“Doula vs. midwife” is a phrase you may see when you’re Googling in the early stages of your pregnancy.
And in this environment where racism can make birthing while Black a matter of life or death, getting the right team is even more important. (Black women are three times more likely to die from pregnancy and childbirth-related complications than white women, according to the CDC.)
As the founder of Wolomi, an online pregnancy and motherhood companion app for women of color, I’ve had the pleasure to work with doulas and midwives. “Should I hire a doula or a midwife?” is a question I hear a lot from pregnant women.
But it’s not a competition, and it’s not an either/or situation. Doulas and midwives are there to support you during your pregnancy—just in different ways. Midwives provide medical support, while doulas are purely there for emotional and physical support.
Let’s talk more about the differences between a doula and a midwife.
- What do doulas do?
- What are the benefits of working with a doula?
- How much does a doula cost?
- How can I work with a doula?
- What are midwives?
- What are the benefits of working with a midwife?
- How much does a midwife cost?
- How can I work with a midwife?
- So It’s Not Really Doula vs. Midwife…
What do doulas do?
In 2016, the World Health Organization (WHO) recommended that every birthing woman have a doula during labor and delivery. So who are doulas? According to DONA International, a doula is “a trained professional who provides continuous physical, emotional, and informational support to a mother before, during, and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible.” Doulas are not medically trained, and can not provide you medical support.
The word “doula” is an ancient Greek word that originally meant “a woman who serves.” Some say its modern use came from medical anthropologist Dana Raphael. (She used the term to describe an experienced woman who assisted the mother with breastfeeding her baby.)
If you want to work with a doula, it’s best to hire them at the beginning of your second trimester.
There are four different types of doulas: birth, postpartum, bereavement, and full spectrum. Each has a specific area of expertise.
Birth doulas provide you and your partner with emotional and physical support during your pregnancy and childbirth. When you hear the word “doula,” this is the type of doula people are most often referring to.
A postpartum doula is a specialist in postpartum care. They are trained to provide assistance and support for the first six weeks after birth. They’re incredibly helpful for birthing people who’ve had a C-section, are breastfeeding, or want a comforting and reassuring presence.
A bereavement doula supports families going through grief or loss during and after childbirth. They help the parents and the entire family grieve a pregnancy loss and give comfort and guidance as they cope with the loss of a child.
As the name suggests, full-spectrum doulas specialize in and cover a wide range of reproductive needs. They are community-based birth workers who support birthing people and their families through preconception, pregnancy, miscarriages, births and adoptions, abortions, and postpartum.
What are the benefits of working with a doula?
Working with a doula has a lot of benefits.
According to The Journal of Perinatal Education, having a doula-assisted birth meant people were “four times less likely to have a low birth weight baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding.”
Here are some other ways having a doula is great for your pregnancy:
Doulas provide emotional support during the birthing process. They help moms-to-be relax so labor can progress as it should. Whether it is an unmedicated birth or a medically complex situation, a trained doula’s presence can be beneficial for everyone involved.
Labor is exhausting and painful, which is why it’s so beneficial to have a doula. They can show you positions to increase comfort, speed the labor’s progress (working with a doula cut labor down by 41 minutes, according to Evidence-Based Birth), and provide much-needed relief.
A doula can help with positioning to help guide baby into birth canal if the baby isn’t in the correct position.
Partner and Family Support
Doulas provide education to birthing people and their loved ones.
A doula can help your support person advocate for your best care. By telling them which questions to ask and providing them with resources, they can help your loved one make informed decisions on your behalf if necessary.
How much does a doula cost?
Doulas can range from $500 to $1,500, but a good one is worth it! (Some states are starting to mandate that insurance companies cover doula care.)
How can I work with a doula?
When choosing a doula, there are certain qualities you can look for to help ensure you make the best choice.
