Childbirth is one of the most profound and life-changing moments in a family’s journey, and the people who support you through it play an incredibly important role. The professionals you invite into your pregnancy and birth experience—whether they’re obstetricians, midwives, or doulas—can deeply influence how you feel about this transformative time. Each of these birth workers brings their unique strengths and philosophies to the table, and understanding their roles can help you make confident decisions about your care.
When I talk to families, I often hear the same questions: What’s the difference between a midwife and a doctor? What does a doula do? Can they work together? These are great questions because choosing the right care team isn’t just about where you give birth or what type of birth you hope for. It’s about surrounding yourself with people who will support and respect your values, preferences, and goals—people who see birth as a medical event and a personal, emotional, and even sacred experience.
Obstetricians bring extensive training in managing complications and performing surgical births, which is vital in certain situations. Midwives focus on normal, healthy pregnancies and often take a more holistic, relationship-based approach. Doulas are there to provide continuous emotional and physical support, no matter where or how you choose to give birth. Each plays an important role, and the right combination of support depends on your needs and vision for your birth.
As a Certified Nurse Midwife, I’ve had the privilege of working with families in all kinds of birth settings—from homes to hospitals—and I’ve seen firsthand how each type of birth worker contributes something valuable. While I strongly advocate for the midwifery model of care, I believe collaboration between obstetricians, midwives, and doulas can create an incredibly supportive and empowering experience for families.
In this article, we’ll explore the roles and philosophies of these birth workers, highlighting their differences, where their responsibilities overlap, and how they can complement each other. Whether you’re planning a home birth with a midwife, a hospital birth with an obstetrician, or a hybrid experience with elements of both, my goal is to give you the information you need to build a care team that feels right for you. By the end, I hope you’ll feel better equipped to navigate your options and make choices that honor your vision for pregnancy, birth, and beyond.
Who Are Birth Workers?
Birth workers are professionals who support women and families during pregnancy, labor, and postpartum. While they aim to ensure a safe and positive birthing experience, their training, scope of practice, and philosophies vary widely. Let’s examine the roles of physicians, midwives, and doulas to better understand their differences and where their expertise intersects.
The Physicians: Experts in Medicalized Birth
Physicians, including obstetricians (OB/GYNs), maternal-fetal medicine specialists (perinatologists), and family physicians, are highly trained medical professionals. They are essential for managing high-risk pregnancies, complications, and emergencies.
Training and Scope of Practice
- Obstetricians (OB/GYNs): Complete medical school and a four-year residency in obstetrics and gynecology. They specialize in both routine and complex pregnancies and can perform surgeries like cesarean sections.
- Maternal-Fetal Medicine Specialists: Focus on high-risk pregnancies, often involving advanced diagnostic tools and surgical expertise.
- Family Physicians: They provide comprehensive care for low-risk pregnancies and offer continuity of care from pregnancy through postpartum. In my experience, not many of these physicians are still performing birth services.
Philosophy of Care
Physicians typically follow a medicalized model of childbirth, which emphasizes interventions like continuous monitoring, IV fluids, and epidurals. This approach ensures safety in high-risk situations but often leads to higher rates of interventions like inductions or cesarean sections.
The Midwives: Advocates for Holistic and Personalized Care
Midwives are the cornerstone of natural and minimally invasive birth practices. They focus on empowering women through education, informed consent, and continuous support. I will go ahead and admit my bias toward midwife care for low-risk pregnancies; after all, I am one…
Types of Midwives
- Certified Nurse-Midwives (CNMs): Registered nurses with advanced degrees and training in midwifery. They provide a full spectrum of women’s health services and can practice in hospitals, birth centers, and home birth settings. This is the certification I hold.
- Certified Midwives (CMs): Similar to CNMs but without a nursing background. They are licensed in fewer states.
- Certified Professional Midwives (CPMs): Specialize in home and birth center births, often trained through apprenticeships or specialized programs.
- Licensed Midwives (LMs) and Direct-Entry Midwives (DEMs): Focus on low-risk, out-of-hospital births with training that varies by state.
Philosophy of Care
Midwives emphasize the natural process of childbirth, using minimal interventions and focusing on the mother’s preferences. They support techniques like water immersion, breathing exercises, and mobility during labor. While they are experts in normal pregnancies, they collaborate with physicians for complications or emergencies.
The Doulas: Emotional and Physical Supporters
Doulas are non-medical birth workers who provide emotional, physical, and informational support to mothers during pregnancy, labor, and postpartum.
Role and Training
Unlike physicians and midwives, doulas do not perform clinical tasks like monitoring or delivering babies. Instead, they focus on creating a positive birthing environment by:
- Assisting with comfort measures like massage and breathing techniques.
- Advocating for the mother’s birth preferences.
- Providing continuous emotional support.
Why Doulas Matter
Studies have shown that having a doula present during childbirth can lead to lower intervention rates, shorter labor, and higher satisfaction with the birth experience. Doulas complement the care physicians and midwives provide, ensuring that the mother feels supported and empowered.
