When you're pregnant and making decisions about the type of care you want, you start to hear words like doula and midwife pretty frequently. Doulas and midwives can be an important part of your pregnancy, both providing essential support and care, but they also serve completely different purposes.
Although some new parents may get confused about what a doula or midwife actually does, the terms can't be used interchangeably. There are many differences between midwives and doulas, but the main distinction is that midwives have medical training while doulas do not.
If you're deciding who you want on your birth team or are considering hiring a doula to support you during labor, we'll break down the difference between these two roles.
What Is a Doula?
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Even if you don't know much about doulas, the role of a doula is certainly not a new one. While professional doulas, or doulas who are paid for their work, are a modern phenomenon, women have been supporting other women during birth throughout all of history.
If you hire a doula for your birth, their role is to provide physical and emotional support during pregnancy, labor, and postpartum. Unlike a midwife, a doula is a non-medical professional — and while your doula may advocate for you during labor or provide you with education and information about the choices you make during pregnancy and labor, ultimately, it's best to consult with your midwife or obstetrician (OB) if you have medical questions.
Whether you give birth in the hospital or outside of it, doulas can provide an extra level of support to moms during pregnancy and birth. The benefits of hiring a doula are well-documented — and the support of a doula can lead to positive outcomes during birth, reduced risk of a c-section, and even a greater chance of success in breastfeeding.
What Is a Midwife?
Although there has been an increase in midwife-attended births in recent years, most women in the United States choose an OB as their provider to support them during pregnancy and childbirth. In 2021, approximately 12% of births in the U.S. were attended by a midwife.
A midwife is a healthcare professional who supports women during pregnancy, birth, and postpartum. While midwives are not doctors, they do have medical training, and certified midwives can typically attend births both in and out of the hospital.
What a midwife is qualified to do depends on the type of midwife. There are four major types:
- Certified Nurse Midwife (CNM): Certified nurse midwives have a degree in nursing as well as a degree in nurse midwifery. All 50 states license CNMs, and they can work in hospitals, birth centers, or home centers.
- Certified Midwife (CM): Certified midwives don't have a degree in nursing, but do hold a bachelor's degree in another field and a graduate-level degree in midwifery. These types of midwives can be certified by the American Midwifery Certification Board, much like CNMs.
- Certified Professional Midwife (CPM): Certified professional midwives aren't required to have a degree but are certified through the North American Registry of Midwives.
- Lay Midwife: A lay midwife is a midwife who might have hands-on training obtained through an apprenticeship program, but doesn't necessarily have a degree, formal certification, or license. This type of midwife is restricted in many states.
When it comes to midwifery practices, each state in the U.S. has different laws regarding how these professionals can be certified and which types of midwives are legally able to practice. For example, states like Alabama have recently increased restrictions, requiring freestanding birth centers to be licensed and regulated as hospitals, which limits where midwives can practice.
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Doula vs. Midwife: What's the Difference?
Both doulas and midwives support women during pregnancy, but they provide different kinds of support. While certified midwives have medical training and provide care for women during pregnancy, birth, and postpartum, they can also provide general health check-ups, prescribe certain medications and birth control, and perform health screenings.
What Does a Midwife Do?
If you choose a midwife as your pregnancy provider, your midwife will:
- Provide prenatal care
- Monitor the growth and health of your baby
- Order necessary lab work, screenings, or medication
- Monitor progress once you go into labor
- Assess any risks during pregnancy, labor, or postpartum
- Provide newborn care once the baby is born
- Support you in feeding your baby
What Does a Doula Do?
Doulas, on the other hand, may assist mothers with childbirth education, breastfeeding, or newborn care, but they don't have medical training and don't provide medical care. Instead, a doula might do the following:
- Help you create a birth plan
- Provide guidance on overcoming fear during pregnancy
- Assist with breathing techniques during labor
- Apply counter-pressure during labor
- Advocate for moms to help them understand options
- Help with newborn care
There are also different types of doulas. Postpartum doulas, for instance, specifically support new mothers after their baby is born. The help they provide might look like giving the baby a bottle in the middle of the night or making meals for the family.
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Cost of Hiring a Midwife vs. a Doula
From purchasing baby supplies to paying for the birth itself, there are a lot of costs that come with having a baby. If you're considering who you want on your birth team, you might wonder about the cost of hiring a midwife vs. a doula.
Cost of Hiring a Midwife
First, it's important to note that since they have very different roles, a doula can't replace a midwife on your birth team (and vice versa). However, if you are having to pay out-of-pocket for any expenses related to your pregnancy or birth, it's essential to consider the cost involved.
Depending on the type of midwife and birth setting you choose, your midwife's services may be covered by insurance. It's common for insurance to cover these services if you're giving birth in a hospital. Additionally, some birth centers accept insurance as well. If you plan on hiring a home birth midwife, it's more likely that you'll pay out-of-pocket.
If you are paying out-of-pocket for a midwife, the average cost ranges from $3,000 to $9,000 for prenatal, birth, and postpartum care.
Cost of Hiring a Doula
Although it's a worthy investment, the cost of a doula is also something to consider when you're planning to have a baby. In most cases, private insurance won't cover the cost of a doula. However, Medicaid does cover these services in many states.
If you're not able to use private insurance to cover doula services, you may be able to use a Health Savings Account (HSA) or a Flexible Spending Account (FSA). There are also some organizations that provide free doula services or use a sliding scale to make it more accessible for women.
For those paying out-of-pocket, the cost of a doula can vary, but the average birth doula charges between $800 and $3,000.
Do I Need a Doula to Have a Positive Birth Experience?
Doulas have always been around to support moms during labor, even if the doula was simply a relative, neighbor, or friend of the mother. As many moms face the reality of having children without the help of family or a village, there is growing interest in doula support, with increased policy and research focus on their role in maternal care.
It's certainly possible to have a positive birth experience without the help of a doula, but having a doula there also increases your chances of avoiding certain interventions. No matter how you plan on giving birth, what's most important is how safe and supported you feel during labor and immediate postpartum. When you choose a doula who aligns with your values and personality, it can significantly impact your birth experience in the best way, even if things don't go as planned.
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