What is the Difference between a Certified Midwife, Certified Nurse Midwife, Direct-Entry Midwife, Doula, and OBGYN?
Midwives, doulas, and OBGYNs are trained professionals who work with primarily with women. Most commonly, they work with women pre-partum, during birth, and postpartum to provide care, consultation, and information. Some do so in medical and supportive capacities, while others do so in strictly supportive capacities. They might provide their services in hospitals, clinics, birthing facilities, homes, and other settings.
Of the professionals who guide women through pregnancy and the birthing process, midwifes, OBGYNs, and doulas are some of the most common. Following are descriptions of the different types of midwifes as well as doulas and OBGYNs:
The Certified Midwife (CM)
A Certified Midwife (CM) is educated in the discipline of midwifery and certified according to the requirements of the American College of Nurse Midwives[i]. Certified midwives typically have a graduate degree in midwifery but DO NOT have a background in nursing[ii]. Some of the many tasks they perform include: conducting physical examinations, providing gynecological careordering laboratory tasks, caring for women during pregnancy and birth, and providing health education to women of all ages. They may work in or out of hospital and clinical settings. Certified midwives can only practice legally in 3 states[iii].
The Certified Nurse Midwife (CNM)
A Certified Nurse Midwife (CNM) is educated in the disciplines of nursing and midwifery and certified according to the requirements of the American College of Nurse Midwives[i]. CNMs are typically advanced-practice nurses with graduate degrees in nursing and/or midwifery[ii]. Much like CMs, they conduct physical examinations, provide gynecological care, prescribe certain medications, order laboratory tasks, care for women during pregnancy and birth, and provide health education to women of all ages. Because of their background in nursing, CNMs may be able to prescribe medications in some states[iv]. They might pursue potential career opportunities in hospitals and clinical settings. CNMs can practice legally in all 50 states[iv].
The Certified Professional Midwife (CPM)
A Certified Professional Midwife (CPM) is educated in the discipline of midwifery and certified by the North American Registry of Midwives. The CPM is the only credential that requires the midwife to have knowledge about and experience in out-of-hospital settings[v]. They too conduct physical examinations, provide gynecological care, order laboratory tasks, care for women during pregnancy and birth, and provide health education to women of all ages. They often work with women in their homes and in hospitals. CPMs can practice legally in 28 states[vi].
The Direct Entry Midwife
A Direct Entry Midwife (DEM) is a category of midwives. Direct-entry midwives are educated in the discipline through self-study, apprenticeship, midwifery school, or a college or university-based program. They are not trained in the discipline of nursing. Certified Midwives, Certified Professional Midwives, licensed midwives, and registered midwives are all examples of direct entry midwives[vii].
The word “doula” derives from ancient Greek and means “a woman who serves”. A doula is a trained and experienced professional who provides physical, emotional, and informational support to mothers before, during, and after birth[viii]. Doulas are often designated by DONA International as Birth Doulas or Postpartum Doulas, and they provide support according to their particular designations. While midwives play a supportive and medical role in the pregnancy, birthing, and post-partum process, doulas play a solely supportive one[viii]. Think of a doula as a person who stands by a mother’s side to provide excellent comfort and support while the midwife, nurse midwife, and/or OBGYN conducts the medical care and delivery.
An OBGYN is a medical doctor trained as an obstetrician (someone who specializes in pregnancy and post-partum care) and gynecologist (someone who specializes in women’s reproductive health). They have doctorate degrees in medicine, have completed an OBGYN program, and are in or have completed a residency. They are licensed and certified to practice by the state government and the American Board of Obstetrics and Gynecology. They provide all of the medical services that midwives do and then some.[ix]
Midwives and OBGYNs are similar because both are trained to provide medical and supportive care. They’re certified, licensed, and educated in the disciplines of midwifery, nursing, and/or medicine. They serve as primary care professionals for women before, during, and after the child-bearing process. To become a midwife or OBGYN, professionals must have a bachelor’s degree, graduate degree, or medical degree depending on their designation. They must also obtain specialized training and test for certification and licensure to practice legally.
Given that midwives and OBGYNs both must have certain levels of education, certification, and licensure to practice, what is the difference between them? First, midwives need not secure doctorate-level education in the field of medicine to practice. Instead, they study midwifery through midwifery programs or nursing programs. OBGYNs, however, must earn doctorate degrees in medicine to practice. Second, because OBGYNs study medicine at the graduate level, they can perform certain procedures and prescribe certain medications that midwives cannot. For example, OBGYNs can perform Cesarean sections and forceps deliveries while midwives cannot. Additionally, OBGYNs can legally practice in all 50 states while certain types of midwives cannot.
Despite these differences, both midwives and OBGYNs are trained and prepared to provide women with supportive and medical care during pregnancy, the birthing process, and post-partum. Midwives are well-trained to identify and respond to medical issues and to work with OBGYNs when necessary to provide women and babies the best care possible.
Doulas work side by side with midwives and OBGYNs, but because they do not provide medical support, they are not required by state law to secure particular education, certification, or even specialized training.
While these are some of the most obvious differences between midwives, OBGYNs, and doulas, there are numerous others. The Midwives Alliance of North America writes that each model of maternity care “relies on different skills, tools, language, underlying beliefs, interventions, and power relationships between patients and providers[x].” Midwives, for example, sometimes focus more on providing natural, holistic care, while OBGYNs often focus on providing targeted, medical care. Additionally, midwives and OBGYNs often differ in the number of invasive procedures they use during pregnancy and birth. To get a clearer sense of the type of care midwives provide, you can review the Midwives Model of Care™ here.
[i] midwife.org/The-Credential-CNM-and-CM | [ii] bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm#tab-4 | [iii] midwife.org/Midwifery-Education-Programs | [iv] nlm.nih.gov/medlineplus/ency/article/002000.htm | [v] mana.org/about-midwives/what-is-a-midwife | [vi] narm.org/certification/current-status/ | [vii] mana.org/about-midwives/legal-status-of-us-midwives | [viii] www.dona.org/mothers/ | [ix] bls.gov/ooh/healthcare/physicians-and-surgeons.htm#tab-4 | [x] mana.org/about-midwives/midwifery-model