As you begin to navigate building your healthcare team during pregnancy, you’ll likely have the question of what is the difference between a doula and a midwife. I've been there! The debate of doula vs. midwife can seem incredibly confusing. Do they do the same thing? What are the pros and cons of each?
At its absolute simplest, think of a doula as your advocate and coach throughout pregnancy and childbirth; midwives are your medical support, ensuring the safe arrival of your little one.
When I was expecting my first child, Caden, I opted for a midwife practice over an OB office. I desired a birth experience with minimal medical interventions and prenatal care that prioritized holistic wellness through natural solutions. Fortunately, I found a hospital with its own midwife practice, the UCSF midwife program, which also offered childbirth education and parenting classes taught by registered nurses, childbirth educators, and obstetric anesthesiologists. (I also intended to hire a doula, but that plan was shelved due to the onset of COVID in my third trimester.)
Doula vs Midwife
What’s the Difference Between a Doula and a Midwife?
When it comes to pregnancy and childbirth support, it's easy to confuse the roles of a doula and a midwife. After all, both play instrumental roles in the birthing journey. But they are indeed different, each bringing something unique to the table.
Midwife
A midwife is a skilled healthcare practitioner with extensive training in delivering babies and providing comprehensive prenatal and postnatal medical care. They handle all things medical and can catch potential complications. Midwives often aim to provide holistic care, looking at a woman's overall health and well-being, not just her pregnancy. And while they're pros at assisting low-risk, unmedicated births, they're also trained to know when medical intervention might be necessary. Midwives can lead the birth process for home births, but can also be found in hospital-settings. Midwives have a defined scope of practice, which includes overseeing birth and care for newborns. Midwifery care is suitable for low risk pregnancies or minor complications.
Like I mentioned, I did use a midwife with my first birth. If you are considering this option, consider how the practice is set up. The downside of the UCSF midwifery program was the rotation system in Labor and Delivery. This meant that the midwife who cared for you during pregnancy might not be the one delivering your baby. Unfortunately, the midwife on duty during my labor was not to my liking, which made my birthing experience less than ideal and to this day I question if I had had a different provider that I felt more comfortable with if my 4 hours of pushing would have still ended with an emergency c-section.
Because of my first birth experience, I decided to choose an OB-GYN since I likely would have another c-section and I chose a different hospital that I had heard nothing but positive feedback on from other mamas (CPMC) for my second child, Willow.
Doula
On the other hand, a doula serves as a birth coach, offering a range of invaluable support, including positional suggestions for pain relief. They provide emotional, physical, and informational assistance before, during, and after childbirth. Although they won't handle the actual delivery, doulas offer a steady presence, comforting words, back massages, clear explanations, and reassurance to navigate any medical situations.
We were days away from signing the contract with our doula for my first birth when we went into lockdown for COVID and unfortunately were not able to have her at my birth. To this day, I wonder if my labor would have ended in a successful vaginal birth instead of an emergency c-section if she would have been there.
Doula's Role in Pregnancy
Different Types of Doulas and Their Roles
Did you know there are different types of doulas? Birth doulas, postpartum doulas, and even antepartum doulas all play unique roles in a woman's pregnancy journey. Birth doulas are there for the labor and delivery room process, providing emotional support and comfort measures. Antepartum doulas assist mothers on bed rest or those experiencing high-risk pregnancies. After baby arrives, it's a postpartum doula's job to ease the transition of bringing a newborn home – offering assistance with infant care during the initial postpartum period, breastfeeding and lactation support. Additionally, fertility doulas can help you navigate the process of becoming pregnant. There is a doula for every part of the pregnancy journey!
Benefits of a Doula During Pregnancy and Delivery
The benefits of doula care are plentiful. From reducing the likelihood of needing a cesarean to lessening anxiety, the presence of a doula can provide much-needed support. Research shows that support from a doula improves birth outcomes, including lower risk for C-sections, improved health ratings for newborns, and may even lower the need for epidurals. Women who have a doula are also less likely to need pain medication and are more likely to report a positive childbirth experience. Plus, who doesn't want a dedicated support person to help navigate the complexities of labor and delivery?