Key Differences and Overlaps
While physicians are essential for managing risks and emergencies, midwives provide personalized, holistic care for low-risk pregnancies. Doulas, on the other hand, bridge the emotional gap, offering consistent support in any setting.
Collaborative Care: Working Together for the Best Outcomes
Childbirth is not a one-size-fits-all experience, and every mother deserves a birth team that meets her unique needs. The ideal team often combines the strengths of various birth workers, fostering collaboration to ensure medical safety and personalized care. By working together, midwives, physicians, and doulas create a supportive and well-rounded approach to childbirth that prioritizes the mother and baby’s health and well-being.
Midwife-Physician Collaboration: Bridging Expertise
One of the most effective collaborative models involves midwives and physicians working together to manage slightly higher-risk pregnancies. As a Certified Nurse Midwife (CNM), I often collaborate with trusted physicians when cases extend beyond the typical scope of midwifery care—situations like breech presentation, twins, or mothers managing conditions like gestational diabetes. These partnerships allow seamless care transitions and ensure mothers receive the right support for their circumstances.
Finding physicians willing to collaborate with midwives can be challenging, as not all are open to midwifery’s holistic and low-intervention approach. However, those who embrace this collaboration are invaluable allies. They respect the midwifery model of care and recognize the benefits of shared expertise. This teamwork creates a safety net where mothers can still have a low-intervention birth, with the assurance that medical support is readily available if needed.
Midwife-Doula Partnership: Balancing Clinical and Emotional Support
In home births or birth center settings, a midwife-doula partnership brings together the best of both worlds: clinical expertise and unwavering emotional support. While the midwife focuses on monitoring the mother and baby’s health and managing the clinical aspects of labor and delivery, the doula provides comfort, reassurance, and advocacy. This combination empowers mothers, helping them feel safe and supported throughout the birthing process.
Physician-Doula Team: Enhancing Hospital Births
Incorporating a doula into a physician-led team can provide a more balanced and supportive experience for hospital births. Physicians bring their medical expertise to manage high-risk cases or unexpected complications, while the doula ensures the mother’s emotional needs are met. This partnership creates a more holistic environment in a hospital setting, helping mothers feel heard, respected, and cared for during what can sometimes feel like a more clinical experience.
Benefits of Collaboration
When birth workers collaborate, mothers receive the best of both worlds:
- Medical Safety: Physicians and midwives bring clinical expertise and the ability to handle emergencies or complications.
- Personalized Care: Midwives and doulas emphasize the mother’s autonomy and preferences, supporting a birth experience that aligns with her values.
- Emotional Support: Doulas focus on the mother’s mental and emotional well-being, creating a calm and reassuring environment during labor.
Collaboration allows for a flexible, adaptable approach to childbirth, ensuring that mothers and babies receive the care they need, no matter the circumstances. Whether it’s a home birth, a birth center experience, or a hospital delivery, a collaborative birth team prioritizes safety, comfort, and empowerment.
In my practice, I’ve seen the profound impact of this teamwork. The trust and mutual respect between midwives, physicians, and doulas create a foundation for positive birth outcomes, even in complex cases. It’s a reminder that, at its core, childbirth is about more than just the technical aspects—it’s about supporting women as they bring life into the world.
Choosing the Right Birth Worker(s)
Selecting your birth team is a deeply personal decision that significantly impacts your pregnancy and birthing experience. The right combination of birth workers can provide the care, expertise, and support you need to feel confident and empowered throughout your journey. Here are some key factors to consider as you make this important choice:
1. Risk Level: Matching Expertise to Your Needs
Your pregnancy’s risk level is one of the most critical factors in deciding which birth worker(s) to include.
- High-Risk Pregnancies: For conditions like preeclampsia, gestational diabetes, or a history of complicated deliveries, having a physician on your team is ideal. Obstetricians and maternal-fetal medicine specialists bring specialized medical expertise and access to advanced interventions, ensuring the highest level of safety for both mother and baby.
- Low-Risk Pregnancies: Midwives are an excellent choice for healthy mothers with uncomplicated pregnancies. They specialize in low-risk pregnancies and emphasize a natural, minimally invasive approach, focusing on empowering women and respecting their autonomy.
2. Setting: Where You Plan to Give Birth
Where you plan to deliver plays a significant role in determining your birth team.
- Home Births: Home births typically involve midwives, such as Certified Nurse Midwives (CNMs) or Certified Professional Midwives (CPMs), trained to provide safe, evidence-based care in a home setting. Many mothers also choose to include a doula for additional emotional support.
- Birth Centers: Birth centers often feature midwife-led care with options to include a doula for holistic support. These settings balance the comfort of home and the proximity to medical facilities, offering a more natural approach while maintaining safety.
