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Doula vs. midwife vs. OB-GYN: Which path is right for you?
What’s the difference between a midwife and an OB-GYN? What about the difference between a doula and a midwife—are there any differences between the three?
It may seem like doulas, midwives, and obstetrician-gynecologists (OB-GYNs) are just different ways of saying the same thing. After all, these three professions revolve around the care of pregnant women throughout the birthing process.
These roles are very distinct, however, and figuring out which one you want to become—or which one you may want to assist with your own pregnancy—begins with understanding what distinguishes each of them.
What is a doula?
Doulas provide non-medical professional support to pregnant women, particularly during labor and delivery. Their objective is to address and advocate for the mother’s physical and emotional needs. Doulas cannot actually deliver babies because they are not medically trained to do so. Instead, they provide general support to a mother as she gives birth.
What does a doula do?
Doulas usually meet with clients a few times before the birth to help them make a birth plan and provide information about what to expect during childbirth. They may help ease labor pains with non-medical interventions such as breathing, massage, or moving the mother into different positions.
A doula gives a mother encouragement during childbirth and emotionally supports her and her partner. When they work with mothers after birth, they provide guidance on breastfeeding, caring for an infant, and caring for themselves during the postpartum period.
Barbara Timson worked as a midwife in her home country of Switzerland before eventually moving to Seattle where she has been a birth doula for over 20 years. She said that she enjoys being a doula so that she can give women the emotional support that is often lacking in the modern healthcare system.
Doulas do not need a license to practice since they are not medical professionals. However, most choose to obtain a certificate to boost their credibility. They can receive training from various organizations such as Doulas of North America (DONA) International or the International Childbirth Education Association (ICEA). A doula’s education comes more from experience than formal education.
Since they do not have a medical education, most doulas work in private practices, birthing centers, or home health.
Unlike doulas, a midwife IS a trained health professional that provides care for women across their lifespan with a focus on the processes of pregnancy and childbirth. Many midwives are also Registered Nurses (RNs).
Midwife job duties
“As a midwife, I was more responsible for making all the decisions, it becomes more medical,” Timson said. Indeed, a midwife’s duties are not restricted to caring for pregnant women—they also provide obstetric and gynecological care to women at all stages of life.
Like doulas, midwives aim to provide physical and emotional support to mothers and may act as a liaison between the patient and her healthcare team. Midwifery education programs encourage minimizing unnecessary medical interventions, which is similar to the philosophies of many doulas.
Unlike doulas, most midwives work in hospitals. In fact, 95% of births attended by Certified Nurse Midwives (CNMs) and Certified Midwives (CMs) occurred in hospitals in 2017. Midwives can also work at birthing centers and in-home health, but it’s less common.
“I’ve worked at a birth center, I’ve worked at a large tertiary care, huge public hospitals, I’ve worked at community-based hospitals, and midwifery can look really different in all of those places,” Thrower said.
Although there are several types of midwives that have differing levels of education and credentials, the majority of midwives in the United States are either Certified Nurse-Midwives (CNMs) or Certified Midwives (CMs).
Both have at least a master’s degree in midwifery and have passed a certification exam administered by the American Midwifery Certification Board. CNMs are also Registered Nurses (RNs).
Their extensive education separates them from doulas and gives them the authority to provide medical care and prescribe medication (depending on which state they practice in)—midwifery salaries are also typically higher than doulas as a result.
Midwife vs. OB-GYN vs. doulas—Do they work together?
Yes, there are many different ways in which OB-GYNs, midwives, and doulas work alongside one another. Because of their shared medical knowledge, nurse-midwives often assist OB-GYNs in a maternity ward or other women’s health settings and work with their lower-risk patients.
It’s also common for doulas and midwives to work together in birthing centers. If a woman has hired a doula and wants a hospital birth, that doula will accompany them to the hospital. A midwife (or OB-GYN, if there is a higher risk for complications) may then be the medical professional overseeing that birth, while the doula is there to provide emotional support.
OB-GYN vs. doula vs. midwife salary comparison
The salaries for these three professions vary greatly. Education is a major factor in the disparity—positions that require more schooling and training typically pay more.
Experience also makes a difference. If working as a doula or a midwife at a private practice or birth center, for example, accruing clients and positive testimonials over time may allow you to raise your rates. In addition, getting certified in any of these positions makes you more credible and can increase your earning potential.
Location could also impact your earning potential as any one of these positions. In populated metropolitan areas, all three of these professions may be able to earn more because of the higher cost of living. On the other hand, more rural locations may have fewer of these professionals available, and therefore they may earn more because of a higher demand for their services.
The Bureau of Labor Statistics does not have salary data for doulas, but does provide information about the median annual salary for nurse-midwives and OB-GYNs.
Median Salary: $120,880
Projected job growth: 6.4%
10th Percentile: $77,510
25th Percentile: $102,510
75th Percentile: $137,010
90th Percentile: $171,230
Projected job growth: 6.4%
|State||Median Salary||Bottom 10%||Top 10%|
|District of Columbia||$84,480||$65,370||$140,080|
Source: U.S. Bureau of Labor Statistics (BLS) 2022 median salary; projected job growth through 2032. Actual salaries vary depending on location, level of education, years of experience, work environment, and other factors. Salaries may differ even more for those who are self-employed or work part time.
According to the Occupational Outlook Handbook provided by the U.S. Bureau of Labor and Statistics, the median salary for the lowest 25% of Physicians (the category OBGY-NSs is filed under) is $76,910.
The field as a whole is projected to grow 3% over the next decade, and for obstetricians and gynecologists, the growth rate was slightly below the industry average at 2%.
Barbara Timson, CPM, CHBE
Professional birth and postpartum doula