Chances are, you’ve heard about how great it can be to have a midwife, doula, or both as part of your maternity care team. Maybe your college bestie raved about how much her doula helped during her marathon labor or you read an article about the benefits of the midwifery model of care, especially for Black mothers. Either way, the hype is real.
The truth is, adding these care providers to your team can be a powerful way to have a better birth and postpartum experience, while also being a valuable health advocate for you. Practically, that means a lower rate of interventions,1 like C-sections,2 but also a higher chance of feeling supported and satisfied 3 with your birth experience. (That said, there is still a place for ob-gyns and medical care in a hospital setting).
Here’s everything you need to know about doulas and midwives, including who they are, what they do, and what’s different about the roles they can play in your birth and postpartum experience.
What Is a Doula?
A doula is a trained, non-medical person who provides support to people during pregnancy and birth as well as other reproductive experiences. Doulas can help you (and your partner!) with the emotional, mental, and physical aspects of pregnancy, birth, and postpartum. Think of a doula a bit like a guide or coach. Your personal coach can talk you through the big game (labor), the tools you’ll need (from mesh undies to swaddles), and all the tricks to get you through the twists and turns of the journey.
But what do doulas actually do? A lot! Your birth doula may help you decide what kind of pain management you’re interested in before labor, rub your back during contractions, and then give you the perfect technique to get your baby to latch after birth. Or they’ll give you a curated list of new parent reads and cook you the best bowl of oatmeal you’ve ever had. Doula care includes assisting you with anything (non-medical) that pops up for you during your transition to parenthood, including resource-finding, communication, advocacy, childbirth education, and so much more.
Most importantly, doula care is always 100 percent personalized to you. I’ve been a doula for over a decade and the way I work with my clients is tailored to the specific person every time. One client may want my help making a birth plan, while another wants me to go to prenatal appointments with her while her partner is at work. I’ve texted helpful videos about hand expression of breastmilk in the middle of the night, made plaster casts of pregnant bellies, and delivered peanut butter protein balls the day after a marathon labor. Doula care is multifaceted and evolving, based on you and your baby’s needs.
What Is a Midwife?
A midwife is a healthcare professional who specializes in the pregnancy, birth, and postpartum period. They care for pregnant people and attend births. Midwives are experts in and provide care for people with low-risk pregnancies and births, meaning those who are not likely to have complications. Midwives are the care providers for your pregnancy, just as a physician would be. Though, in some cases, you can work with a midwife and an OB-GYN (who would take over your care if complications arise). Midwives can do things like order ultrasounds, check your baby’s heart rate, and provide advice on things like diet and exercise.
Midwifery has existed for about as long as humans have—for most of history, people were cared for by midwives in their communities. They are common care providers in other countries (like the UK—queue up Call the Midwife and get ready to cry happy tears!) although it’s less common to get care with them in the United States.
The Difference Between Doulas and Midwives
Both doulas and midwives generally see pregnancy and birth as a normal part of your life, rather than a medical condition that needs to be managed. They provide holistic care that incorporates education and lots of attention to how you’re feeling, emotionally and mentally.
Have previous medical trauma? They’re there to make a plan to ensure you feel comfortable from the second you step into the hospital. Want your partner to be uber-involved in birth? They’ll help them strip down to do skin-to-skin during that post-birth golden hour. This more holistic approach to care is likely one reason why people get the two roles confused. Still, the specific way that doulas and midwives care for you and support you throughout your experience is distinct.
The main thing to understand is that midwives are medical care providers and doulas are not. Midwives are there to monitor you and your baby throughout pregnancy and birth, including doing things like ordering medication, listening to the fetal heart rate, and checking your cervix (if you so choose, of course). Doulas, on the other hand, are focused on your emotional and mental well-being. During labor, midwives monitor your progress, catch babies, and repair tearing, while doulas may hold your hand and help you breathe through a contraction. You'll find that doulas and midwives are excited to work together as a team to help families have healthy and meaningful experiences in pregnancy and birth.
When it comes to payment, your health insurance will likely cover any provider working in a hospital setting, including a licensed midwife. If you want to give birth at a birth center or at home, things are a little more murky—some insurance will cover care with midwives, but many will not. Sometimes, this depends on the state where you live. Most often, home birth is paid out-of-pocket.
In general, doula care is not covered by insurance, although that’s starting to change as Medicaid reimbursement for doulas 4 becomes possible around the country. You will likely have to pay for a doula yourself, although you might be able to get some of their fees covered by an FSA or HSA. Many doulas and some home birth midwives will accept sliding scale or payment plans, especially if they don’t take insurance, and some doulas may even barter for their services. So, if their services are out of your budget, don’t be afraid to ask if there are any alternative payment options.
Types of Doulas
Doula training and certification can vary widely—some doula certification programs take place over a weekend, while others last for months online. Generally, doulas will have cared for a required number of people and done other learning (on things like breastfeeding) before they are certified. Doulas are not regulated in the United States.
What makes doulas extra special is they are trained to work in tandem with other care providers, including ob-gyns, midwives, and lactation consultants (IBCLCs). They are deeply knowledgeable about the care available in their local community and can provide recommendations for additional resources that may work for you.
Doulas can either specialize in one stage of the pregnancy journey (like birth or postpartum), or they can provide multiple types of care. A full-spectrum doula is someone who is trained to support people through all reproductive experiences, including birth, loss, abortion, and postpartum. Here’s a little about what you can expect from the two main specialties:
Birth doulas
What they do for pregnant people: Birth doulas are trained to help people through the powerful transition of pregnancy and birth. They help you plan for your birth and are physically present throughout labor. Most also provide some kind of postpartum support or visit. They are experts in allllll of the things that can help you through labor, including physical support like massage and mental help like birth affirmations. Doulas can also act as advocates for you in a hospital setting, helping you understand your options and communicate with medical staff.