Every doula is different, so asking questions during your interview is essential to getting to know their personality and finding which one you connect most deeply to. Keep these in mind as well:
- Interactions: Do you feel comfortable? Do your personalities complement each other? Do you feel a personal connection? These are all questions to ask yourself about your potential doula. If the answer is no, continue your search until you can say yes to all three!
- Experience: Finding a doula with extensive experience can give you peace of mind and confidence that she knows how to assist and support you and your partner.
- Certifications: Depending on the state, your doula may or may not be required to have specific certifications. However, it’s best to choose one who does, even if it isn’t required. Top certifications include doula, birth doula, and postpartum doula certification.
In addition to the mainstream training and certification groups like DONA, there are Black and brown-focused organizations that train and certify culturally-competent doulas. This list includes Ancient Song Doula Services and Mama Glow in New York City, Mamatoto Village in the DMV-area, and Shafia Monroe Consulting in Portland, Oregon.
- References: References are one of the best ways to find out about a doula, so don’t hesitate to ask for them. The more you hear from past clients, the greater your understanding of how the doula operates. Ask your friends who had doulas for their pregnancy for their recommendations, too.
Simply put, doulas are like best friends who have training and know all the basics you need during your pregnancy and right after. They can help guide you through the process, making it more enjoyable and relaxing so that you can focus on welcoming your baby into the world with the best start possible!
But remember: a doula isn’t a medical professional. They can’t deliver your baby, give you medical advice, give you a diagnosis, prescribe you meds, or do anything for you medically if things start to go wrong during your labor and delivery.
So let’s talk about someone who can offer that type of care. (This difference is probably where the doula vs. midwife searches come from.)
What are midwives?
In the United States, there are generally two medical professionals who can provide birthing people care and deliver babies: midwives and OB-GYNs. (Family practice physicians can and do manage pregnancy and attend births in some parts of the country.)
These are the people you need to see for your appointments, to manage the course of your pregnancy, to deliver your baby, and to monitor you for signs of complications. Given the doula vs. midwife question, though, we’re going to focus on midwives.
When it comes to receiving quality medical care, midwives are like a best-kept secret. This is why accessibility of midwifery philosophy is one of our core values at Wolomi. These professionals are healthcare providers who care for and support birthing people, and are just like doctors. According to the International Confederation of Midwives, midwives must “have successfully completed a midwifery education programme” in order to be qualified and/or licensed to practice midwifery.
All midwives provide care during pregnancy, birth, and postpartum. Depending on their education, they may provide well-woman health care as well, from when you have your first period through menopause and beyond.
There are four types of midwives: a certified nurse-midwife, certified midwife, certified professional midwife, and traditional midwife. While their scope of practice will vary depending on their education and training, all believe in the midwifery model of care. This model centers the birthing person and respects what is called physiologic birth. That means a labor and birth that is powered by the baby and its birthing parent and has little to know interventions.
Certified Nurse-Midwives “are educated in graduate-level midwifery programs accredited by the Accreditation Commission for Midwifery Education” and must pass a national board exam to get this title, according to the American College of Nurse-Midwives.
They are licensed to practice in every state, which is important to note because different states have different licensing requirements for other types of midwives. While most CNMs practice in hospitals, many also attend births at homes and in birthing centers.
Like CNMs, a certified midwife is someone with a graduate degree in midwifery who has passed a national board exam. But unlike their peers, they don’t have a nursing degree. (They do have to meet specific science and health requirements to be certified though.)
As of today, only nine states and the District of Columbia recognize certified midwives. Those states are Delaware, Hawaii, Maine, Maryland, New Jersey, New York, Oklahoma, Rhode Island, and Virginia.
Certified Professional Midwife
Certified Professional Midwives are, according to the National Association of Certified Professional Midwives, folks “trained and credentialed to offer expert care, education, counseling, and support to birthing people during the pregnancy, birth, and the postpartum periods.”
There are several educational pathways to becoming a CPM, including apprenticeship and accredited programs, and they have to pass a national exam to become credentialed. (Note: CPMs don’t need to have a bachelor’s or master’s degree like CNMs and CMs do, and they can’t prescribe you meds.)
