What's the Difference between an OB, Doula, and Midwife?


Photo by Pixabay

The birthing options known to the modern woman today seem pretty limited: hospital, OB, every intervention, no questions asked. In most developed countries around the world, the birth situation appears to be better than ever. We are whisked away, numbed, and end up with a happy baby in our hands. That’s good enough, right?

The statistics are saying no. The U.S., with arguably the “best” and most healthcare, ranks as the worst for maternal health out of all of the developed countries.  Clearly, we are not doing something right.

Other developed countries, such as Holland, are going back to the basics of birth Indeed, most of their women still deliver at home and see much better maternal health outcomes. Though it’s still a very small percentage, more and more women are delivering out of the hospital in the U.S. each year. In 2014, there were 60,000 out of the hospital births, and the numbers keep rising.

Women are doing the research and see that the hospital benefits are not adding up.


An obstetrician (dubbed OB for short), is a trained surgeon and healthcare professional for birth and female reproductive issues. An OB obtains a bachelor’s degree, then goes to medical school, then does a residency program. It’s interesting that an OB never has to see a normal, natural birth to obtain licensure, but they do need to perform surgery. Their training is focused on surgeries and high risk birth procedures, which is a small percentage of the real birth outcomes.

I am not downing OB’s or the need for them. OB’s are desperately needed for high risk situations and emergency births, but they should not be the common birth go-to physician. They simply are not trained for it.


Midwives are trained to facilitate natural, lower risk births. Some work in hospitals, others in birth centers, and still others deliver babies at the mother’s home. There are two designations of midwives. Certified Professional Midwives (CPMs) attend a midwifery college program. These midwives tend to be more natural-based. Certified Nurse Midwives (CNMs) have obtained a nursing degree and then also trained in midwifery. Both will need to complete a residency program depending on the state laws. The licensing of each type of midwife varies per state, with some states only currently licensing CNMs (meaning you cannot legally have a birth with a CPM, unfortunately). A midwife can perform most of the same procedures as an OB, outside of surgery and other invasive procedures. If a mother ever needed to have an emergency C section, the midwife would transfer her to the hospital.

Truly, during my time as a doula, I saw midwives help out nurses and OBs in the hospital time after time, and deliver higher risk babies at home safely that would have been an instant C section in the hospital. They hold knowledge that the modern obstetricians of today simply do not have. Their specialty is natural birth, and they’ve normally attended so many births, that they can predict the course of the birth before an emergency may even arise. Statistics show that birth outcomes are much better when a birth is attended by a midwife. This is because of lower interventions, a higher standard of care, constant attention, the same caregiver (OBs and nurses may switch shifts), and a general better understanding of the birth process.

Hospital vs Birth Center

A midwife may attend births at a hospital, birth center or home. A birth center may be attached to and legally owned by a hospital, or may be a “stand alone” Center which is privately owned. Less interventions will be found in the stand alone birth center, and fewer still at home. Still, a birth center may be a good option if you want the luxury and proximity of a hospital, with a more natural environment and provider.


Doulas are trained birth attendants – they do not do any medical procedures, but assist the mother and family with her desired birth. Doulas really are there to assist the mother, physician, and birth partners in creating the mother’s ideal birth.  Doulas keep the father fed, guide him and other birth partners, ensure mom has what she needs, are trained in natural pain management as well as other natural birthing techniques, are knowlegable about the birth process and interventions, and will help inform the mother of these during a stressful time. A doula is basically your personal attendant with an education. It’s also scientifically proven that having a doula at your birth is likely to produce a better birth outcome. 

Do your full research and explore all your birth options well before your birth. Unfortunately, the current maternity model of care is not bringing about healthier mothers or babies. You will have to make that happen yourself. Below has more resources, including two documentaries I highly suggest every to-be mother watch before planning their birth.


DONA International – information regarding and finding doulas.

Midwifery laws per state – each state has its own midwifery laws, and this link will show you which type of midwives are licensed in your state.

National Vaccine Information Center by State Exemption Information – see what exemptions are available in your state, how to get them, and what laws may be on the way.

Pregnant in America – a documentary chronicling the birth process in the U.S. today (also available on Netflix at time of posting).

Business of Being Born – a documentary with a sequel by Ricki Lake about birthing in the U.S.