When it comes to preparing for childbirth, it’s easy to feel overwhelmed with decisions. Who do you want present? Should there be meditation? What about photos? A tub of water and an Enya soundtrack? While we can’t help you figure out your playlist, we can help you settle the doula vs. midwife confusion, so you can decide which one (if either) you want in the delivery room with you.
What is a midwife?
A midwife is a medical professional who is trained to deliver babies, either in hospitals, birthing centers or even at home. Midwives are usually proponents for natural births and advocate as little medical intervention as possible, however, certified nurse-midwives are able to do a lot of the same procedures that your OB-GYN can do (like administer drugs, stitch tears and use equipment to monitor the fetus). Midwives cannot, however, perform C-sections (your OB-GYN or surgeon does that). They often work together with doctors (especially if complications arise) but typically handle low-risk births on their own. While your doctor will likely come and go during your labor, a midwife will stay with you throughout if she's able.
Got it. And what is a doula?
A doula is a non-medical professional (so she can’t deliver your baby) who offers support and encouragement throughout the labor—sort of like a childbirth coach. Some things a doula might do: help you create a birth plan (and advocate for you when you’re too disoriented to speak up for yourself), suggest techniques for pain relief, rub your back during the delivery and visit your home after the birth to help you adjust. A doula will stay with you throughout the labor.
What certifications are required?
Midwives in the US are certified by the North American Registry of Midwives and the American Midwifery Certification Board. In order to be certified, midwives must first undergo specific education, training and supervised clinical experience in programs accredited by the Midwifery Education Accreditation Council. Many midwives are also registered nurses, referred to as certified nurse-midwives (CNM). In order to be a CNM, you must have a bachelor’s degree from an accredited institution and certification from the American College of Nurse Midwives.
A doula does not necessarily have medical training, and there is no formal licensing required. However, many doulas choose training and certification by organizations that oversee doula training programs, such as DONA International and the Childbirth and Postpartum Professional Association.
And how do I find one (or both)?
Ask friends and doctors for midwife referrals, or use the "Find a Midwife" feature at Midwife.org. To find a doula, ask for recommendations or go through an organization such as DONA to ensure that your doula has had extensive training.
What about the cost?
Insurance providers typically cover the cost of midwifery services. But because doulas are not health-care professionals, they’re usually not covered by insurance, although you may be able to get a reimbursement under your health savings plan. The cost of getting a doula varies greatly by location and experience, ranging from a couple of hundred dollars to thousands.
What is it like to work with a midwife?
“With my first son, I had a male OB/GYN,” mother-of-three Lauren tells us. “However, we moved by the time I was pregnant with our second child, so I had to switch doctors and by chance, I ended up with a midwife. She was kind, sympathetic, attentive and very knowledgeable. The biggest difference I noticed between her and my OB was that there were fewer ultrasounds taken (only two that I can remember, compared to my OB who took ultrasounds at nearly every visit). For most of the appointments, she would measure my belly and listen to the heartbeat. As for my delivery, I really liked working with the midwife because I never felt rushed or pressured to get my baby out faster than necessary. And she never pressured me to have any drugs or interventions that I wasn’t comfortable with, but she was happy to give me an epidural whenever I asked about it. Honestly, compared to my previous doctor, she just seemed more ‘in tune’ with my body...but I don’t know if that was just because it was a woman versus a man!”
And what is it like to have a doula?
Here’s how one mom describes her experience with a doula: “I choose a doula for my first child because I was hoping to stay home as long as possible before going to the hospital and I was also aiming for a non-medicated delivery. I called my doula as soon as I started having contractions at 1:00 a.m. and she guided me over the phone for a little bit before coming over to my house about three hours later. At home, she helped me get into a bath and made me feel as relaxed as I could (under the circumstances) and made sure I had something to eat before coming with me to the hospital. We had to take an Uber to get there and I was in active labor so I think she provided as much reassurance to me as she did to the driver (“Don’t worry, she’s not going to deliver the baby in the car!”). At the hospital, she helped me get through the contractions for a few hours longer but eventually, I asked for the epidural (we had set up a code word between us so that she would know when I really meant it—it was “vino”). After the epidural, she rubbed my back, created a very calm atmosphere in the room and even went to get a cup of coffee for my husband. Then when it was time to push, she held one leg up while my husband held up the other! Honestly, I loved having a doula because she helped me advocate for myself and also helped me understand what was going on—the doctors wouldn’t explain very much but she was able to walk me through everything that was happening. I wouldn’t necessarily get one for the next birth since I feel more prepared now, but I’m glad I had one for my first.”
Which one is right for me?
Both doulas and midwives offer benefits to expectant moms, and you can actually have both present during the birth process if you so choose. Whoever you choose to have in the delivery room, make sure you find someone that you feel comfortable with (remember that this person is going to get to know you, intimately).