midwife vs. doula — what kind of birth support do you need for your chicago-area birth?
If you’re planning your birth, you may be asking, Do I need a midwife, a doula, or both? Or — are they actually the same thing?
Most people know that midwives and doulas both offer support for birth, but often confuse the two. This comes up all the time in my world, so don’t worry if you’re not sure about it yourself. Let’s break it down.
In a nutshell, the difference between a doula and a midwife when it comes to birth support is that a midwife has clinical* responsibilities, whereas a doula is not responsible for anything clinical during your care.
Training, certification, & licensure
As clinicians, midwives of all kinds do lots of training in supporting the whole person health needs of childbearing individuals. Certified Nurse Midwives (CNMs) (like me) and Certified Professional Midwives (CPMs) are the two main type of midwives in the United States. CNMs (and Certified Midwives, or CMs) are certified by the American Midwifery Certification Board, while the North American Registry of Midwives certifies CPMs. Both types of midwives do extensive training to understand and promote healthy pregnancy and birth, as well as how to identify and evaluate risk factors and complications, and when to refer to a higher level of care (in home birth — when to refer to a hospital-based midwife or physician).
Most low-risk birthing folks (someone having only one baby; and without a major pre-existing medical problem like diabetes, high blood pressure, lupus, or a seizure disorder) are great candidates for working with midwives as their healthcare provider during pregnancy. And since most CNMs work in hospitals, you may even be able to work with a CNM if you plan to deliver in a hospital.
Because midwives are primarily held responsible for the outcomes of clients in our care, midwives’ practice is typically regulated by the state in which we practice. CNMs have been licensed by the states of Illinois for decades, whereas CPMs had to advocate for decades to be recognized and licensed — only able to apply for licensure in 2025.
In contrast, birth doulas** receive training and therefore offer support for the emotional, physical, advocacy, and educational needs of birthing folks. Great doulas will also be educated and familiar with lots of clinical aspects of pregnancy and birth, so they can better support their clients, but doulas do not make clinical recommendations or decisions. Doulas can receive formal training*** or do self-study; some will get certified, whereas others will practice without certification.
scope of care
Working with a midwife for your pregnancy and birth means signing up with a care provider — someone you will see on a regular basis throughout your pregnancy and in the lead-up to your birth, who can provide you with clinical and holistic guidance to support your and baby’s health needs. Midwives provide referrals for services like ultrasound; order labs; and some midwives (CNMs) can prescribe medications as needed. Your midwife, along with a qualified birth assistant, will attend your birth to monitor you and your baby; provide guidance and support; catch your baby or help you catch your baby; and respond to emergencies or concerns. Your midwife will provide postpartum visits — opportunities to check on you and support you as you recover from birth; feed your baby; and adjust to new parenthood — over the course of the first 6 weeks postpartum.
CNMs also provide care between pregnancies, offering well person care, preconception planning, family planning services, reproductive healthcare, and some primary/preventive healthcare. CPMs may offer some preventive care between pregnancies, but are generally focused on care for childbearing.
If you hire a doula, you will likely have 1-3 prenatal visits to get to know your doula and work together to build a birth plan. Your doula may provide childbirth education during your time together, or they may recommend specific childbirth education that will be a good fit for you. The focus of your relationship with your doula will be on how you want your doula to support you with your birth plan. That may include advocacy in your birth setting; but it may also be largely focused on things like helping you stay hydrated; finding effective or helpful positions during labor; supporting your partner; being emotionally affirming; and getting in that perfect hip squeeze!
Your doula will be on call to come to your birth when it’s time, and your doula will provide continuous labor support. Even if you’re looking forward to the support your partner, mother, sister, sibling, friend, and even your midwife can provide — there’s nothing quite like what a doula can offer. Why is it different? Doulas are experts in supporting birth, and they aren’t your loved one. This means that as a birth professional, they care for you in a way that’s different from how your partner or other loved one cares for you, and can stay steadier in their emotional support because they are grounded in knowing birth. There’s no substitute for your partner or other loved one(s) at your birth — but the doula can bring a confidence, calm, and presence that can not only set you at ease during your labor, but also give your other support people that sense of ease.
Evidence
If you’ve hung around here for a while, you’ll know that it’s important to me to promote care and interventions that are evidence-based. That means that I’m not here to sell you the latest fads or whatever wellness influencers are peddling these days.
The great news is that both midwife care and doula care are evidence-based ways to have fewer chances for unnecessary medical interventions. The best data we have about the effects of doula care during birth comes from a systematic review of 26 randomized controlled trials that studied the effects of continuous labor support from a doula, including more than 15,000 birth givers (Bohren, M.A., Hofmeyr, G., Sakala, C., et al. (2017). “Continuous support for women during childbirth.” Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD003766).
In this research, those who received continuous labor support were more like to have a normal vaginal birth (no instruments like forceps or vacuum); and less likely to have pain medication, negative feelings about their birth, and Cesarean births. That’s huge! Furthermore, people receiving that continuous support had shorter labors on average, and their babies were also less likely to have complications.
Translating that to the home birth setting, and we can see how doula support can potentially lead to fewer transfers to the hospital for pain management in labor, or possibly fewer transfers for dysfunctional labor.
And fortunately, there’s also fantastic data showing that midwifery care is also evidence-based for increasing rates of spontaneous vaginal birth (again, without instruments), labor augmentation (with medications like pitocin), epidural anesthesia, and episiotomy (ouch! most midwives hardly ever cut an episiotomy!), according to a 2024 Cochrane review (Midwife Continuity of Care Models Versus Other Models of Care for Childbearing Women. The Cochrane Database of Systematic Reviews. 2024. Sandall J, Fernandez Turienzo C, Devane D, et al.).
Finding support & building your team
So what kind of support do YOU need? If you’re planning a home birth and will be giving birth for the first time; planning your first unmedicated birth or your first vaginal birth after a cesarean; are planning to solo parent; or planning your first birth after a previous traumatic birth, I would highly recommend considering hiring both a midwife (hopefully me!) and a doula. And anyone else that just wants some extra support could also benefit from hiring a doula and a midwife.
Why? While working with a midwife to get prenatal, birth, and postpartum covered clinically is the minimum for supporting a healthy process, adding on that extra layer of support with a doula that you really like and feel comfortable with can make a huge difference in feeling cared for as a whole person while you journey through welcoming your baby.
As a midwife, I relish working as team with my clients’ doulas to make sure that we can provide that wrap-around care that can make all the difference. While I provide a list of recommended doulas who are particularly skilled in supporting home birth, you can work with any doula that you want — the doula is there for you! It’s usually a good idea to hire a doula as you enter your third trimester, to make sure you can book the doula that is the best fit for you, but if you know early on who you want to work with, don’t hesitate to book them sooner!
And if you’re leaning toward working with a midwife and planning a home birth, please reach out to me about a free consultation to see if I am a good fit for your birth team!
*I say clinical, even though this word might not be as commonly understood, rather than medical, because midwives follow the midwifery model of care, not the medical model. We will talk about that more in a future blog post!
** Doulas practice in other settings too. Some offer postpartum support; others offer miscarriage and abortion companionship or gender transition companionship; and still others offer services to dying individuals as death doulas.
*** If you’re looking to get training as a birth doula, I highly recommend the following organizations, which offer education from a reproductive justice framework: ToLabor, Birthing Advocacy Doula Trainings, and Cornerstone Doula Trainings. Also check out Chicago Volunteer Doulas, which will hopefully resume training doulas soon!
