Doula vs Midwife: Understanding the Differences in Your Birth Team

Choosing your birth support team is one of the most important decisions you'll make during pregnancy. While both doulas and midwives provide care during childbirth, they serve distinctly different roles—and understanding these differences can help you build the right support system for your birth experience.

What Is a Doula?

A doula is a trained professional who provides continuous physical, emotional, and informational support to a person before, during, and after childbirth. Unlike midwives, doulas do not provide medical care or perform clinical tasks—their role centers entirely on supporting the birthing person and their partner through the labor experience.

Research published in the Cochrane Database of Systematic Reviews found that continuous support during labor, such as that provided by doulas, is associated with improved birth outcomes. The study showed that people who received continuous support were more likely to have spontaneous vaginal births and less likely to use pain medications or report dissatisfaction with their birth experience.

What Doulas Do During Labor

Doulas offer a range of non-medical support techniques that help you stay comfortable, informed, and empowered throughout labor:

• Suggesting comfort measures like position changes, breathing techniques, and massage
• Providing emotional reassurance and encouragement throughout labor
• Helping you communicate your preferences to medical staff
• Supporting your partner in how to best help you
• Offering information about labor progress and hospital procedures
• Creating a calming environment with aromatherapy, music, or dim lighting

Types of Doulas

Birth Doulas provide support during labor and delivery, typically joining you when active labor begins and staying until shortly after birth.

Postpartum Doulas offer support after birth, helping with newborn care, breastfeeding guidance, emotional adjustment, and practical household tasks during recovery.

Antepartum Doulas support people experiencing high-risk pregnancies or bed rest during pregnancy, though this type of doula is less common.

What Is a Midwife?

A midwife is a licensed healthcare professional trained to provide comprehensive medical care to women throughout pregnancy, labor, delivery, and the postpartum period. Certified Nurse-Midwives (CNMs) complete advanced nursing degrees and specialized midwifery training, allowing them to manage low-risk pregnancies and births independently.

Midwives can work in various settings including hospitals, birth centers, and homes. They are qualified to perform physical examinations, order lab tests and ultrasounds, prescribe medications, and deliver babies. According to the American College of Nurse-Midwives, midwives attend approximately 10% of all births in the United States.

Types of Midwives

Certified Nurse-Midwives (CNMs) hold nursing degrees and have completed graduate-level midwifery education accredited by the Accreditation Commission for Midwifery Education. CNMs can practice in all 50 states and are recognized by most insurance plans.

Certified Midwives (CMs) have similar training to CNMs but may not have a nursing background. They complete the same midwifery education and certification process, though CMs are licensed in fewer states than CNMs.

Certified Professional Midwives (CPMs) typically focus on out-of-hospital births and are trained through various pathways including apprenticeships and midwifery schools. Their scope of practice varies by state.

Direct-Entry Midwives may have various levels of training and certification. Licensing requirements differ significantly by state, so it's important to verify credentials.

Medical Scope Differences

The most fundamental difference between doulas and midwives lies in their medical authority and responsibilities.

Doulas' Non-Medical Role

Doulas specifically do not:

• Perform any medical procedures or examinations
• Monitor vital signs or fetal heart rate
• Make medical decisions or diagnose conditions
• Prescribe or administer medications
• Deliver babies or provide clinical care
• Replace medical professionals on your birth team

This distinction is crucial: doulas complement medical care providers but never replace them. Their focus remains on your emotional wellbeing, physical comfort, and ensuring you feel supported and informed throughout your birth experience.

Midwives' Medical Responsibilities

Midwives are healthcare providers who:

• Conduct prenatal examinations and order tests
• Monitor fetal heart rate and maternal vital signs during labor
• Perform cervical checks to assess labor progress
• Deliver babies and placentas
• Repair perineal tears if needed
• Prescribe medications and administer IV fluids
• Identify complications and transfer care when necessary
• Provide postpartum medical care including contraception counseling

The American College of Obstetricians and Gynecologists recognizes midwives as qualified primary care providers for women with low-risk pregnancies.

Training and Certification Requirements

The educational paths for doulas and midwives differ dramatically in length, depth, and regulatory oversight.

