Becoming A Midwife Vs. A Doula: What Are The Differences?

Midwives and doulas both support patients before, during, and after labor and delivery, and more expectant parents are using both. The roles look similar from the outside, but the training, credentials, and scope of practice are very different. Here's how they compare, along with what it takes to enter each field.

Midwives and Doulas at a Glance

Nurse Midwives

Education: Certified nurse midwives are advanced practice registered nurses (APRNs) who hold an MSN or a Doctor of Nursing Practice (DNP). Admission to a graduate midwifery program requires a bachelor's degree in nursing and an RN license.

Median salary: $128,790 (BLS, May 2024).

Roles: Midwives provide education and healthcare throughout pregnancy, supervise labor and delivery, and handle followup care after childbirth. They also deliver primary care services, well checks, and contraception.

Certification and licensure: Nurse midwives certify as CNMs through the AMCB, then apply for state licensure. Every state license requires certification first.

Other types of midwives include certified midwives (CMs), who complete a graduate midwifery degree without becoming an RN and are licensed in only a limited number of states, and certified professional midwives (CPMs), who usually hold an associate's or bachelor's degree in midwifery, don't need an RN license, and train for out-of-hospital births in birth centers and homes.

Doulas

Education: Doulas don't need a postsecondary degree. They typically complete training in childbirth education and labor support.

Median pay: About $50,000 (Payscale). The BLS doesn't track doulas as a separate occupation.

Roles: Doulas provide education and emotional support before, during, and after childbirth. A doula offers nonmedical guidance and doesn't perform medical services.

Certification and licensure: No state requires a doula license, and few require certification. Many doulas certify as a birth and/or postpartum doula.

Key Differences

Both roles lead to better outcomes for parents and babies, but they work in different lanes. Midwives are healthcare providers authorized to deliver medical care throughout pregnancy, labor, and birth. Doulas are not qualified to deliver babies or provide any medical service; they provide education, advice, and support.

Education. Midwives are trained healthcare practitioners, and many are APRNs with CNM certification. Doulas can enter the field without a postsecondary degree and aren't licensed to provide medical care. They usually complete formal training in childbirth education, though not all states require certification.

Licensing and certification. Nurse midwives earn CNM certification through the AMCB after completing a graduate degree from an accredited nursing school. CMs are also certified by the AMCB after a graduate degree but aren't nurses. No state requires doulas to hold a license, and most don't require certification, though a growing number certify through organizations such as DONA International and the International Childbirth Education Association (ICEA).

Workplace. Nurse midwives work in OB-GYN offices, hospitals, clinics, and birth centers, and those in private practice may offer home births. Doulas work in many of the same settings and also from their own or their patients' homes, supporting home births.

Scope of practice. Nurse midwives provide primary care and gynecological services, family planning education, and care through pregnancy, childbirth, and the postpartum period. They often focus on low-risk, low-intervention births, but in a hospital they can manage labors involving epidurals or labor-inducing drugs. Their work can include monitoring fetal growth, performing ultrasounds, and assisting with breastfeeding and infant care in the first 28 days. Doulas provide physical and emotional support: helping develop birth plans, teaching relaxation methods, offering massage and coping techniques during labor, and supporting new parents afterward with recovery, lactation, and basic newborn care.

How to Become a Doula

Requirements differ for birth and postpartum doulas. A birth doula trains in pain management, labor and delivery, and physical and emotional support, typically completing 7 to 12 hours of childbirth education, 16 hours of birth doula training, and attending two to five births. A postpartum doula trains in infant feeding, basic newborn care, and home visitation, completing roughly 27 hours of education and supporting at least two clients. Both train in business practices, cultural sensitivity, and ethics.

Certification varies by organization and can involve workshops, readings, birth observation and assistance, provider evaluations, and business education. Each certifying body has its own scope and philosophy. Major organizations including DONA International and ICEA offer in-person and online training.

How to Become a Nurse Midwife

You'll need at minimum an RN license and a bachelor's degree in nursing. A CNM holds an MSN or DNP with a midwifery specialty from a program accredited by the Accreditation Commission for Midwifery Education. Graduate programs usually require one to two years of clinical experience. After your graduate degree, take the AMCB certification exam, then apply for a state license as an APRN.

A certified professional midwife takes a different route. The CPM credential through NARM requires neither an RN license nor a postsecondary degree, though most CPMs complete an associate's or bachelor's program in midwifery. Their training emphasizes free-standing birth centers and home births. Unlike CNMs, CPMs have no prescriptive authority and can't provide primary care.

Can a Nurse Also Work as a Doula?

Yes. Some people work as doulas before committing to a midwifery program to confirm they enjoy attending births. Some midwives add doula training to support patients in nonclinical ways, though labor support is already part of most midwifery programs.

Because a licensed nurse has a wider scope of practice than a doula, a nurse working in both roles has to keep them separate and set clear expectations with patients about what services they'll provide. Nurses sometimes take doula training for continuing education credit, which also gives them a nonclinical perspective on childbirth and new techniques to comfort patients during labor.

For people considering nursing, doula work is a low-commitment way to gain birth experience first. Doula training is short, lets you start working quickly, and can help fund a future midwifery degree.

Common Questions

Whether to become a midwife or a doula depends on your goals. Doulas can enter the field after a short course, while midwives hold a nursing degree and certification that can take five years or more. Midwives are healthcare practitioners with higher salaries and a far wider scope of practice; doulas often have more schedule flexibility and frequently work independently.

There are no entry restrictions for becoming a doula. You can start with a few weeks of training and birth experience, but certification through an organization can take up to a year. Certification isn't required to work, though it gives you an edge in the job market.

Demand for doulas has grown since at least 2016, when the World Health Organization recommended doula support for all births. Acceptance has risen as more parents choose natural childbirth and out-of-hospital options, and as Medicaid and private insurance coverage for doulas expands.