The Difference Between a Midwife and a Doula

Midwives and doulas are often mistaken for each other. Especially if you’re just learning about the benefits of midwives, they may sound similar to what doulas offer. Both midwives and doulas offer increased physical and emotional support and more time with you compared to a standard hospital visit with an OB. But there are several very important differences between midwives and doulas.

What is a midwife?

A midwife is a trained medical professional who specializes in caring for pregnant people throughout their pregnancy, birth, and postpartum. 

Are there different types of midwives?

All midwives do the same core tasks, but different midwives have different types of certifications. Certified nurse-midwives (CNMs) have nursing degrees and midwifery certifications. Because they are registered nurses (RNs), they tend to practice in hospitals. Certified midwives (CMs) do not have nursing degrees, but they have master’s degrees in midwifery. 

Certified professional midwives (CPMs) are not hospital-certified nurses, but they do have extensive medical training. They are the experts at home and birth center births. Licensed midwives (LMs) and CPMs are sometimes called direct-entry midwives, because their training does not require a nursing degree. 
 

Some states differ in their license and naming conventions. For example, West Virginia does not accept direct-entry midwives. Washington state uses the term Licensed Midwife for CPMs who are registered with the state midwifery board. Consider what your state regulates when starting a search for a midwife.

Regardless of the type of midwife you choose, midwifery is grounded in a practice of patient-centered care. That practice includes informed consent and shared decision making between the midwife and their patient. Midwives don’t just tell you what to do. They trust you to be the expert on your needs, values, and priorities. They provide information and help you understand your options so you can make informed decisions about your healthcare.

What do midwives do? 

Midwives are responsible for the health and safety of the pregnant person and their baby. During pregnancy, they gather your medical history and other assessments so they have an accurate understanding of your whole health. They conduct physical exams, listen to the baby’s heartbeat, prescribe medications, and order lab work and imaging. During labor and delivery, they provide emotional support and encouragement as well as medical monitoring. 
 

In some states, nurse-midwives practice as independent, licensed practitioners, meaning they can prescribe medications, order labs and imaging, refer to other providers, and admit their own patients to the hospital. In other states, they can do most (if not all) of these things but may have to practice with a physician's sign-off.

Midwives are often known for their high standard of whole-person care. They have more time to spend with patients to get to know them, and they recognize that a healthy pregnancy includes both physical and mental health. Some nurse-midwives also provide reproductive care beyond pregnancy and immediately postpartum.

What is a doula?

Doulas are birthing companions who provide physical, emotional, and informational support throughout pregnancy, labor and delivery, and postpartum. Some doulas provide full reproductive care support beyond pregnancy.

Are there different types of doulas?

Just as there are different types of midwives, there are different types of doulas. However, the spectrum of what doulas do varies more widely than midwives. Most doulas provide support from the moment you hire them during pregnancy up until after labor and delivery. They go by various names. Birth doula, birth coach, and labor coach are some of the terms used by doulas. Some doulas are specifically postpartum doulas. They start providing care after the baby is born. Full-spectrum doulas help with pregnancy, labor and delivery, and the postpartum period. A full-spectrum doula may also support a person through fertility treatments, abortions, or miscarriage and loss. In these cases, the assistance they provide is largely emotional support.

What do doulas do?

Doulas offer physical, emotional, and informational support. They may provide assistance in the form of supplying information, answering questions, connecting you with resources, bringing meals and postpartum healing supplies, or helping prepare you and anyone present at your birth for what to expect. They take time before your birth to get to know you. While doulas are by no means necessary, there are many reasons you may want one. A 2017 review found that continuous support provided by a doula improved labor outcomes, shortened labor times, and decreased cesarean births, among other benefits.

Related: 7 Reasons to Hire a Birth Doula
 

Birth doulas provide continuous support throughout labor and delivery. This is when doulas often provide hands-on physical support to make you more comfortable. They are trained in understanding labor positions and various massage techniques. You can also ask a doula for anything from water to dimming the lights.

Can you have both a midwife and a doula?

A common belief is that midwives and doulas are roughly the same. Though midwives and doulas work together, they are not the same. Midwives and doulas have different roles. 

Doulas do not provide any kind of clinical or medical care, diagnosis, advice, or treatment. Their steady presence and support complements the care provided by the midwife, who takes on the clinical role. While a doula might suggest different labor positions and rub your back, your midwife can order pain or anti-nausea medication. Both will help explain what is going on and answer any questions.
 

If you’re giving birth at a hospital or birth center, your midwife may not be present for your entire labor. Midwives often have additional patients to care for during their shift. The presence of a doula to provide support the whole time can be very helpful.

Midwives and doulas work together to provide physical and emotional support for the birthing person and their baby(s). While a doula is not required for a safe birth, they are a valuable addition to your pregnancy support system. Having both a midwife and a doula at your birth is one way to improve outcomes for you and your little one.