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.
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.
“I just love the intensity of birth and the connection one has with a [pregnant] woman,” Timson said. “It’s so raw, you get so close. There’s no status. It’s just the most beautiful human connection for a short time of total trust.”
Doula requirements
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.
Midwife definition
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.
“Our focus as midwives is more typically on normal birth and really having the time to stay with patients during normal labor and birth, whereas physicians [and OB-GYNs] are by necessity constantly pulled into the more complicated patients,” said Dr. Eileen Thrower, Chair of the Department of Midwifery and Women’s Health at Frontier Nursing University.
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.
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.
What is an OB-GYN?
An obstetrician-gynecologist (OB-GYN) is a medical doctor that specializes in women’s health, reproductive health, pregnancy, and childbirth. Like a midwife, they provide care to women across the lifespan.
OB-GYN job duties
OB-GYNs are medically trained to perform a variety of procedures on women, from routine gynecological exams to fertility treatments and advanced surgeries like hysterectomies.
During the birthing process, OB-GYNs know how to recognize signs of distress in a mother or baby’s health, and will act accordingly to keep both the mother and baby healthy. They can perform Cesarean-sections when necessary.
Same as doulas and midwives, OB-GYNs are committed to ensuring that women have a positive pregnancy and birth experience. They strive to make sure women have the information needed to make informed decisions about their health.
OB-GYN education
OB-GYNs must go through years of schooling to earn their title, including at least four years of medical school and about four more years of residency to hone their specialty. They may also choose to get board certified in obstetrics-gynecology by the American Board of Obstetrics and Gynecology (ABOG).
Since they have the most education and training out of all three roles, OB-GYNs typically care for higher-risk pregnancies where complications may be more likely.
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.
Doulas as a hospital service?
Some hospitals even employ doulas as a service available to their patients.
“Swedish Hospital has its own doula program, so they’re very used to having doulas in their hospital. It’s become much more acceptable,” Timson said.
“My vision is that every maternity care setting has midwives and physicians so that you really have both those areas of focus present,” Thrower said. “And it’s moving to that in a lot of places, though certainly not everywhere.”
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.
Midwives
Nurse Midwives
National data
Median Salary: $129,650
Projected job growth: 6.4%
10th Percentile: $87,320
25th Percentile: $110,000
75th Percentile: $146,770
90th Percentile: $177,530
Projected job growth: 6.4%
State data
State
Median Salary
Bottom 10%
Top 10%
Alaska
$125,080
$104,000
$173,080
Arizona
$129,160
$39,710
$155,000
California
$189,770
$136,520
$228,900
Colorado
$135,160
$90,360
$152,010
Connecticut
$121,600
$78,060
$170,240
Delaware
$124,840
$84,920
$161,000
District of Columbia
$94,240
$85,690
$139,930
Florida
$94,010
$70,910
$136,170
Georgia
$130,540
$61,980
$163,900
Hawaii
$175,930
$132,880
$178,630
Idaho
$92,090
$22,090
$103,240
Illinois
$126,450
$104,010
$144,560
Indiana
$117,530
$77,310
$150,760
Iowa
$131,360
$76,610
$137,470
Maine
$127,790
$110,290
N/A
Maryland
$127,250
$108,670
$154,960
Massachusetts
$144,540
$116,830
$204,470
Michigan
$125,310
$90,910
$143,090
Minnesota
$126,120
$85,660
$140,680
Missouri
$124,840
$104,000
$152,000
New Hampshire
$130,720
$111,560
$142,090
New Jersey
$128,050
$113,830
$157,610
New Mexico
$115,390
$64,160
$151,880
New York
$129,790
$110,290
$165,370
North Carolina
$120,100
$95,000
$139,850
Ohio
$115,970
$99,290
$158,270
Oregon
$141,340
$118,400
$157,440
Pennsylvania
$126,940
$96,860
$148,350
Rhode Island
$135,940
$88,230
$141,260
South Carolina
$103,060
$31,740
$124,290
Tennessee
$94,640
$83,710
$125,710
Texas
$123,390
$72,150
$143,450
Utah
$134,550
$75,340
N/A
Virginia
$130,860
$77,020
$145,000
Washington
$138,200
$78,530
$166,440
Wisconsin
$131,020
$88,020
$156,290
Source: U.S. Bureau of Labor Statistics (BLS) 2022 median salary; projected job growth through 2031. 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.
OB-GYNs
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 $85,110.
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%.
Frequently Asked Questions
Can someone be more than one birth specialist?
Yes, some people choose to be both midwives and doulas. For example, they might be a dual midwife and doula at a birth center, or a midwife who works in a hospital could also have their own separate doula business.
OB-GYNs, on the other hand, tend to stick to their job since their schooling is so extensive and specific for their position.
If I am pregnant, which one should I choose?
Choosing a birth specialist all depends on your own needs and desires for your birth. No specialist is the ‘right’ one. Timson’s advised women to first establish what level of care they may need based on any health risk factors they may have.
“I always suggest that women who look for doulas or midwives or OBs, it’s really who are you and what is the likelihood that you are going to have a home birth or unmedicated birth and then make a decision according to that,” Timson said.
Factors such as age, whether this is your first pregnancy or not, if you had complications in previous pregnancies, and pre-existing health conditions like diabetes or high blood pressure can all affect your likelihood to need more medical support in childbirth.
Can someone have more than one birth specialist?
Yes, it’s common for a woman to choose more than one (or even all three) to be a part of their pregnancy and childbirth journey. It all depends on their birth plan preferences and the risk level of her pregnancy.
How much do they cost?
The amount that you may pay for their services depends on many factors including the type of provider and geographic location. Doulas typically charge a flat fee which includes an arranged package of services, such as a certain number of prenatal and postpartum appointments and support during labor and delivery.
The cost of midwives and OB-GYNs is harder to determine because their prices are more likely to be determined by the facility they work in. Midwives and OB-GYNs may be covered by insurance at little to no cost to the patient.
