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Pregnancy

Midwives v Doulas: How About Both? 3 Ways to Compare Midwifery and Doula Services

Written By
Jessalyn Ballerano
Certified Childbirth Educator & Doula

How can a doula or a midwife serve your pregnancy, labor, birth and postpartum support? Turns out, in pretty different ways. Here are the top three differences – and similarities - between midwifery practitioners and doulas.

1. Medical v. Non-Medical

  • Prenatal Care
  • Labor Care

2. Costs

  • Covered by Insurance
  • Out-of-pocket

3. Benefits

  • Client-led Care
  • Fewer Interventions
  • Lasting Successes

Medical v. Non-Medical Health Care

Doulas and midwives may be unfamiliar to anyone who has either had a baby through the more standardized hospital-based system of maternity care, or to people who have yet to be pregnant or expecting. As parents and families become more aware of their options in prenatal and maternal health care, childbirth education, and labor and delivery support, it’s important to get clear on which roles do what.

Midwives are primary medical care providers for typical low risk pregnancies and the reproductive cycles of pregnant, birthing, postpartum and menopausal people. They give medical care and advice and help a birthing person to deliver their baby. They may serve as the primary medical professional a pregnant client receives care from, and they may share or transfer care with an OB-GYN if someone’s health status or desires determine that to be the most appropriate or safest choice. 

Midwifery practices see clients at home, at clinics or private offices, in standalone birth centers, and sometimes in larger hospital settings, although the integration of midwifery with higher-risk obstetrics services is much more common in counties outside of the United States, which has some of the highest infant and maternal mortality and morbidity rates among technologically and democratically developed nations.

Prenatal Care takes place at least as frequently as standard prenatal health practice guidelines, and may include longer or more frequent visits, biweekly and then weekly later in pregnancy. Standard check-ups with a midwife include all required medical care for a pregnancy and may include:

  • Blood pressure
  • Fetal heart tones monitoring
  • Vaginal exams if appropriate
  • Assessments, diagnosis, some prescriptions
  • Nutritional and/or herbal guidance
  • Pregnancy labs & screenings
  • Comfort & emotional check-in
  • Partner education & support
  • Birth planning

Labor Care usually starts at a point described as “active labor” when uterine contractions are in a regular pattern in a full term pregnancy. Midwives and their assistants oversee a laboring person and fetus’ progress with regular monitoring and an array of tools and medications, following protocols such as:

  • Regular checks and documentation of fetal heart tones and estimated position
  • Assessments of labor progress, safety, and overall status of adult and baby
  • Support and encouragement in labor techniques and methods such as positions, movement or more advanced maneuvers
  • Application of certain medications or interventions such as labor augmentation drugs, saline fluids, or antibiotics
  • Monitoring and assessment for any complications of labor that would necessitate a non-emergency or more urgent transfer of care
  • Assistance in delivery of baby, care and assessment of the newborn and birthing person
  • Intensive documentation of all readings, medications, and procedures

Doulas are non-medical perinatal professionals who generally serve pregnant and birthing clients, and may also specialize in supporting postpartum, lactation, fertility, or infant care journeys. Doulas may or may not also practice other modalities of care or medicine, such as acupuncture, massage therapy, or nursing, but within their scope as doulas they do not diagnose, treat or give medical advice, nor do they interfere with medical oversight and treatment. They do not generally catch babies unless no medical staff are around and they are the only person available to assist a laboring person.

Some doulas are profoundly adept as advocates, parent educators, or infant care specialists and many hold multiple certifications in the realm of parental, pregnant, and newborn wellness. Birth doulas usually see their clients in their homes and at hospitals, as well as online. Many are also educators and may host group classes or pregnancy cohorts, or partner with midwifery practices to provide learning and holistic supplementation to standard prenatal care.

Prenatal Care might not happen if a doula is provided to someone through a clinical volunteer rotation, but usually birth doulas meet with their clients at least a few times before the end of pregnancy, and postpartum doulas often prefer to meet a client before birth for the purposes of becoming familiar and planning. These visits might include:

  • General or in-depth education about pregnancy, childbirth and postpartum
  • Birth planning assistance and prenatal education about medical options in birth
  • General wellness self-care, tips, inspiration, and encouragement 
  • Help finding high-quality, useful resources
  • Physical practice in labor techniques and partner support
  • Lactation, infant feeding and infant sleep planning
  • Debriefing, emotional support and continuity of support navigating pregnancy
  • Advocacy practice, help understanding your rights, or systemic logistical support

Labor Care from a doula includes all the things that medical providers may not have as much time for, such as:

  • Body massage and soothing touch
  • Facilitating hydration and nourishment
  • Assistance with each contraction’s coping mechanism, be it breath, movement, or something else
  • Continuous focus on the laboring person’s comfort, including temperature, lighting, and sense of safety
  • Translating or repeating information about labor progress or options that arise
  • Helping the client to ask questions or better understand their options
  • Protect and serve client in receiving culturally appropriate, respectful care
  • Capturing special moments in photography and video

Costs of Midwifery and Doula Services

Even as midwives are skilled, low-cost, primary care providers with excellent outcomes, and serve the majority of low-risk birthing people in most developed nations, obstetrics is the standard of insured pregnancy care in the United States. As a result of this trend and some of the historical occurrences that led to today’s maternity care economics, only some midwifery services are currently covered by insurance. Likewise, although doula services come with outstanding benefits for immediate and long-term health outcomes, despite being non-medical in nature, only some of a doula’s services are considered reimbursable.

Covered services will vary by state and insurance plan, but in most cases, your primary prenatal medical visits will be partially or fully covered. Some midwives work with medical groups or physicians directly, others outsource certain labs so that their clients can cover costs and access testing more easily. At this time, coverage for perinatal health services associated with hospitals, birth centers and clinics is more common than for home birth services. Find out ahead of time about anticipated billing so that you have realistic expectations for your care budget and reimbursement processes. 

Common midwifery costs insurance might cover could include:

  • The recommended 1-2 ultrasounds for prenatal care
  • Standard blood work, screenings and prenatal check-ups
  • Generic prescriptions during pregnancy
  • Emergency services
  • All or a portion of postpartum follow-up care

Common doula costs insurance might cover could include:

  • Childbirth education services
  • Lactation professional services, if certified
  • Postpartum recovery in-home care

Ask your midwife and/or doula about their provider codes and any other billing details that may help you claim a reimbursement for such services.

Out-of-Pocket services, of course, can include any number of services. For a doula or midwife, depending on how you access them and where you live their costs may be entirely or partially reimbursable – overall, the costs of midwifery care are considered relatively low, even in a hospital setting. Doulas nationwide range from a few hundred to about $2500, with midwives costing about twice that or more, comparable to other private medical practices. Many community-based providers have sliding scale or donation funds for lower-income families, and virtual doulas and childbirth educators provide a convenient, affordable alternative to in-person classes. 

 Biggest Benefits of Midwifery & Doula Care

Throughout human history, midwives have been the primary care providers for people giving birth, and today practice in all kinds of settings to support birthing people, infants and families. Doulas have stepped into the role of expert coaches, guardians, and nurturers of birthing people in the obstetrician-led hospital setting. Whether either of these professionals is a good fit for you depends most of all on your preference but also your health history, birth goals, and beliefs about maternity care.

  • Client-Led care is a hallmark of both midwifery medical care and doula services. Both professionals prioritize client-led collaborative decision-making, informed choice, listening to patient feedback, and prioritizing lifestyle and cultural elements of someone’s pregnancy experience. This generally leads to higher rates of client satisfaction in discussing options and receiving care.
  • Fewer interventions are one of the evidential benefits of doula care, and definitive of the low-intervention style of management that most midwives practice. This could be a perfect approach for you if you are a healthy person wanting to avoid common interventions such as induction techniques, pain medications and drugs to speed up labor.
  • Lasting Successes including exclusive breastfeeding, smoother postpartum recovery, and avoidance of Cesarean sections are all benefits that have been documented in research about doulas and midwives.

Overall, goals we all share for birthing people and babies are best supported by inter-professional collaborations across medical and non-medical care providers. That’s why Seven Starling combines expert doula coaching with small-group social support and an OB-approved curriculum developed by midwives, childbirth educators and reproducing people.

We hope this overview of midwives, the care they provide, and the ways a doula can support a pregnancy, birth or postpartum experience was informative and clear. Learn more about relevant prenatal and postpartum topics at the links below, or book a free consult about our virtual support services today!

Selected Sources

Jessalyn Ballerano
Certified Childbirth Educator & Doula
Jessalyn (she/her) is a Childbirth Educator and Doula serving families in the San Francisco Bay Area, nationwide, and in her new home of Eugene, Oregon. She started studying birth in 2010 as an anthropologist, and often brings a systemic approach to helping birthing people to understand their options, experiences and possibilities. She integrates evidence-based training and research with a holistic mindset and an activist’s passion for reproductive empowerment. Jessalyn serves on the board for the Oakland Better Birth Foundation, where birthworkers, birthing people, and care providers work together to end preventable maternal and infant mortality and address racial disparities in health care. Jessalyn is a CAPPA-Certified Childbirth Educator, SMC Full-Circle Doula.
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