Doula Training and Certification

Doula certification is less standardized and varies by organization. Most doula training programs include:

• 12-24 hours of classroom or online instruction
• Reading assignments on birth physiology and support techniques
• Attendance at a certain number of births (typically 2-5)
• Submission of client evaluations
• Written examination or essays

Organizations like DONA International, Evidence Based Birth, and others offer certification programs that can typically be completed within several months to a year. Certification is voluntary—some experienced doulas practice without formal certification.

Midwife Education and Licensing

Becoming a Certified Nurse-Midwife requires:

• Bachelor's degree in nursing
• Registered Nurse (RN) licensure
• Graduate degree in midwifery (Master's or Doctorate)
• Successful completion of the national certification examination
• State licensure to practice
• Ongoing continuing education requirements

According to the American Midwifery Certification Board, this process typically takes 6-8 years of education and training beyond high school.

Cost and Insurance Coverage

Understanding the financial aspects of hiring a doula versus a midwife can help you budget for your birth team.

Doula Costs and Coverage

Doula services are increasingly being covered by insurance, though coverage varies. Some Medicaid programs in states like California, Minnesota, Oregon, and New York now provide doula coverage. Private insurance coverage varies significantly.

The American College of Obstetricians and Gynecologists has acknowledged the value of doula support, which may influence future insurance coverage decisions.

When paying privately, expect doula fees to range from $800 to $2,500 depending on experience and your geographic area. Some doulas offer sliding scale fees or volunteer with programs serving low-income families.

For California residents: Raya Health connects you with doula support covered by your health insurance, making this valuable care more accessible and affordable.

Midwife Costs and Coverage

Midwifery care is generally covered by health insurance, including Medicaid, when provided by licensed CNMs or CMs. The Centers for Medicare & Medicaid Services requires that state Medicaid programs cover CNM services.

Typical midwifery care includes:

• All prenatal visits throughout pregnancy
• Labor and delivery care
• Postpartum checkups (usually 6 weeks)
• Newborn care immediately after birth

If you're paying out-of-pocket, comprehensive midwifery care typically ranges from $2,000 to $6,000 depending on your location and birth setting.

Working Together: Doulas and Midwives as a Team

Rather than choosing between a doula and a midwife, many people benefit from having both as part of their birth team.

Complementary Roles

When working together, doulas and midwives create comprehensive support:

The doula concentrates on your emotional and physical comfort—suggesting position changes, providing massage, offering encouragement, and helping you stay calm and focused. The midwife focuses on your medical care—monitoring labor progress, checking vital signs, making clinical decisions, and managing any complications that arise.

Research in the Journal of Perinatal Education indicates that the combined support of medical providers and doulas can lead to improved birth satisfaction and outcomes.

How They Collaborate

In an effective birth team:

• The doula helps you understand and process medical information the midwife communicates
• The doula provides comfort and support during medical procedures the midwife performs
• The doula helps you articulate your preferences and questions while the midwife makes clinical decisions

This collaboration allows each professional to focus on their area of expertise while supporting your overall wellbeing.

When Each Professional Joins Your Care

The timing of when doulas and midwives become involved in your pregnancy differs significantly.

Doulas usually connect with clients during the second or third trimester:

• During pregnancy: One or more prenatal meetings to discuss birth preferences, practice comfort techniques, and build rapport
• Labor: Join you when active labor begins (timing varies based on your preferences)
• Birth: Stay throughout labor and delivery, leaving within a few hours after birth
• Postpartum: May offer one or two follow-up visits (postpartum doulas provide more extensive support)

Midwives typically provide care from early pregnancy through postpartum:

• First trimester: Initial prenatal appointment, often around 8-10 weeks
• Throughout pregnancy: Regular prenatal visits, increasingly frequent as you approach your due date
• Labor and birth: Present for active labor, delivery, and immediate postpartum period
• Postpartum: Follow-up visits at intervals, typically including a 6-week checkup

Choosing Based on Your Birth Setting

Your planned birth location may influence whether you need a doula, a midwife, or both.

Hospital Births

In hospital settings, you'll have a medical provider—either a midwife or obstetrician—assigned to oversee your medical care. A doula can be particularly valuable in hospitals where nursing staff may not be able to provide continuous support due to multiple patients.

