When you’re pregnant and searching for providers to put together your ideal birth team, it’s easy to feel overwhelmed and confused by all the choices available to you.
In many areas of the world, you have the option of choosing between receiving care with an obstetrician, midwife, and doula. You also have the option of choosing to birth in a hospital, birth center, or at home.
It can be difficult to navigate these options and fully understand what exactly it is that each one does, and what benefits there are to working with each.
In this article, we’re exploring the difference between two types of birth professionals that are commonly confused for being the same thing: midwives and doulas. Most people think they’re the same thing – while in reality, they’re not.
As a professional birth doula myself, I’ve been asked many times if I catch babies (spoiler alert: I don’t!), if I can attend hospital births or home births (I attend both), and if I need a license to do what I do.
Midwives and doulas are two different (but complementary) types of professionals, and you may be surprised to learn that you probably want both to attend your birth, no matter where you choose to have it.
What is a Doula?
A doula is a non-medical, emotional and physical support person. A doula guides women through pregnancy, labor, and the postpartum period with knowledge, advice, and physical comfort support.
A doula may help a woman create a birth plan, educate her on what to expect during labor, and coach a woman and her partner through learning various labor coping and support techniques.
Doulas are known for their ‘bag of tricks’, containing everything from lip balm and bendy straws to handheld massagers, rebozos, and essential oils.
A doula is a practical asset to any labor in any location. She can do hip-squeezes (check that out in the video right below this paragraph) and remind the birthing woman of her goals for an unmedicated birth (if that should be the case), or make the experience of having an epidural or other medical intervention more pleasant.
Doulas are often confused with midwives because they attend births – but they are not taking any measurements, catching babies, or providing any medical care.
Everything they do is learned through self-education, such as reading books or attending trainings. There is no licensure for doulas, and anyone can call themselves a doula with any level of education or training, but most doulas are certified.
There are many certifying bodies involved. Most offer a 2 to 4-day training, where those who wish to certify as doulas meet and are educated in how to best support women in childbirth. These trainings, along with reading, essays, tests, and usually a few “certification births” are required for certification.
The vast majority of doulas are well-informed, highly-responsible individuals. Their presence at a woman’s birth can reduce stress, increase her ability to make decisions, and ensure her voice is heard.
The presence of a doula, along with everything else she has to offer, has been shown in studies to reduce the rate of induction, epidural use, the perception of pain, the need for cesarean section, and more.
In short, doulas are highly beneficial to a woman and her partner in labor.
Regardless of where or how your doula is trained, you can expect that she will – and she should – provide the following:
- Emotional and education support during pregnancy, usually in two prenatal visits and over the phone or email
- Attendance at your birth to provide non-medical support
- Follow-up postpartum to provide community resources as needed
Your doula may also specialize in massage, birth photography, postpartum belly binding, energy healing, herbs and essential oils – among other things.
Doulas often cost in the range of $400 – $2000, depending on your area and the availability and experience of the doula in question. Insurance rarely covers the cost of a birth doula attending your birth, but most families find that the benefits make the financial investment worthwhile.
What is a Midwife?
There are several different types of midwives, so it’s important to make those types clear before we begin learning everything a midwife does. For the sake of this article, there are three main types of midwives:
- Certified Nurse Midwives (CNM)
- Certified Professional Midwives, also called Licensed Direct Entry Midwives (CPM or LDEM)
- Direct Entry Midwives, also called Lay or Traditional Midwives (DEM)
Each of these midwives gains their education about childbearing and practices a little differently, but it should be noted that they are each experienced in their own right, and there this is not one type that is ‘better’ or more specialized above the rest.
Certified Nurse Midwives (CNM)
A CNM has gone through nursing school. She has completed a degree, gained licensure as a nurse and completed several years worth of courses and training as a student midwife.
Most often a CNM is the type of midwife you’ll find working in a hospital, often in a rotation or group with other CNMs, and typically under the observation of an obstetrician.
She can provide gynecological well-woman care, prenatal care, oversee labor and delivery, and postpartum follow-up in healthy, low-risk women.
Women under the care of a CNM may find that certain restrictions in licensure make it impossible for their midwife of choice to be present at the delivery of their baby, such as going “too far” overdue, having a premature birth, having a cesarean section, etc.
The situations that risk a woman out of the care of a CNM vary from practice to practice, and it may be different depending on your country as well.
Certified Professional Midwives (CPM)
A CPM might, at first glance, be easily confused with a CNM, but there is a difference between the two. According to NARM, the North American Registry of Midwives:
“A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings.”
Consider these wise women the experts in unmedicated birth. If you want your best chance at a natural (i.e., vaginal) birth, choose a care provider with the most experience, and the most to gain if you succeed (as opposed to an obstetrician, who – depending on the country you birth in – may get paid more if you have a cesarean section).
These women are regulated by state licensure, but not overseen by obstetricians, so there’s more freedom for the type of care they can give you. It’s more personal, more holistically-focused, and often more comfortable for women.
