Becoming a Nurse Midwife vs. a Doula: What Are the Differences?

​​More expectant parents than ever before use the services of midwives and doulas to help them through pregnancy and childbirth. These healthcare professionals both offer support before, during, and following labor and delivery. While the roles of midwives and doulas share some similarities, they have very different training and responsibilities. If you are considering how to become a midwife or doula, this guide will help you explore the key differences between the two fields, as well as the educational, licensing, and credential requirements, and career and salary prospects.

Other Types of Midwives:

– Certified midwives (CM) complete a graduate degree in midwifery, but do not have to become an RN first. CMs are licensed in only a few states.

– Certified professional midwives (CPM) usually complete an associate’s or bachelor’s degree in midwifery, but a few train by apprenticeship model. They do not need to become an RN first. They can obtain licensure in most, but not all, states. CPM training focuses on out-of-hospital birth, such as birth centers and home births.

The midwife and doula both provide services that lead to better health outcomes for parents and babies, but their specific roles differ considerably. Midwives are healthcare providers authorized to give medical care throughout pregnancy and labor and birth. Doulas, while not qualified to deliver babies or offer any other medical services, provide education, advice, and support before, during, and after childbirth.

Midwives are trained healthcare practitioners. Many midwives are APRNs with certified nurse midwife certification. Doulas, who may enter the field without a postsecondary degree, are not licensed to provide any medical care. Although they usually complete formal training in childbirth education, not all states require them to have certification.

Nurse midwives acquire CNM certification through the American Midwifery Certification Board (AMCB) after completing a graduate degree from an accredited school of nursing. Certified midwives (CM) are also certified by the AMCB after completing a graduate degree, but are not nurses.

No states require doulas to hold a state license and most do not require certification. However, a growing number of doulas seek certification to enhance their career opportunities from organizations such as DONA International and the International Childbirth Education Association (ICEA).

Nurse midwives work in obstetrician and gynecologist offices, hospitals, healthcare clinics, and birth centers. Midwives in private practice may offer special services such as at-home births. Doulas find employment in many of the same settings as midwives. They may also work from their own homes or their patients’ homes and offer support during and after home births.

Nurse midwives provide primary care and gynecological services, family planning education, and care during pregnancy, childbirth, and the postpartum period. They often focus on low-risk, low-tech births that do not involve surgical intervention, epidurals, or labor-inducing drugs, but in a hospital setting, they can manage labors that include these interventions. Other duties can include monitoring fetal growth and development, performing ultrasounds during pregnancy, and assisting with breastfeeding and infant care in the first 28 days after birth.

Doulas provide physical and emotional support throughout the childbirth process. During pregnancy, they can help clients develop birth plans and teach relaxation methods. A doula offers encouragement and physical assistance during labor, such as giving massages and suggesting coping techniques. They may also help family members participate in the birth. After childbirth, doulas support new parents as they recover, offer lactation guidance, and sometimes teach childcare techniques such as bathing and diaper changing.

The answer depends on your personal and career preferences. Doulas can enter the field after a short training course, but midwives typically hold a nursing degree and certification which can take five years or more. Midwives are healthcare practitioners, earn higher salaries and have a far wider scope of practice. However, doulas may have more flexibility in their schedules, often working independently.

There are no entry restrictions for becoming a doula. Some nurses choose to acquire doula training to help them support their patients in different ways than as a trained and licensed RN. Because the scope of practice is very different for licensed nurses, nurses who also work as doulas need to clearly delineate their roles.

​​You can become a doula with just a few weeks of training and assisting with childbirths. However, to become a certified doula, you must complete the requirements of a certification organization, which can take up to a year. Becoming certified is not required to enter the field but will give you a competitive edge in the job market.

The demand for doulas has been growing since at least 2016, when the World Health Organization recommended that doulas assist all births globally. Their acceptance has also increased as more expectant parents choose natural childbirth and birth center or at-home birth options, and as Medicaid and private insurance coverage for doulas becomes more widespread.

Educational requirements vary somewhat for birth doulas and postpartum doulas. A birth doula has training in pain management techniques, labor and delivery, and emotional and physical support before, during, and after the childbirth experience. Birth doulas typically complete 7-12 hours of childbirth education, 16 hours of birth doula training, and attend between two and five births.

A postpartum doula receives training in breastfeeding and other infant feeding methods, emotional and physical support, basic newborn care, and home visitation techniques. They must complete approximately 27 hours of postpartum doula education and provide postpartum support to at least two clients. Both birth and postpartum doulas receive training in business practices, cultural sensitivity, and ethical guidelines.

Depending on the certifying organization, certification training involves workshops and readings, birthing observation and assistance, evaluations from doctors or midwives, and business education. If you choose to pursue certification, keep in mind that each certifying organization has its own scope of practice and philosophy. Many of the major certifying organizations, including DONA International and ICEA, offer in-person and online training.

If you plan to become a nurse midwife, you need at minimum an RN license and a bachelor’s degree in nursing. A certified nurse midwife must hold an MSN or a doctor of nursing practice (DNP) degree with a midwifery specialty from a school accredited by the Accreditation Commission for Midwifery Education. Graduate programs usually require applicants to have 1-2 years of clinical experience.

After completing your graduate nursing degree, you can take the national exam for CNM certification through AMCB. Once you pass your certification exam, you need to apply for a state license as an advanced practice registered nurse.

The CPM certification offered through NARM does not require an RN license or a postsecondary degree, but most CPMs complete an associate’s or bachelor’s degree program in midwifery. While CPMs may practice in a variety of settings, their training places a special emphasis on free-standing birth centers and at-home births. Unlike CNMs, CPMs do not have prescriptive authority and cannot provide primary care services.

Nurses usually do not become doulas before deciding to enter a nurse midwife program, but some people do so they can make sure they enjoy attending births prior to committing to a graduate degree program. Some midwives choose to acquire doula or birth companion training to provide additional support to their patients, although training in labor support is included in most midwifery programs.

Nurses may decide to work as doulas because they want to connect with their patients outside their clinical role as licensed nurses, use alternative techniques to manage stress and pain, and assist them through childbirth without epidurals or medication. Because licensed nurses have a wider scope of practice than doulas, they must be careful to keep these two roles separate and make expectations clear to patients about what services they will perform.

Nurses may take doula training to earn continuing education credits required for recertification in their nursing specialty. Exploring the doula role through continuing education courses provides nurses with a non-clinical perspective on childbirth and techniques to encourage and comfort patients during labor and delivery.

Because doulas may enter the field without advanced nursing training, many students choose to become doulas to gain experience before they decide to enter nursing school. They learn what the field is like without committing the time and money required for a nursing degree. Once they complete their doula training, they can start working right away, using their earnings to pay for a midwife degree in the future.