- Hospital Births: Hospital births are often physician-led, particularly for high-risk pregnancies or cases requiring advanced medical care. However, many hospitals also support midwife-attended births and encourage doulas to provide continuous emotional support as part of the care team.
3. Your Preferences and Birth Philosophy
Your preferences and philosophy about childbirth are key in shaping your birth team.
- Natural Birth Preferences: Consider a midwife-doula partnership if you value a low-intervention birth experience. Midwives prioritize natural pain management techniques like movement, hydrotherapy, and breathing exercises, while doulas provide emotional support and advocacy.
- Desire for Medical Interventions: If you anticipate wanting pain relief, such as an epidural, or feel more comfortable with access to advanced medical care, a physician-led team is likely the best fit. Physicians excel in managing pain relief options and addressing complications as they arise.
- Hybrid Approach: Some families choose a collaborative model that blends the strengths of multiple providers. For instance, having a midwife as your primary caregiver but working closely with a physician for higher-risk scenarios can offer the best of both worlds. Adding a doula to this team can enhance emotional and physical support during labor.
Questions to Ask Yourself When Choosing Your Team:
- Do I prefer a more natural or medicalized approach to childbirth?
- What setting feels most comfortable and safe for me?
- Am I comfortable with the level of risk my chosen provider specializes in?
- How important is continuous emotional support during labor and delivery?
A Tailored Team for Your Unique Journey
Choosing the right birth worker(s) is about finding a team that aligns with your values and provides the care and support you need for a positive experience. Whether you opt for a physician-led hospital birth, a midwife-doula partnership at home, or a combination of all three, the goal is to create a birth team that makes you feel safe, respected, and empowered as you welcome your baby into the world.
Remember, there’s no “one-size-fits-all” solution. Trust your instincts, ask plenty of questions, and choose the right team.
Final Thoughts
Birth is one of life’s most profound and transformative experiences, and the people who support you during this journey play an essential role in shaping how you feel about it for years to come. Birth workers—whether physicians, midwives, or doulas—each bring unique expertise, perspectives, and care styles. Their diverse but interconnected roles create a safety net of physical, emotional, and medical support to help ensure you and your baby have the best possible outcome.
Choosing your birth team is deeply personal, and there is no right or wrong answer. It’s about finding the providers who align with your values, address your needs, and make you feel confident and supported. Whether you choose the expertise of a physician, the holistic care of a midwife, the steadfast emotional support of a doula, or a combination of all three, your decision is valid and powerful.
Everyone on your team shares the ultimate goal: a safe, healthy, and positive birth experience for both mother and baby. This is not about fitting into one model of care but about tailoring the experience to honor your unique preferences and circumstances.
As a Certified Nurse Midwife, I’ve had the privilege of standing beside countless women and families during their most vulnerable and joyous moments. If there’s one truth I’ve learned, it’s that birth isn’t just a medical event—it’s a deeply personal, life-affirming moment that deserves respect, compassion, and care.
Remember, this is your journey. Take your time to ask questions, explore your options, and trust your instincts. Your strength and intuition are at the heart of this process. Surround yourself with a team that believes in you, supports you, and works collaboratively to ensure your birthing experience is one you’ll cherish forever.
You’ve got this, and you’re not alone—there’s a whole community of birth workers ready to stand by your side every step of the way.
— Stay Strong! Jaelin —
Additional Reading:
Note:Full disclosure: I earn a small (very small) commission on any links in the article that take you to Amazon.
About the Author
Jaelin Stickels, CNM, WHNP, is a deeply passionate and highly skilled Certified Nurse Midwife, Women’s Health Nurse Practitioner, and the owner of Holistic Heritage Homebirth in Houston, Texas. With over a decade of experience, Jaelin has had the privilege of helping several hundred women welcome their babies into the world. In addition to her advanced practice licensure training, she has additional advanced training in twin and breech births, making her one of only a few with these skills in her area. Jaelin approaches every birth with expertise, compassion, and a deep respect for the birthing process. Jaelin is finishing her doctorate and looking forward to being Dr. Jaelin in early 2025.
Jaelin’s journey into midwifery began with a profound love for supporting women through the incredible experience of pregnancy, labor, and postpartum. Since 2010, she has been dedicated to walking alongside families during these transformative moments, offering guidance, support, and care tailored to each individual’s unique needs. She is a big believer in informed consent and ensures clients are given the best evidence-based information to make the best decisions for themselves and their families.
Married to her high school sweetheart Ted (aka Chef Ted) since 1984, Jaelin is the proud mother of three grown children and the delighted grandmother of one amazing granddaughter. When she’s not assisting in births, Jaelin finds joy in going to the movies with her husband, quilting, and cherishing time with her family. Known by the other midwives in her practice (Holistic Heritage Homebirth) affectionately as the “Birth Hog,” she brings an unmatched dedication and enthusiasm to her work—no one loves birth quite like she does.
Find out more about Jaelin’s Homebirth Practice (Holistic Heritage Homebirth) in Houston, TX