Although many people think doulas are only for parents who are planning an unmedicated birth, birth doulas attend and support all kinds of births, including those that include pain medication and surgery. Doulas are there for your whole journey, no matter the path you choose or end up on. Their support is continuous and unconditional, focused wholly on you—what you want and need to have a happy, healthy birth.
How much they cost: Generally, birth doulas offer a package of support for a flat fee that can range anywhere from $500 to $3500 and up, depending on where you live.
Postpartum doulas
What they do for pregnant people: Postpartum doulas specialize in the time right after birth—the fourth trimester, otherwise known as the first three months of your baby’s life. These professionals will help you make everything about this intense time easier, from practical support (bottle washing! laundry folding! cooking delicious meals!) to baby care and birth recovery. A postpartum doula is there to help you learn, adjust, and thrive as a new parent, whether it’s demonstrating a rock-solid swaddle or prepping a soothing herbal sitz bath. They may also support your partner and older children.
How much they cost: Postpartum doulas often work on an hourly basis, but will often offer packages. They do both day and night shifts to support you and your newborn’s needs.
Types of Midwives
Midwives work in all birth settings, including hospitals, homes, and birth centers—but not all midwives work in all settings and provide all types of reproductive care. Licensed midwives, including CNMs and CPMs, are generally trained in the standard and scope of the International Confederation of Midwives, which includes medical care during pregnancy, birth, and postpartum.
Certified nurse midwives (CNM)
Training and duties: Certified nurse midwives, sometimes called nurse midwives, are trained and certified nurses. They have completed both nursing school and a graduate degree in nurse-midwifery. Most nurse midwives work in hospitals, although they can attend births in any setting. CNMs can also provide general reproductive healthcare, like yearly well-woman exams, pap smears, and more. They can write prescriptions and order testing.
What they do for pregnant people: CNMs do all of the labor care that would happen in a hospital, including fetal monitoring, repair of tears, and more. They don’t perform C-sections, although some may be trained to assist during them. CNMs can work with any and all pregnant and birthing people, including those who want to use interventions and pain medication during their births.
Certified midwives (CM)
Training and duties: Certified midwives are similar to CNMs, except they come from a background other than nursing. Still, they are required to do the same graduate-level training and education and they take the same licensing exam as nurse midwives (via the American College of Nurse Midwives). They can attend births in all settings, in the 11 states (plus D.C.) where they are licensed.
What they do for pregnant people: CMs are trained to provide the same level of care as a CNM, they just do not have a nursing background.
Certified professional midwives (CPM)
Training and duties: Certified professional midwives5 are trained and certified to work only in homes and birth centers—not hospitals. These types of midwives have completed coursework, an apprenticeship, and a national certifying exam called the NARM.6 Some may have completed other additional training. Their licensing standards and training requirements may vary from state to state. CPMs are licensed to practice in 36 states.
What they do for pregnant people: CPMs carry medication for use at births (including IVs and medication used to stop bleeding) and can order ultrasounds and fetal testing. They can’t prescribe medication. Some CPMs work in collaborative practices with CNMs or have relationships with physicians who support parents who may need more medical care. Because CPMs only attend births in birth centers and homes, they only attend the births of people who are eligible for and desiring low-intervention care (that means no epidural or access to hospital tools like vacuums or operating rooms).
Traditional/unlicensed midwives
Training and duties: Traditional midwives are people who do not hold a certification or license as a midwife in the United States, but who may still be caring for people in home birth settings. Their training and experience is variable—they may have attended midwifery school or studied with elders in their communities. Usually, they only provide care during pregnancy and birth but they may do other reproductive care.
What they do for pregnant people: Traditional or unlicensed midwives often serve their own communities, such as immigrant, religious, or indigenous communities. Traditional midwives cannot order testing or ultrasounds and cannot prescribe medications. Traditional midwives only work in homes with people who want to have unmedicated births with no intervention.
How Doulas and Midwives Can Help Support Your Mental Health
Doulas and midwives aren’t therapists, but they can still have a positive impact on your mental health. A 2023 systematic review 7 concluded that midwifery care can help lessen the depression and anxiety that some women may feel before birth. And midwives are actually more likely8 than obstetricians to fully screen new parents for perinatal mental health and anxiety disorders (PMADs).
Doulas can also reduce the risk of perinatal mental health issues. Research published in 2022 found9 that people who work with doulas have over 50 percent lower odds of experiencing postpartum depression or anxiety. Doulas listen and hold space for everything you’re going through—and have tons of useful suggestions for the common struggles of pregnancy and postpartum. That includes educating and helping you plan for both your birth experience and newborn life, giving you realistic expectations and suggestions that fit you. Whether it’s solid info about how many hours a day you can expect your newborn to sleep or advice on how to deal with your mother-in-law who wants constant pregnancy updates, your doula’s emotional support can be major.
Developing trust and closeness with your doula is a must, so if you’d like to add one to your birth team, it’s a good idea to interview a few and focus on finding the one that you feel most comfortable and confident with. The same goes for midwives. Many midwives work in group practices, especially those who work at hospitals and birth centers—so you may not have your favorite midwife at your birth or see them at all of your prenatal appointments. So, choosing a group with a philosophy you appreciate will be useful for your overall care.
Above all, a big part of the mental health boost from working with a holistic provider comes from the experience of feeling seen and supported. If you’re able to openly discuss your worries and stresses with your midwife and doula, chances are you’ll be able to come up with solutions to make it all feel a little less daunting.
