Doula vs Midwife: Differences & Should You Choose One?

By Dr. Kenosha Gleaton, OBGYN

Understanding the Role of a Doula

Doulas are professionals who provide non-medical support for the pregnancy, labor, birthing, and postpartum phases. Let’s take a closer look at the role of a doula. 

What Is a Doula?

According to Dona International, the world’s first doula certifying organization, a doula is a trained professional who provides continuous physical, emotional and informational support to their client before, during and shortly after childbirth to help them achieve the healthiest, most satisfying experience possible. [1] 

The word doula originates from a Greek word meaning “servant”. [2] The term was coined in 1976 to describe an experienced woman who assisted a new mom with breastfeeding after giving birth. More people began to seek out doulas in the 1980s as a result of the increasing rate of cesarean sections being performed. [2] Doulas act as a support system for those who are pregnant, approaching labor, or have recently given birth. Their role is to provide labor-support skills, techniques, and strategies, and offer encouragement through the birthing experience. Doulas can also act as a bridge between nursing staff, caregivers, and the patient. Doulas are not medically trained and can not provide medical services. [1-2] 

Doula care has been named one of the most effective tools to improve health outcomes and reduce racial disparities among pregnant and postpartum people. [3] Read more about what a doula is and if you need one from Erica Chidi- doula, author, and co-founder of LOOM. 

Types of Doulas

Many doulas can provide services for pregnancy, labor, birth, and postpartum care, while others may specialize or be certified for a specific phase. [4] For example, birth doulas assist a birthing person and their family before and during childbirth. Birth doulas provide non-medical emotional and physical support, ensuring the patient is as comfortable as possible. [4] Postpartum doulas provide families with information and support on caring for a newborn, including infant feeding, recovery from childbirth, infant soothing, parent coping skills, and can also help with light housework, cooking, and other household tasks. [4] There are even doulas who specialize in loss, fertility, and more. 

Training and Certification

There is currently no standard training regime to become a doula, as doulas are non-medical support people. [3] There is no licensing requirement or exam that must go through a medical board. States can all require their own unique set of credentials for someone to become licensed, especially if they are looking to be covered under Medicaid. [3] This process may include certification programs or workshops through independent organizations, providing evidence of attending X amount of births or community work, recommendation letters, etc. [3] Learn more about pregnancy, providers, and parenting with the parent prep pack! 

Exploring the Role of a Midwife

A midwife is a healthcare provider who is trained to provide a wide range of obstetric and gynecological services. Let’s learn more about the role of a midwife. 

What Is a Midwife?

Midwives are healthcare providers that can aid in pregnancy, childbirth, newborn care, postpartum health, and may even provide more routine reproductive care, including pelvic exams, birth control counseling, and more. [5] Midwives often take a more holistic and supportive approach to pregnancy and birth, and are a popular choice of provider for those who are interested in a non medicated or home birth. [5] 

Midwives are not the same as obstetricians and gynecologists (OBGYNs) but they can work alongside one another in a healthcare setting. Midwives are not trained to complete surgery and are not recommended for anyone with a high-risk pregnancy. [5] Midwives will refer people to OBGYNs if their pregnancy or birthing experience becomes complicated or high-risk. [5] 

Types of Midwives

There are a few different types of educational training that someone can complete in order to become a midwife. Some of the most common types of midwives include certified nurse midwives (CNMs), certified midwives (CMs), certified professional midwives (CPMs), and unlicensed or lay midwives. [5-6] 

Training and Licensure

To become a CNMs, someone will need to complete nursing school as well as go to graduate school for midwifery. CNMs can provide pregnancy care, aid in delivery, and can provide general reproductive care, prescribe medication, order lab tests, and diagnose patients. [5-6] CNMs are certified by the American Midwifery Certification Board and can practice in all 50 states as well as D.C.

Becoming a CM requires a master’s degree in midwifery, but nursing school is not a requirement. [5-6] CMs will need to have completed various science and health courses and related skills training prior to enrolling in a graduate midwifery program. [5-6] CMs and CNMs have the same scope of practice- CMs can also provide a full range of primary health care services, prescribe medications, diagnose patients, and more. CMs are only licensed to practice in a few states and are certified by the American Midwifery Certification Board. 

CPMs do not require an academic degree, but certification is based on demonstrated competency in specified areas, including microbiology, anatomy, physiology, childbirth education, doula certification, postpartum, and more. [6] The North American Registry of Midwives (NARM) evaluates and certifies CPM candidates. NARM does require at least two years of education under a certified midwife. [6] CPMs are not licensed to practice in all states and cannot prescribe medications, but can conduct physical exams, administer medications, and order and interpret lab tests. [5-6] 

While a midwife can provide excellent, holistic care, they may not be the right provider for everybody. Midwives are reserved for those who have a low-risk, routine pregnancy. [5] If someone is considered high-risk, has an underlying condition, or if a complication arises, an OBGYN would step in. Midwives typically are not trained to perform surgeries. [5] 

Learn the most common fears and concerns around giving birth. 

Comparing Doulas and Midwives

Doulas and midwives can both provide support during the pregnancy, labor, and postpartum process, but which one is right for you? When making a decision about your care providers, it’s important to be well-informed on their scope of practice, common work settings, expertise, and more. 