Midwife's Role in Pregnancy
Different Types of Midwives and Their Roles
In the world of midwifery, there are a few different categories. A Certified Nurse Midwife (CNMs) is a registered nurse with advanced training in midwifery and can practice in all 50 states. Direct-Entry Midwives (DEMs) are trained through self-study, apprenticeship, or a college- or university-based program distinct from the discipline of nursing. Finally, Certified Professional Midwives (CPMs) are certified by the North American Registry of Midwives (NARM) and follow the Midwives Model of Care. They are the experts at home and birth center births, as they have extensive medical training and certification.
Each type provides a different level of care and can offer different services, so it's essential to find the one that fits your needs for your pregnancy and birth.
Benefits of a Midwife During Pregnancy and Delivery
Midwives tend to foster a more personal relationship with their patients, often spending more time at prenatal visits than traditional OBs. They are experts in normal birth and can provide a more natural, less medicalized approach, which is appealing to many women. Plus, studies have shown that midwife-led care, just like care provided by obstetricians, is associated with a lower chance of premature birth, and it's equally safe. I personally loved that my midwife prenatal appointments took place in a group setting with 10 other expecting moms. Care didn’t feel so medical, instead it felt personal and communal. The midwife led a labor and delivery program during each prenatal visit, teaching us about the birthing process and the choices we had to make.
Deciding Whether a Doula or a Midwife is Right for You
While there's no one-size-fits-all answer to this question, considering certain factors can help you make a well-informed decision that feels right for you and your family.
What Factors Should You Consider When Choosing Between a Doula and a Midwife?
- Medical Interventions – If having a natural birth with minimal interventions is your priority, a midwife and doula team might be the best fit.
- Emotional support – Remember, childbirth can be emotionally daunting, and that's where a doula steps in. A doula can provide continuous emotional and psychological support, helping you navigate the twists and turns of labor and birth.
- Budget – The cost for both doulas and midwives can vary widely, so it’s worth researching what's included in their services and how it fits into your budget and insurance coverage. While midwives might be covered partly or entirely by insurance, doulas usually aren't, which potentially makes them an additional pocket expense.
- Birthing Environment – A hospital, a birth center, or a home birth? Midwives usually are the main healthcare provider for home births and birth centers, and are becoming more popular in hospital settings. Doulas offer support in any location you choose.
Can I Have Both a Doula and a Midwife?
Absolutely! In fact, they make a great team. Having a doula and a midwife means you get the best of both worlds. A medical professional to guide the safe delivery of your baby, and a comforting presence to support you emotionally. With my first pregnancy, the thought of hospitals and doctors made me anxious, so choosing a midwife and doula provided me more comfort during my pregnancy and birth. Collaborating with physicians, nurses, and other hospital staff, doulas can be most effective in providing care and support for the birthing person.
So it really does come down to what you value most in your birthing experience and what you desire for your individual birth plan. Whether you choose a doula, a midwife, or both, remember it’s your journey and you get to decide what feels right for you.
Additional Resources
- American College of Nurse-Midwives: a comprehensive look at what midwives do, how they're trained, and where they practice.
- DONA International: DONA International is a leading organization for doulas. Full of information about the roles and benefits of doulas, and guidance on how to find a doula.
- The Birth Partner by Penny Simkin: This book provides a comprehensive guide to childbirth for dads and doulas.
- Midwives Alliance of North America: MANA's website offers a wealth of resources for learning about midwifery, including a directory of midwives in North America.
Remember, it's always a good idea to do your own research and consult with healthcare professionals when making decisions about your birthing experience.
Feature image Photo by Jordan Whitt on Unsplash
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