Birth Center Births

Birth centers are typically staffed by midwives who provide medical care in a more homelike environment. Many birth center clients still choose to hire doulas for additional support.

Home Births

Home births require a midwife to provide medical care and emergency management if needed. Many people planning home births also hire doulas for additional support, especially for first-time parents who may benefit from extra guidance.

Making Your Decision

Selecting your birth support team depends on your individual circumstances, preferences, and birth plans.

Consider Hiring a Doula If:

• You want continuous emotional and physical support during labor
• You're planning a hospital birth and want someone focused solely on your comfort
• You want help communicating with medical staff about your preferences
• Your partner wants guidance on how to support you during labor
• Research shows you value evidence-based comfort measures
• You want someone experienced in normal labor to reassure you throughout the process

Consider Hiring a Midwife If:

• You have a low-risk pregnancy and want personalized medical care
• You prefer a less interventionist approach than typical obstetric care
• You're planning a birth center or home birth
• You value longer appointments and more time with your provider
• You want one provider for prenatal care, birth, and postpartum care

Consider Having Both If:

• You want comprehensive support—both medical care and continuous labor support
• Your budget allows for both services (or you have insurance coverage through programs like Raya Health)
• You're planning a first birth and want maximum support
• You have specific birth preferences you want help advocating for
• You want your partner to have guidance and breaks during long labor

Accessing Doula and Midwife Care Through Raya Health

For California residents, Raya Health makes it easier to access both doula and midwife support covered by your health insurance. Raya connects you with qualified birth professionals who can provide the personalized care you need throughout pregnancy, birth, and postpartum—without the financial barriers that often prevent people from getting comprehensive support.

Whether you're looking for a doula to provide continuous labor support, a midwife for medical care, or both as part of your birth team, Raya Health helps you navigate your options and connect with providers who align with your birth preferences and values.

Frequently Asked Questions

Can I have both a doula and a midwife?

Absolutely. Having both a doula and midwife on your birth team is common and beneficial. They serve different but complementary roles—the doula offers continuous emotional and physical support while the midwife provides medical care. Many midwives welcome doulas and recognize the value they bring to the birth experience.

Will my midwife provide the same support as a doula?

While midwives are compassionate and supportive, they cannot provide the same continuous, undivided attention as a doula. Midwives have medical responsibilities including monitoring your health and your baby's wellbeing, completing documentation, and managing clinical aspects of labor. If your midwife is attending multiple births or working in a busy hospital, they may not be present in your room continuously.

Do doulas deliver babies?

No, doulas do not deliver babies or provide any medical care. Only licensed healthcare providers—midwives, obstetricians, or family physicians—can deliver babies. Doulas support you during labor but step back for the actual delivery, which is handled by your medical provider.

Are midwives only for home births?

Not at all. While midwives do attend home births, many Certified Nurse-Midwives work primarily in hospitals or birth centers. According to recent data, the majority of births attended by midwives occur in hospitals. Midwives can provide care in any setting where they have privileges and are licensed to practice.

Is doula support covered by insurance in California?

Yes, many California insurance plans now cover doula services, including Medi-Cal. Raya Health helps California residents access doula support covered by their health insurance, making this valuable care more accessible and affordable.

Medical Disclaimer

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. The information provided should not replace consultation with a qualified healthcare provider. Individual circumstances, local regulations, and scope of practice vary significantly.

Always consult with your doctor, midwife, or other qualified healthcare provider about your specific pregnancy, health conditions, and birth plans. The decision about your birth team should be made in partnership with your healthcare provider based on your individual medical needs and risk factors.

Sources

DONA International - What is a Doula?

Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017

American College of Nurse-Midwives - What is a Midwife?

American College of Obstetricians and Gynecologists - Doulas Committee Opinion

American Midwifery Certification Board - Certification Requirements

Kozhimannil KB, Attanasio LB, Hardeman RR, O'Brien M. Doula care supports near-universal breastfeeding initiation among diverse, low-income women. J Midwifery Womens Health. 2013

American College of Obstetricians and Gynecologists - Collaboration in Obstetric Care