Scope of Practice

One key difference between doulas and midwives is their scope of practice. Generally speaking, doulas are non-medical support people who can provide techniques, support, and physical, and emotional comfort. [1] Some doulas may have a background in nursing or a medical field, but this is not a requirement to become a certified doula. Doulas can help you feel more comfortable, relaxed, and empowered as you tackle pregnancy, childbirth, and postpartum care. 

On the other hand, midwives are trained medical professionals who may be able to conduct exams, deliver babies vaginally, prescribe medications, monitor a fetus, and more. [5] The specific scope of practice for a midwife will depend on what type of licensing they have, but CMs and CNMs can both provide a wide range of services. 

Work Settings

Work settings can also vary between doulas and midwives. Doulas can work in or partner with many different healthcare settings, including hospitals, birth centers, clinics, and more. Doulas may also provide independent services. Depending on their certification, midwives can also work in hospitals, clinics, private practice, oversee home births, and more. 

Impact on Pregnancy and Childbirth

Both doulas and midwives can contribute to a pleasant pregnancy and birth experience. A doula's work will focus more on fulfilling your emotional and physical comfort needs, coaching on labor techniques, helping with postpartum recovery and infant care, etc. A doula can be the person who fetches you ice chips while also advocating for your wants and needs during childbirth. 

A midwife can provide holistic care during pregnancy and childbirth, encompassing more of your medical needs. This includes monitoring your baby, delivering your baby vaginally, prescribing medications, and more. 

Want to learn more about different healthcare providers? Read my guide on who you’ll meet during your fertility and pregnancy journey. 

Making the Right Choice for Your Pregnancy

Deciding who your care team is going to be can be a difficult decision. It can be helpful to take some time to weigh your options. It’s also important to meet with and speak directly to different providers to find someone that you feel comfortable with and cared for. 

Factors to Consider

What do you envision for your birth? Is your pregnancy considered high-risk or routine? Have you given birth before, what did you like and dislike about your experience? These are all questions to consider when putting together a care team and birth plan for yourself. 

Benefits of Having Both

Depending on your access to healthcare, you may not have to choose between a doula, midwife, or an OBGYN. Some birth centers or hospitals will have many different professionals on staff, including OBGYNs who can step in if there is a complication or if surgery is needed. [5] You can also independently hire a doula to join you wherever you decide to give birth, whether you decide to go with an OBGYN or a midwife. Doulas can be very helpful for prioritizing your comfort level and your desires for your birth experience, even in clinical settings. [1] They can act as a bridge between you and your providers to take some of the stress off of your birthing experience. Meanwhile, midwives have the medical training needed to deliver a baby vaginally, deliver medications, monitor the fetus, and more. [5] 

Questions to Ask When Choosing

You should meet with any providers or doulas you are considering using for your pregnancy and birth experience. Ask about their official certifications, previous experiences, and expertise to get a better idea of what services they can provide. You want to put together a team of people that will make you feel comfortable while assuring you you’re in good hands. 

Natalist's Commitment to Your Reproductive Health Journey

When planning for your pregnancy, birth, and postpartum care, the two most important things are prioritizing healthy outcomes and making sure you feel supported every step of the way. One way you can encourage healthy outcomes is by taking a comprehensive women's prenatal vitamin. Natalist is committed to supporting your journey with a wide range of products. Shop products for pregnancy and postpartum, our ovulation test kit, early pregnancy test strips, and more. 

References:

1. What is a doula? DONA International. Accessed December 2023. https://www.dona.org/what-is-a-doula-2/
2. Papagni K, Buckner E. Doula Support and Attitudes of Intrapartum Nurses: A Qualitative Study from the Patient's Perspective. J Perinat Educ. 2006;15(1):11-18. doi:10.1624/105812406X92949
3. Chen, Amy. Rohde, kate. Doula Medicaid Training and Certification Requirements: Summary of Current State Approaches and Recommendations for Improvement. National Health law Program. March 2023. https://healthlaw.org/doula-medicaid-training-and-certification-requirements-summary-of-current-state-approaches-and-recommendations-for-improvement/
4. BIRTH AND POSTPARTUM DOULAS. Postpartum Support International. Accessed December 2023. https://www.postpartum.net/learn-more/doulas/
5. Midwife. Cleveland Clinic. April 2022. https://my.clevelandclinic.org/health/articles/22648-midwife
6. Comparison of Certified Nurse-Midwives, Certified Midwives, Certified Professional Midwives. Clarifying the Distinctions Among Professional Midwifery Credentials in the U.S. American College of Nurse-Midwives. 

Dr. Kenosha Gleaton is board-certified in gynecology and obstetrics and is the Medical Advisor of Natalist. She received her MD from MUSC and completed her residency at Carolinas Medical Center in Charlotte, NC.

Dr. Gleaton is passionate about women, health equity, and mentoring. She is the CEO of The EpiCentre, an OBGYN spa-like practice, and is a Clinical faculty member of Charleston Southern University.  She is also a member of the American College of Obstetrics & Gynecology, the American Association of Gynecologic Laparoscopists, and the American Association of Professional Women.