They say it takes a village to raise a baby, but sometimes it seems like it takes a village to bring one into this world. From doctors to nurses to midwives to doulas, there are several roles birthing professionals can play—and if you're not quite sure what is the difference between a midwife and a doula or where to draw the line between their respective responsibilities, you're not alone: The roles of doulas and midwives are particularly misunderstood, but there's a world of a difference between these two designations.
Some of the confusion may arise from the fact that some midwives also work as doulas. Take Emily Kurtz, an Ohio-based doula/midwife. "Midwives and doulas are similar in that they are supporting birthing individuals. However, they have very different roles and a very different scope of practice during pregnancy, birth, and postpartum," says Kurtz.
What Midwives Do
"Midwives provide medical care for you during pregnancy, birth, and the immediate postpartum period. They see you monthly for prenatal appointments (more often toward the end) and make sure you and the baby are doing well. They take on the clinical role. They attend your birth and are trained to help in an emergency," explains Kurtz.
A large part of the distinction comes down to training. "Midwives, whether a certified nurse midwife or certified midwife, are trained through rigorous programs and then certified by the American College of Nurse Midwives (ACNM)," says Amy Kayler, midwifery director at Northside Women's Specialists in Atlanta. "They are taught about well-woman care, normal pregnancy and common complications in pregnancy as well as normal labor, birth, and delivery, including fetal assessment and well-being. They are responsible for caring for the woman and her baby during labor and assuring a safe delivery."
The bottom line? Midwives can deliver babies. And contrary to popular belief, they don't just do so in hospital birth settings. "Historically, midwives were known more for attending out-of-hospital births and caring for women who preferred a more 'natural birth,' particularly with little or no pain medication," says Kayler. "In 2017, data collected by ACNM showed that certified nurse-midwives attend approximately nine percent of births in the U.S. The majority of those are in hospitals with epidural anesthesia as a pain management option."
What Doulas Do
"Doulas don't actually deliver babies," says Elizabeth Joy, a birth doula. "We're not medically trained to deliver babies, to know all the different signs."
So what do doulas do? Well, a lot.
"We are trained to help you make decisions throughout our labor, we are trained to guide you so when you go into labor, you're empowered by the choices you make," says Joy. "We provide physical, emotional, and informational support."
That support can involve helping a birthing person advocate for a specific kind of delivery, offering positional suggestions for pain relief, or even supporting a laboring person's partner in the delivery room. Becoming a doula involves a certification process.
What’s the Value of Hiring a Midwife?
Some expectant mothers choose to deliver with a midwife as opposed to an OBGYN. Much of that choice comes down to the experience: Midwives are known for offering a more "natural" approach. According to Joy, many people report feeling more heard and understood by midwives as opposed to OBGYNs.
But that being said, you don't always have to choose one or the other. "In most situations there is a collaborative agreement between a midwife and OBGYN," says Kayler. "The physician is available if something arises that requires care outside of the midwife's scope of practice or needs assistance. In our practice, we often have moms who prefer to see the midwives during her prenatal visits, even though they know they will have a scheduled C-section with a physician."
Mothers with complicated or high-risk pregnancies can involve midwives in their cases even if they're seeing an OBGYN throughout, according to Kayler.
Why Work With a Doula?
"There's a ton of research and statistics that [support the benefits doulas provide]," says Joy. "You're 28 percent less likely to have a Cesarean [if you have a doula]. That's huge. Some insurance companies are recognizing the importance of doulas and are covering them because the medical costs go down when there's one present overall."
Because doulas invest their full attention on one birthing person at a time, their ability to change labor outcomes can't be underestimated—Joy believes doulas could even help reduce our maternal mortality rates.
"One of the biggest reasons to have a doula is to have somebody with you throughout your entire labor and delivery," she says. "I gave birth with a midwife, but she had other patients, nurses have other patients, doctors have other patients. Doulas are your constant."
Which Option is Right for You?
How about both? Midwives and doulas often work in collaboration with one another. Even someone like Kurtz, who is trained and qualified to fill both roles, typically occupies them one at a time.
How Do You Pay for These Services?
"Oftentimes, a delivery by a midwife will be billed under a consulting physician," Kayler explains. "Home birth is usually not covered."
As Joy mentions, some insurance companies are covering doula services, but for many expectant parents, they remain out of reach financially. However, doula fees vary widely. Joy suggests using a resource like Doula Match to find someone who works within your price range—you may be able to find someone who will provide free services while undergoing the training process to become a fully certified doula.