Breaking Down Birth Support: The Differences between a Midwife, OBGYN, and Doula
As you prepare for your upcoming birth, you may wonder who will support you and your baby. You may have heard the terms "midwife," "OBGYN," and "doula" and wonder what the difference is between them. In this post, we'll explain what each of these roles entails and how they can support you during your birth.
A midwife is a trained medical professional who supports pregnancy, childbirth, and postpartum. Midwives provide medical care, including prenatal exams, childbirth support, and postpartum care. Midwives typically provide personalized care and focus on building relationships with their clients. They specialize in supporting natural (physiological) childbirth and often offer options for unmedicated births. Midwives can attend births in hospitals, birth centers, or at home. Midwives support low-risk pregnancies (90% of pregnancies are considered low-risk). If a pregnancy becomes high risk a midwife will often refer you to a OBGYN but can still offer support throughout the process.
An OBGYN is a medical doctor who specializes in the female reproductive system. OBGYNs can provide medical care, including prenatal exams, childbirth support, and postpartum care. They are trained to manage high-risk pregnancies and complicated births. Most OBGYNs practice in a hospital setting. While they can provide care for both unmedicated and medicated births, their approach may be more medically-focused. OBGYNs are trained to perform cesarean births.
A doula is a trained birth professional who provides emotional, physical, informational, and advocacy support to the birthing person and their partner during labor and birth. Doulas are not medical providers and do not perform medical tasks. Instead, they focus on providing comfort measures, such as massage, breathing techniques, and positioning support. Doulas can also provide education and advocacy throughout the birth process, helping their clients make informed decisions and advocate for their preferences. If you’re planning a hospital birth, it’s important to note that your medical provider, midwife, or OBGYN typically is only present for the final pushing phase or infrequent check-ins throughout labor. Having continuous support throughout labor has been proven to improve birth outcomes. Doulas are usually present for the duration of active labor until a few hours after the baby is born. More information about doula support and if it’s right for you can be found here.
Models of Care
midwives and OBGYNs often work in one of the four models of care. Doulas are typically hired directly by expectant parents and can be present in any of these models. Ask which model of care is used where you are giving birth, as well as open-ended questions regarding what care will look like during labor.
The medical model of care is obstetrician-led, where the OB typically only arrives when you're pushing.
The family medicine model of care varies but is also obstetrician-led, and the OB may be present for labor or only for birth.
Midwifery-led care is led by midwives who support throughout labor and refer out to an obstetrician if abnormalities arise. This is the most common model globally, except for the USA and Canada, and is the most evidence-based model, meaning it yields the best birth outcomes.
Lastly, the shared care model is when OBs and midwives work collaboratively, likely with OB taking the lead. In most parts of the USA, if there are midwives in a hospital practice, they are practicing under a shared care model.
All of these models of care include nursing support. While nurses are knowledgeable and caring professionals, they have strict guidelines regarding how much time they can spend which each of their patients. For every 10 hours of labor, typically, a nurse is present for 3 hours. Of those three hours, about 1.5 of those hours are used for documentation. Much of the time is spent checking vitals and fetal heart tones. For more hands-on support during labor, a doula is a terrific option.
Choosing Your Birth Team
Each role can provide valuable support during your birth, and many families choose to have all three on their birth team. As you consider who you want on your team, think about what type of birth you want and what kind of support you need. If you are planning an unmedicated birth and want personalized care, a midwife may be a good fit for you. If you have a high-risk pregnancy or anticipate needing medical interventions, an OBGYN may be the best choice. If you want to go from the unmedicated route but would like assurance in meeting an OBGYN in the chance you need them, maybe you work with both a midwife and an OBGYN. And if you want emotional, physical, informational, and advocacy support during labor, a doula can be an excellent addition to your team in any of these scenarios.
Understanding the difference between a midwife, OBGYN, and doula can help you make informed choices about who you want on your birth team. It's up to you to decide who will the best fit for your needs and preferences. I recommend interviewing potential birth team members with open-ended questions to ensure you have the support you need for a positive birth experience. We cover this in detail in my birth courses.
This information is for educational purposes only and is not meant for diagnosis or treatment. Use of this information should be done in accordance with your healthcare provider.
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Meet the Author
Clara O'Rourke (she hers),
Holistic Doula & Childbirth Educator.
I am a researcher turned total birth nerd with a passion for supporting people birth in their full power! I guide people through their pregnancy, labor, and postpartum journey by helping them overcome fear or anxiety about birth, providing evidence-based information so they can make informed decisions, and ensuring they have everything they need to birth with confidence. Birth is sacred and it should be treated that way. I am committed to providing support for birth and beyond, regardless of a person's background, sexual orientation, gender identity or expression, or relationship status. También ofrezco mis servicios en español. I wish you and your growing family the brightest of beginnings!