I get this question a lot — which is really unfortunate because the roles of a doula and a midwife are REALLY different. Honestly, I think people mis-understand midwives for the most part, but let’s talk about midwives vs doulas and what the difference is. While we’re at it — let’s throw in labor nurses, how do they work in the middle of all of this?
Oh, and how do I know so much about this? Hi — I’m Hilary, many people know me as The Pregnancy Nurse. I’ve been a nurse since 1997 and I have 20 years of labor and delivery experience — including with midwives and with doulas. SO, I’m a great resource on this!
Really quick, doula or no doula I recommend EVERYONE get a birth class in. I recommend this one. Thousands of couples agree (seriously, those reviews 🤩).
What’s a Doula?
A doula is someone who helps support you during a difficult process. This article is specifically talking about LABOR doulas, but there are:
- Hospice/Death doulas
- Postpartum doulas
Honestly, if you google, there are doulas for all SORT of occasions.
Amusing since I was actually a hospice nurse before I became a labor nurse…. maybe it’s in my blood too?
Doulas do not need to be licensed, certified or whatever. Anyone can say they’re a doula for any reason. Which makes it really tricky.
So — in regards to a labor doula, they help support you in a few different ways:
- Answer basic questions
- Help you communicate with your healthcare team better
- Pain management
- Baby positioning management
The one thing they are NOT allowed to do is anything medical. That means they can not DO anything medical, or advise you anything medical.
That means they should NOT be checking your cervix, giving you IV fluids, talk about which medical choice you should make (although they can talk about options they have seen). That’s the BIG difference between doulas and the other people in this article.
Doulas can practice in homes, hospitals, birth centers…. (essentially they’re just the patient’s visitor).
🚩🚩🚩 It is a real red flag if you see a doula talking medical advice. That isn’t their place and it can be extremely problematic. When looking for a doula, you want to be sure that they’re staying away from that area.
Want to learn more about doulas, check out these posts:
- When to Hire a Doula: 4 Signs You Need a Birth Assistant
- Should You Get a Doula? – 11 Pros and Cons from an L&D Nurse
- Doula Boundaries with Heidi Mills from WhatADoulaDo
What’s a Midwife?
Midwives deliver babies. They do (or order) the interventions during pregnancy, labor & birth.
Here’s the real problem. There are three main types of midwives (names vary state to state but these are the basic categories):
- Lay Midwives — these people who’ve just seen/helped at a lot of births but have no licensure or formal training. Most often these deliver in homes.
- Professional Midwives — these people have gone through a training program and may be licensed (depending on your state). Most often these deliver in homes or birth centers.
- Nurse Midwives (more formally called Certified Nurse Midwives or CNM) — these are nurses who’ve gone on to get a masters sometimes a PhD training to become a midwife. They’re licensed and deliver in birth centers or hospitals, most often. They are actually trained to also assess babies as well.
We somehow talk about all three of these segments as “midwives” — which, honestly, is really unfair because nurse midwives have a TON of training and basically a “residency” where they deliver hundreds of babies under a preceptor.
In the hospital, most often you wouldn’t be able to tell the difference between a Nurse Midwife or an OB for the most part. However, I am a HUGE fan of nurse midwives because….
- They often come to birth in a more with a more natural plan
- They often help out more during labor and tend to be in the hospital longer while the patients are in labor (think of it as extra hands in the labor room)
- Tend to have a more holistic view of you & your birth (they often spend longer with you at your appointments as well).
That isn’t to say that I’m not a huge fan of OB’s, but my favorite is a practice in which midwives take the low-risk patients and then if that patient needs a higher level of care, they can see an OB or transfer their care to them (in the same practice) if necessary.
I talked about this on my podcast with one of my favorite midwives:
I think that midwives often allow us to do more of the interventions that doulas often help with in the labor room. You’ll see them helping with natural pain management more, educating more and helping with positioning more — similar to a doula.
I find a lot of people (especially moms/grandmas) think that midwives only deliver in homes, so when someone picks a “midwife” for their care they get antsy. Feel free to send them that podcast for more info on it!
What’s a Labor Nurse Do?
So, while we’re here — what’s the labor nurse do then?
In general your labor nurse is your advocate in labor, they also carry-out doctor or midwife orders, and mange your stay in the hospital.
They can’t order medical interventions, but they can ask for them, and carry them out (think, putting in an IV or giving medicine).
They can position you, they can help you manage pain. However, often labor nurses have more than one patient and may be assisting in other rooms if there are issues arising. They help when they’re there, but they’re not always there — if that makes sense.
So, what’s the difference between a doula, nurse and a midwife?
A lot of it has to do with scope of practice. We use that term a lot of in medical settings — it just means what we’re “allowed” to do.
A midwife can only support, shouldn’t be doing anything medical.
A nurse can assess, carry-out and ask for orders, but shouldn’t make orders on their own.
A midwife can make orders, support, and assess.
Personally, we never had the money for a quality doula in my birthing years. We needed to save that cash to survive on after baby was born.
However, I think they can be so helpful. However, the good ones usually come with a large price tag.
What I tell friends:
Join a great midwife practice (bonus if the practice also includes OB’s that can help in case you have higher risks involved), and use that.
Your insurance should cover midwife care. Your midwife will help with a lot of the interventions a doula might do during labor, they’ll educate you more in your prenatal appointments, and hopefully during birth as well.
Of course, that’s not a reason to NOT take a birth class, I recommend this one.
I should also say that I’ve seen a lot of really bad doulas. I have on idea how much experience they had (if any), but they weren’t helpful to their client, and in some cases made everything worse. Like I said above, anyone can call themselves a doula — so, as hospital staff we never know what we’re getting when someone says they’re a doula.
Vs a nurse or a CNM — we know those people at least have a basic level of training. The same can’t be said for doulas.
There are bad midwives just like there are bad OB’s or labor nurses (or doulas)… so be sure to shop around and find one that “fits” well. Some are just as medical-minded as an OB, so they vary quite a bit.
In Summary
Midwives deliver babies.
Nurses assist in the duties of an OB or a midwife.
Doulas are a support to the birthing person but should not carry out anything medical.
Hopefully, that helped. I’d love to see midwives be a bit more separated, because they really are very different, but for now that’s what we have.
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