While most people think they have similar functions, doulas, and midwives actually have vastly different training, duties, and certifications.
Every new parent needs a helping hand. Fortunately, there are two types of experts who can help expectant families make the transition from pregnancy to parenthood: doulas and midwives.
Read on to learn about the major differences between the two.
Think of a doula as an expecting mother’s BFF. The word doula is actually Greek for woman’s servant. Your bond develops long before the due date, as you both plan how you’d like the birthing process to go, and learn the answers to the many questions you likely have.
There are two types of doulas: birth and postpartum.
The main job of the birth doula (or labor doula) is to be by your side offering nonmedical techniques during labor, such as breathing, massage, and helping you move into different body positions.
They can also provide emotional support and act as an advocate on your behalf. No matter what type of birth you have, a doula will be there to help you feel safe and empowered. A doula will support you in your decision to use medications or have a “natural” or unmedicated birth.
In the event of an unplanned C-section, a doula can help comfort you and give you extra attention to help alleviate fears and anxieties. A doula can be a helpful part of your birthing team.
According to a 2017 Cochrane Review, many mothers report the need for less medical intervention and increased satisfaction with the birthing process when using a doula.
However, it’s important to note that a doula is not a substitute for a midwife or doctor since doulas do not have any medical training.
After birth, postpartum doulas help new parents as they recover from the birthing process. This can include caring for the infant and providing lactation support.
Doulas can also play an important role in your home life, especially if there are older siblings in the home.
Not all doulas go through a certification process. If a doula seeks certification training, it usually includes didactic training and assisting during live births.
Certification is typically not required but may vary by state. Lawmakers in a few states are working to allow doulas to be reimbursed by Medicaid. This may increase certification and regulation.
A family member or friend, who is not certified, can also use the title of doula, but they might not have the same breadth of knowledge or experience as a trained doula.
Untrained doulas can still provide excellent labor support, but they might not be as familiar with the process of labor and birth. Whether certified or not, doulas do not have any medical training and should not be part of any medical aspects of the birthing process.
A midwife is a trained medical professional. A midwife frequently functions as an independent medical provider for all of a person’s prenatal care, birth, and the early postpartum period.
If a pregnant person desires midwifery care for pregnancy and birth, they generally have a midwife as their only healthcare practitioner and do not need to have a doctor. Different types of midwives can have various levels of training and different scopes of practice.
The two main types of midwives in the United States are Certified Nurse Midwives (CNMs) and Certified Direct-Entry Midwives.
Certified Direct-Entry Midwives can have different titles depending on the state where they live. Nurse Midwives must become registered nurses first and then complete a master’s degree in nurse-midwifery prior to becoming certified.
Direct-entry midwifery programs vary, but usually issue an associate’s degree or bachelor’s degree. Direct-entry midwives do not need to be nurses and have a narrower scope of practice than CNMs.
Generally, if someone chooses a midwife as their healthcare provider for pregnancy and birth, the midwife is the only obstretical provider they need (ie. you can choose a midwife instead of a doctor).
Certified Nurse-Midwives can do many of the same things as doctors, including:
- perform annual wellness exams
- perform gynecological exams
- provide prenatal care
- prescribe medications
- give labor-inducing drugs
- monitor the fetus using electronic equipment
- order pain medications during labor
- order an epidural
- perform an episiotomy
- deliver a baby vaginally
- assist with cesarean sections
- resuscitate a baby
- stitch tears
Direct-entry midwives can provide all of the care during pregnancy, birth, and the first six weeks postpartum, but they usually cannot provide any healthcare beyond the scope of pregnancy. All midwives can manage postpartum hemorrhage and most other complications that might arise during labor and birth.
Midwife care typically focuses on education and empowerment. Midwives usually spend more time with pregnant people during prenatal visits than doctors do and try individualize their care based on their patients’ needs and wishes.
Often, midwives promote unmedicated birth, but they will support people who desire pharmacologic pain relief in labor as well. Midwives are trained to detect complications and use emergency measures when needed.
Certified Nurse Midwives most commonly work in hospitals, but can also work in health clinics, birth centers, and the home. In the U.S., Direct-entry Midwives can provide care only for out-of-hospital births, like in the home or in freestanding birth centers.
Certification and licensure
Like doulas, laws on midwife certification and licensure vary by state. According to the International Confederation of Midwives, a midwife must be registered or licensed by a program recognized in the country they practice in.
All midwives must undergo specific education, training, and supervised clinical experience, and must complete certification requirements. Education and certification requirements differ for CNMs and Direct-entry midwives.
In the United States, Certified Nurse Midwives are certified through the American Midwifery Certification Board, after completing a master’s degree, meeting other specific requirements, and passing a certification exam. The CNM certification is recognized in all 50 states.
CNMs can also be licensed in every state and are usually licensed as an Advance Practice Registered Nurse (APRN), similar to a Nurse Practitioner. The American College of Nurse Midwives has information about what CNMs can do and can also help people find a CNM in their area.
Certification requirements for most Direct-Entry Midwives are set forth by the Midwifery Education Accreditation Council. Direct-Entry midwives who are certified by the North American Registry of Midwives are called Certified Professional Midwives (CPMs). They can be licensed in many states, but not all.
Some midwives are also certified as International Board Certified Lactation Consultants, (IBCLCs) with advanced knowledge on lactation.
The most important consideration when choosing a midwife or a doula is finding someone you like, trust, and feel comfortable around. Look for someone who respects your opinions and viewpoints on pregnancy and the birthing process.
Experience can be another important factor. Doulas and midwives with more years of experience and births under their belts will bring different skills and perspectives than someone who is more recently trained.
Getting a recommendation from a friend or family member who has used a midwife or doula can help you find a capable and experienced person.
Should you find a midwife or doula from an online service, ask for references from other families and do your own research. It’s always okay to ask a midwife or doula, (or a doctor, for that matter) to tell you about their training, experience, and philosophy about pregnancy and birth.
Since midwives and doulas provide completely different services, you can have both! Many people choose a midwife as their healthcare provider and a doula for extra support during labor, birth, or postpartum. The two professions both offer many benefits to expectant parents.
If you’re planning a home birth, you’ll need to choose a midwife as your medical provider, as their medical training and expertise is crucial if problems arise. Many parents also choose to have a doula for home birth.
While home birth midwives can offer some labor support, their primary job is to do continual assessment of the laboring person and the baby, to anticipate problems, and manage any complications that might occur.
If you’re planning to give birth in a hospital, no matter if you have a midwife or a doctor as your medical provider, it’s smart to have a doula with you as well. Hospital staff get busy with multiple patients, but your doula’s only job will be to provide support to you and your partner if you have one.
Having the continuous labor support that a doula provides has been found to lower the rates of interventions, improve health outcomes, and leave birthing parents feeling happier with their experiences.
Think about your priorities for your pregnancy and birth. Do some research to see if a midwife and/or a doula would help you have a positive and fulfilling experience bringing your baby into the world.