Doula vs. Midwife: The Differences and How to Choose

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 many different roles that 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.

If you're finding yourself unsure of the difference between a doula vs. a midwife, you've come to the right place. Ahead, learn more about the roles each of them play in the birth experience, and how to decide which one—if any!—may be right for you.

What Is a Midwife?

In a nutshell, a midwife is a health care professional who can assist with anything ranging from pregnancy to labor to postpartum care.

"Midwives provide medical care for you during pregnancy, birth, and the immediate postpartum period," explains Emily Kurtz, an Ohio-based doula/midwife. "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."

A large part of the distinction between midwives and doulas comes down to training. "Midwives—whether a certified nurse midwife, certified midwife, or licensed 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 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 parents who preferred a more 'natural birth,' particularly with little or no pain medication," says Kayler.

Research has shown that the number of midwife-attended births has increased throughout the years; in 2021, 12% of all births were attended by a midwife.

What Is a Doula?

While doulas are not medically trained professionals, they can add tremendous emotional value and support to a birthing team. "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.

Benefits of Hiring a Midwife

There are many research-backed benefits to working with a midwife. Studies have shown that midwife-assisted low-risk births have resulted in less instances of C-sections and medical interventions. Experts report other benefits of midwife-assisted births can include decreased infant mortality rates; decreased risk of preterm birth; and decreased instances of third and fourth-degree perineal tears.

Some expectant parents choose to deliver with a midwife as opposed to an OB-GYN. Much of that choice comes down to the experience: Midwives are known for offering a more "holistic" approach. According to Joy, many people report feeling more heard and understood by midwives as opposed to OB-GYNs.

But that being said, you don't always have to choose one or the other. "In many situations there is a collaborative agreement between a midwife and OB-GYN," 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."

Parents with complicated or high-risk pregnancies can involve midwives in their cases even if they're seeing an OB-GYN throughout, according to Kayler.

Benefits of Working With a Doula

The presence of a doula throughout pregnancy, labor, delivery, and beyond can be extremely beneficial, particularly for marginalized or socially disadvantaged parents. Beyond providing emotional support, studies have shown that expectant parents working with a doula have better birth outcomes, including reduced risk of birth complications and a higher sense of empowerment within the first few weeks of parenthood.

"There's a ton of research and statistics that support the benefits doulas provide," says Joy. "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. "One of the biggest reasons to have a doula is to have somebody with you throughout your entire labor and delivery," Joy adds. "I gave birth with a midwife, but she had other patients, nurses have other patients, doctors have other patients. Doulas are your constant."

Cost of a Midwife or Doula

The cost of a midwife can vary, but many insurance policies do cover midwifery care. Be sure to check with your provider for further information, and keep in mind that home births or birthing centers may not be included in your coverage.

Doula fees can vary widely, depending on your geographic location. Joy suggests using a resource like Doula Match to find someone who works within your price range—and you may be able to find someone who will provide free services while undergoing the training process to become a fully certified doula.