Difference Between Midwife and Doula

Midwives and doulas can each play an essential role in caring for pregnant individuals and helping to ensure that the birthing experience occurs in a safe and respectful environment, despite having different certifications and training. While midwives are often covered by insurance, coverage for doulas varies, with some insurance companies fully covering them, some partially, and some not at all. 

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What is the Difference Between a Midwife and a Doula?

It can be overwhelming and confusing to weigh up the variety of care options now available to pregnant people. In particular, many individuals and their families are unsure of the differences between midwives and doulas, and the services provided by each of them. To help clear up the confusion, we’ve put together a summary of each type of provider, including their education, certifications, and roles and responsibility in your care. 

The following table summarizes the similarities and differences between midwives and doulas, as well as obstetricians (doctors who are specially trained to care for pregnant people):

Sources: WebMD, American College of Nurse Midwives, HealthcareDegree

Midwives

Midwives are healthcare workers who help people during pregnancy and childbirth. They may also provide care to non-pregnant individuals including family planning, STI testing, and preventative care, such as pap smears.

• Education: There are a few types of midwives in the United States, with two of the most common being Certified Nurse Midwives (CNM), and Certified Professional Midwives (CPM). CNMs must complete nursing school before entering into a midwifery program, while CPMs can enter a program with just a high school diploma.
• Certification: CNMs are certified by the American Midwifery Certification Board and must renew their certification every 5 years, while CPMs are certified by the North American Registry of Midwives and are required to renew their certification every 3 years. CNMs are licensed to work in all 50 states as well as the District of Columbia and other US territories, while CPMs are licensed to work in 31 states.
• Roles and responsibilities: CNMs can work with women from their early teen years until menopause. They provide a range of services, which include pregnancy care for healthy women, as well as preventative care. They can prescribe medications and test for sexually transmitted infections as well. The role of CPMs is somewhat limited and extends to care only during pregnancy.

Doulas

Contrary to popular belief, doulas are not medical workers. Rather, doulas are meant to provide support to people and their families both during and after childbirth. 

• Education: To become a doula, candidates must complete several weeks of training in a variety of areas relating to childbirth including breastfeeding and postpartum care. They will also have to attend a few live births.
• Certification: Doula certification can be obtained through a doula training program or childbirth education organization. Certification is not required, however, many doulas will obtain certification so that they can work in larger settings such as hospitals or birthing centers.
• Roles and responsibilities: Doulas offer emotional support to people during childbirth. They can also help with communication between the birthing individual and the medical team, which often includes articulating the person’s preferred birth plan and pain management goals. Doulas also offer a scope of services beyond pregnancy. There are a number of doulas who can work with people after giving birth. They will usually provide support for things like breastfeeding, newborn care, and even physical support if the person who gave birth requires it.

Despite a somewhat contentious history between traditional medical providers and doulas, recent studies have shown that having continuous emotional support during birth can actually provide significant health benefits, such as 

• The decreased need for pain medication during birth
• Lower rate of C-section
• Faster labor
• More positive birthing experiences (which has long-term mental health benefits)

These benefits are even more significant in traditionally worse-off communities, such as African American communities. In these communities, using a doula can increase the rate of breastfeeding, and decrease the barriers to care for underserved individuals. 

Health Insurance Coverage of Midwives and Doulas

It is rare nowadays to find an insurance provider that will not cover midwifery services. In fact, with the expansion of Medicaid under the Affordable Care Act (ACA), even women accessing government healthcare have access to midwife providers. For uninsured or government-insured pregnant people, the main barrier to accessing midwifery care is actually the fact that most midwives work out of birthing centers, which people using Medicaid have historically had poor access to. 

Cost of Midwives without Insurance

In general, the cost of a midwife (which averages around $2,000 without insurance) is far less than the cost of an obstetrician (which averages between $5,000 to $10,000 without insurance). Therefore, insurance companies are actually saving money when people utilize the services of a midwife. In some states, such as New York, there is a legal mandate that midwives must be fully covered by private insurers.  

Cost of Doulas without insurance

With doulas, coverage will vary significantly depending on both the state you live in, as well as the insurance carrier you are using. Given that doula services can be quite expensive ($800 to $2,500), it’s important to ask your specific insurance provider before shopping around for a doula. 

You may be able to have some, or all of your doula services covered, or you can consider using your healthcare flexible spending account (if you have one through work) to pay your doula. Some states have Medicaid coverage for doulas (Florida, Minnesota, New Jersey, and Oregon), and others (California, Washington, D.C., Illinois, Indiana, Maryland, Nevada, Rhode Island, and Virginia) are beginning to consider adding coverage for their services as well.

Midwives and Doulas Frequently Asked Questions (FAQs) 

Choosing which providers to use during an exciting and emotional time like pregnancy can be challenging, and it is natural that questions will arise. Below are some of the most frequently asked questions about midwives and doulas, to help you learn more about each of them.

Can I use both a midwife and a doula?

As you may have already understood from this article, midwives and doulas have vastly different roles and responsibilities. Therefore, it can be beneficial to have both present when you are giving birth - it’s up to you and what you feel you need during birth. 

Are there services other than pregnancy care that midwives can provide?

Certified nurse midwives (CNMs) can provide many services outside of pregnancy care. They are also important healthcare providers for anyone with a uterus and can perform sexually transmitted infection testing and treatment, screening for cancer such as cervical cancer, and family planning services. 

How can I find the right midwife or doula for me?

Finding the right provider can be nerve racking, especially in a high stakes situation like pregnancy. The best way to find the right provider, be they a doula or a midwife, is to get referrals from trusted friends, and meet with as many candidates as possible. Try to find someone who is respectful of you and your goals, and who you feel you can trust when things get rough. Not every provider will be a perfect fit, and that’s ok. There are a variety of personalities and styles, and you’re bound to find the right providers if you put in a little bit of effort.

Can a family member or friend act as my doula?

While a close family member or friend can be an incredible support during birth, they are ultimately not trained and therefore cannot act as your doula during birth. That being said, if you prefer having someone you know as your designated support person during birth, meeting with them prior to giving birth to discuss your birth plan and goals can be helpful, since it will help get you both on the same page and maximize the benefit this person can provide. 

Who should not be cared for by a midwife?

Midwives are generally excellent providers for healthy people during pregnancy. However, they should not be the primary provider in the case of a high-risk pregnancy, for example in people who are carrying twins, those over age 35, or people with pregnancy-related diseases such as gestational diabetes or preeclampsia. In these cases, a midwife can work closely with an obstetrician to provide prenatal care but should not be the sole provider. Additionally, midwives in the United States do not have surgical training and can therefore not perform C-sections, so if there’s a high chance that you’ll need a C-section, they're probably not the right provider for you.

Bottom Line 

Midwives and doulas both work with people who are pregnant or giving birth, but they have very different training requirements and roles. Midwives provide medical care during birth, while doulas support people giving birth both emotionally and physically. Most services provided by midwives are covered by insurance, but only some insurance companies will cover doula services, with the percentage of this coverage varying from company to company.  

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