth or birthing center. Some insurances may cover some costs of a midwife for a home birth, but most insurances will only help pay for a midwife if you deliver at a hospital, although they may be subject to specialist fees. Call your insurance and ask what birth professionals and settings may be covered or reimbursed under your policy. 

Midwives and doulas are both potential members of your birth team and provide labor support. The main difference between doulas and midwives is that a midwife is a medical professional, while a doula is not formally trained as a healthcare provider. 

A doula does not provide healthcare in a preventative or medical manner. Their main purpose is to assist the birthing person emotionally and give continuous support during labor. 

A midwife is able to provide healthcare through prenatal visits, medical interventions, pain relief options, and postnatal care. They are also able to medically care for your newborn in low-risk pregnancies. Midwives are experts in women’s health and can also provide care for their patients outside of pregnancy. 

A doula’s role is continuous, emotional support of the expectant mother throughout labor. They will also provide physical support through positioning, counter-pressure, and massage, and may coach your birth partner in carrying these out.

Doulas will not be able to provide medical interventions if necessary, but their goal is to avoid any unnecessary interventions that may be presented within a hospital setting. 

Midwives are responsible for the health and safety of the expectant mother and her baby throughout the pregnancy and birth. They offer a more holistic approach than OBGYNs and other doctors you may encounter in a hospital setting. Although they may be able to also provide emotional support to their patients, their main role is safety. 

A doula can help you shape your birth plan. They will advocate for you during labor so your birth plan is followed and respected. A doula can be part of your birth plan no matter where you deliver, and whether you choose a medicated or non-medicated birth. Everyone can benefit from added emotional support and coaching to remain calm and confident during labor. 

A midwife will not develop a birth plan with you, but they will acknowledge it during your labor. If a birthing center is part of your birth plan, it is likely a midwife will be as well. If you are planning a home birth, consider hiring a midwife to help you and your baby stay safe and healthy. 

The decision to hire a midwife or a doula is ultimately up to you. Both are a great addition to your birthing team and provide different types of support to the expectant mother. They are also not an either-or decision: You can hire both if you like! 

Think about what type of support is most important to you, and what provider best suits your needs. It is important to ask questions. Here are some that may help you find the best option: 

● How many births have they attended? 

●Did any of these birth experiences involve complications? If so, how did they handle them, and what was the outcome? 

●Is the doula certified under any organization? If not, how did they gain knowledge of the field, and can they provide you with references? 

●Is the midwife a CNM, CM, CPM, or traditional? 

● Ask any follow up questions you need to feel confident about their training and experience. 

●How many expectant mothers are currently on their schedule? 

●How much time do they need to arrive at your home, birthing center, or the hospital? 

●Ask about their procedures if you deliver earlier than expected. You may also want to ask how long they will stay after the birth, and if any follow up visits are included. 

●Does their birthing philosophy match yours? Be sure that the things which you find important match theirs. If they feel strongly against medicated births, but you want an epidural, they would probably not make a good addition to your birthing team.

●Discuss who you want in the room, and how they feel about this. Are they okay with teaching your partner how to support you, or would they rather take a leading role? 

●Be sure your chosen midwife or doula is allowed to assist or deliver at the birthing center or hospital of your, or your insurance’s, choice. 

●Even if you’re planning a home birth, ask about any hospital affiliations they have in case of emergencies or complications. 

●Ask your potential doula or midwife if they accept any insurance plans. 

●What is their fee, and how are the payments scheduled? Do they offer a sliding scale or payment plan? 

A doula or midwife should also ask you questions to see if you are a good fit as their client. Here are some questions they may ask you. 

●Do you want an unmedicated birth or epidural? 

●Would you like to use pain management techniques? 

●Do you want to use pitocin? 

●What are your cord cutting preferences? 

●What if an episiotomy is recommended?

● Will your spouse or other family members be present? Would you like visitors after or do you want alone time with your baby right away? 

Be sure to have an idea of your wants and needs before finding a doula or midwife. However, you do not need to have it all figured out, and an experienced provider can guide you through your options. 

Both doulas and midwives offer unique benefits to your birthing team, and can be used individually or together. The most important things are that you have a safe, healthy birth and that you feel supported and confident. 

Interested in learning more? Check out our blog for all you need to know about designing the perfect nursery, preparing for your baby, and beyond!