You’ll find CPMs, who are recognized in 35 states and D.C., practicing mostly in homes, birth centers, and offices.
Traditional midwives choose not to receive certifications or licenses due to religious, philosophical, or personal reasons. And because of this, these midwives do not meet the standards set forth by the International Confederation of Midwives.
Instead, they believe their accountability is to their community and that midwifery is a contract between the patient and themselves.
So you can see why the doula vs. midwife question isn’t exactly correct. These providers offer completely different services and have a different educational background.
What are the benefits of working with a midwife?
Midwifery focuses on supporting birthing people during labor to help make the process as relaxing and efficient as possible. Midwives provide support, education, guidance, encouragement, comfort, and much more to help the birthing process go as smoothly as possible.
In low-risk pregnancies, they contribute to lower complication rates, reduced C-section rates, and reduced risk of premature birth. While you may hear that midwives are best suited for low-risk pregnancies, they’re able to support your birth in collaboration with an OB-GYN or family physician if you don’t qualify to get your care by a midwife.
Another great thing about midwives is that they provide personalized care. They’re also big believers in shared decision making and empowering you to make decisions about your body and your birth.
“Shared decision making” happens when a provider shares all relevant information with their patient and they arrive at a decision about a plan for care together. Midwives recognize their patients as experts in their own experience, leveling the playing field between provider and patient.
Considering that implicit bias can lead health-care providers to spend less time communicating with their patients, working with professionals who make this type of care part of their model is a huge benefit.
How much does a midwife cost?
Did you know that many insurance companies cover midwifery care?
Federal law requires Medicaid covers certified nurse-midwives services in all 50 states. (CNMs services are also covered by most private insurance companies in the country.) Insurance coverage for certified midwives and certified professional midwives varies state by state.
So you’d approach finding a midwife the way you would any other health care provider. See if they’re in-network and take your insurance. If they’re out of network, check and see what your insurance company’s out-of-network coverage is.
If you don’t have insurance or Medicaid, a midwife may cost anywhere from $2,000 to $9,000 according to some estimates.
How can I work with a midwife?
Like choosing a doula, you want to ensure that the midwife you choose has qualities that align with your personality and ensure she is the best option for your birthing process. Pay attention to these four areas.
- Interactions: Since you will have your midwife with you throughout your pregnancy, labor, and postpartum experiences, you want to ensure you connect with each other and that your personalities click well.
- Experience: Find out if your midwife has ample experience so they can provide you with knowledgeable and informed care.
- Certifications: Unless you’re choosing a traditional midwife, your midwife must have the proper certifications to practice in her field. They are licensed and trained differently, so make sure you’re familiar with the different types of training and are comfortable with the background of the one you chose.
- References: Always ask for references: They’re the best way to get an inside look at how your midwife works and her interactions with others.
Back to the beginning
So It’s Not Really Doula vs. Midwife…
As you can see, doulas and midwives are great members of a birthing team, serving two different but complementary roles. So instead of thinking about it as doula vs. midwife, you should look at it as this:
“Who will provide my medical care: a doctor or a midwife?” and “Do I want a doula?”
Because there’s no getting around this: You need a medical person at your birth. Choosing a doula as your only care provider can be a dangerous choice for you and your baby, as they can not provide medical assistance.
If you’d like to consider working with a midwife instead of a doctor, schedule an appointment with a midwife to see if you qualify for their care. If you qualify, then the choice to move forward with midwifery care is absolutely up to you! The most important thing is to choose a medical provider you trust!
Then you can consider adding a doula to your birth team for emotional and physical support.
Do you want one-on-one support in your pregnancy, during labor, and postpartum? Someone who can comfort and encourage you and your partner and show you different positions and tricks that will help labor progress more smoothly? A doula may be an excellent choice.
Your pregnancy and birthing experience should be a beautiful time for you and your family. Choosing the right people to give you the care you need and deserve will help make that possible.