CPMs provide care to women giving birth at home and in birth centers completely unaffiliated with hospitals. They can carry medical equipment, such as oxygen, Pitocin (in case of hemorrhage), etc.
They are every bit as equipped as a CNM in a hospital unless an epidural or surgery is called for, in which case they are trained to recognize such situations and will transfer to emergent care as needed.
Unfortunately, CPMs aren’t legal in every state or country. Some areas are still fighting to make these licensed home birth attendants an option for women.
For a complete list, see the Midwives Alliance of North America website.
Direct Entry Midwives, or Lay Midwives (DEM)
Similar to CPMs, traditional midwives do not attend hospital births and do not have an obstetrician overseeing their practice. In fact, traditional midwives are the only type of midwife not regulated by the state or any public or private governing body.
These midwives have typically gained their knowledge and skill through personal study and extensive apprenticeship. Sometimes they have gone to school, but more often experience has taught them what they know about birth.
The difference between Direct Entry Midwives and Certified Professional Midwives is that DEMs aren’t legally allowed to carry most medical equipment, like oxygen or Pitocin.
They tend to rely on herbs and traditionally-based knowledge to resolve most simple problems that come up in birth and will transfer a woman to hospital care if they are unable to resolve the problem.
Like CPMs, traditional midwives are not legal everywhere, although that doesn’t stop all of them from practicing regardless of the laws.
These midwives choose to serve women above a system that is slow to change and even slower to support giving women another option in pregnancy and birth.
Which Of The Three Types Of Midwives Should I Choose?
Choosing a midwife is made simpler by choosing where you will give birth and taking the laws in your country or state into consideration.
You can interview several to help make your choice, and they may help you decide if you would like a hospital or out-of-hospital birth.
In the end, no matter what you choose, all midwives will provide the following:
- Prenatal care, from the time you find out you’re pregnant until you go into labor
- Attendance at your birth and delivery of your baby (unless there’s an emergency, at which point you’ll be transferred to obstetrical care in a hospital setting)
- Access to blood tests, labs, doppler, and ultrasounds as desired
- Postpartum follow-up appointments
The level of medicalization in a midwife’s care depends on her method of practice and whether or not there are governing policies in place that require her to do things a certain way.
However, in most cases, midwives are considered more natural in their approach to caring for a pregnant and birthing woman. So, if unmedicated birth is your intention, a midwife will probably serve you best.
Midwives typically cost anywhere from $1,500 – $7,000. This depends on your area, the demand for midwives and whether or not they serve you from a birth center.
Most of the time, in-hospital midwives such as CNMs may be covered by insurance, whereas home and birth center midwives are only partially-covered or not covered at all.
Still, many families find that the cost of midwifery care is equal to or below their out-of-pocket deductible for hospital care, and decide to make the investment in receiving more personal, holistic care.
Doulas VS Midwives: Which One Should I Choose?
Honestly, you will find the most benefit in hiring both!
Doulas and midwives bring different experiences, knowledge, and types of support to the table during your pregnancy and birth.
A midwife, and any assistants (should she have them), will be mainly focused on the medical aspects of your pregnancy, ensuring you and your baby are healthy. A doula will be mainly focused on the comfort and support of you and your spouse (and possibly any children you have at your birth).
It’s valuable to have both at your birth.
A doula will typically come to you sooner in labor, to help you cope and provide emotional support, while a midwife will want to wait until closer to your baby being born so she is fresh and able to make the best medical decisions she possibly can.
A midwife will help you catch your baby, something a doula is not trained to do.
Most people do not hire a doula without hiring a midwife (or obstetrician) unless they are planning an unassisted or free birth (a birth without a medical care provider in attendance). This tiny minority prefers the comfort provided by a doula without having someone there to check fetal heart tones with a doppler, “deliver” the baby, or provide any medical assistance.
It is most likely the case, then, that for your birth you will want both.
When Would I Possibly Not Need Both?
Is there any reason you wouldn’t want both a midwife and a doula?
Perhaps if you are an especially private individual, you may want to limit the number of people in the room. Or if you have a friend or family member who has vast knowledge about pregnancy and birth, you may want to invite them instead.
Just realize that with the amount of education and training, combined with the personal relationship you can form during pregnancy, a doula may be of more benefit to you when it comes time to birth than it would be to have your mother, sister, friend, or mother-in-law present.
It all depends on the relationship dynamics and what your intentions and goals for birth are.
Wrapping it Up
There are many things about doulas and midwives that you will find the same.
They are both passionate about pregnancy, childbirth, and postpartum. They are both extremely knowledgeable on all of these topics, and those relating. They love serving women throughout these times.
Passionate doulas and midwives will always be learning, gaining new skills, and staying on top of the research in regards to best practices for pregnancy and birth so they can best serve you and your family during this time.
Midwives and doulas typically work well together, and most importantly of all: they support your decisions during your birthing time!