Expectant parents have plenty of decisions to make about pregnancy and birth, and choosing a support system for the duration of the pregnancy is chief among them. An obstetrician/gynecologist (OB/GYN), midwife, and doula are all available to assist, but it can get confusing to figure out who you need, when, and where.
Knowing what each of these birth-workers is trained and authorized to do will help you build the best support team for your whole family. Ahead, we’ll break down the difference between these three key roles in order to help you decide what’s right for your birth plan.
What Is an OB/GYN?
An obstetrician/gynecologist, commonly known as an OB/GYN, is a “physician trained in women’s health,” explains Greg Marchand, MD, a board-certified OB/GYN in Arizona. Doctors in this field specialize in both obstetrics (which covers pregnancy, childbirth, and postpartum health) and gynecology (which covers female reproductive health). As with all doctors, OB/GYNs have completed extensive medical education, residency, and additional years of experiential training. They also must pass a certification exam overseen by the American Board of Obstetrics and Gynecology.
An OB/GYN provides medical support throughout the duration of the pregnancy. They conduct ultrasounds, listen to the baby’s heartbeat, and take measurements at prenatal appointments to assess the health of the parent and baby.
Throughout regularly scheduled appointments, parents and physicians will discuss birth plans, including pain management and preventative care for potential complications. Even after birth, an OB/GYN provides postpartum care for up to eight weeks and continues ongoing reproductive health checks. Most health insurance plans cover prenatal care, hospital childbirth services, and newborn care, but additional emergency care for the parent and baby (including intensive care units) may not always be covered at the same levels.1
What Is a Midwife?
A midwife is a health professional who specializes in caring for pregnant parents and their babies. Though not technically a physician, midwives have specialized training too. Since physicians have limitations on practicing outside of a hospital or doctor’s office, parents who opt to birth at home or in a birthing center rely almost exclusively on midwives.
Midwifery care is often covered by medical insurance, though patients may have to pay their provider upfront and later be reimbursed.
Erin Andrew, a certified nurse midwife (CNM) who holds a Bachelor’s and Master’s Degree in Nursing from the University of Pennsylvania, explains that there are multiple types of midwives. They can be licensed—or not—depending upon the state.
Although there are exceptions, Andrew notes that lay midwives, certified professional midwives (CPMs), and direct entry midwives work in homes and birth centers, while certified midwives (CMs) and certified nurse midwives (CNM) work in the home, birth centers, and hospitals.2 “CNMs first get a Bachelor of Science in nursing, so they are nurses or registered nurses, while CMs are not,” she explains.
While lay midwives often have years of practical experience, they generally do not have certified medical training, are not authorized to deliver in hospitals, and are not always covered by insurance companies.
A certified midwife’s role depends on their training, but generally, they offer prenatal appointments and pregnancy monitoring.
In addition to prenatal, postpartum, and labor and delivery care, CNMs can provide patient care from adolescence through menopause, as well as gynecological and family planning services, including abortion and trans-affirming care.3 CNMs can also perform many procedures, including surgical abortions. They can also assist with C-sections and collaborate with other physicians on complicated cases; however, midwives generally do not take on patients who are considered high-risk.
In cases of milder medical complications, sometimes an OB/GYN works with a midwife in a hospital setting. “I have backed up many certified nurse midwives in my career,” says Dr. Marchand. “I have enjoyed working with them.”
Although a hospital birth does not usually involve both an OB/GYN and midwife, there are cases “where a medically complicated patient will have an MD as their primary provider but will elicit advice from a midwife for labor support,” says Andrew.
Midwives sometimes take more natural and holistic approaches that are uncommon in hospitals, like non-medicated births. By law, some midwives are not allowed to administer pain medication, so parents planning for such treatments might need an OB/GYN present as well.2
What Is a Doula?
The word doula means “woman who serves” in Greek. Though doulas do not have formal medical education, they are trained to comfort and guide parents through the labor and delivery process, and often act as patient advocates.4
Fatima Abdallah, a certified doula for Innate Postpartum Care with expertise in traditional Moroccan postpartum medicine, notes that there are many different types of doulas that go beyond the pregnancy and birthing process. There are also postpartum doulas, full-spectrum doulas, fertility and pregnancy termination doulas, and even death doulas. “Doulas hold space for people through major life events in their journeys,” Abdallah elaborates.
Birth doulas provide emotional and informational support by helping parents understand their options and advocating for a patient’s preferences during the birth process. Doulas often help parents manage labor at home before going to the hospital. Depending on hospital policy, doulas can be present to soothe a birthing parent, though they cannot override the medical care decisions of a nurse or physician. For home births, doulas might work in tandem with a midwife to care for the birthing parent, as well as to tend to the emotions of birth partners and other children.
Postpartum doulas help parents adjust to life with a newborn and ensure that patients physically and emotionally recover from birth. Abdullah says that “they help you troubleshoot challenges that come up for your individual circumstances and help you find ways to work with these challenges.” Such obstacles might include formula feeding, breastfeeding, or sleep training.
While some parents choose between either a midwife or an OB/GYN, doulas are a bonus helper who can work with both types of medical professionals. Rather than offer medical assistance, they comfort, encourage, and support parents with breathing exercises or relaxation techniques during labor.4 Doulas don’t need graduate-level education, though many are credentialed.
Because doulas do not always have medical training, they are not usually covered under health insurance plans. However, some states do cover doulas under Medicaid, so be sure to check with your insurance provider. Also, many doulas offer sliding scales to families in need.
Tips For Choosing Your Birth Team
Choosing between an OB/GYN, midwife, and doula depends on your health risks, pain management plan, and finances. Midwives tend to focus on low-risk pregnancies, along with unmedicated, non-surgical, or non-hospital births.
OB/GYNs almost exclusively operate in hospitals, and they are the best choice for parents with high-risk pregnancies, pre-existing conditions, and/or a low threshold for pain. Although both OB/GYNs and certified midwives are typically covered under health insurance, financial concerns can arise for those who are uninsured or whose plan has a limited number of in-network providers. Additionally, some providers do not accept insurance, so you might have to fund services up-front and be reimbursed later.
Doulas are not usually medical professionals, so you’ll have to foot the bill on your own. However, birthing parents tend to get a great deal of value from doulas who are with them every step of the way. Doulas are particularly helpful for single parents, parents without strong local support networks, and/or those who have experienced past trauma. They can also help birth partners and siblings learn how to cope with the maternity and labor experience, especially for home births.