What are the main differences between doulas, midwives and obstetricians?

Understanding Modern Birth Today

Birth is a beautiful, natural process.  For thousands of years, labor and birth happened at home.  Depending on cultural traditions, women were supported by a variety of individuals with and without medical training.  Currently in developed countries, most births happen in the hospital under the supervision of a physician, usually an obstetrician (ObGyn).  Birth is also big business.  $3 billion dollars per year are spent on birth in the United States alone.  As a future doula, understanding the different players involved in birth is very important.

The Modern Birth Team

Let’s talk  about who is likely to be involved in the birth team.  This will help you understand the important role doula’s play in the birth process for mom.

1) Obstetrician

An obstetrician is a physician that has earned a degree of either Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) and completed 4 years or more of residency training specializing in women’s health issues.  Obstetricians guide women through the pregnancy process.  They run screening tests and ultrasounds to ensure pregnancy is progressing safely for mom and baby.  

During labor, obstetricians lead the medical team to ensure a safe progression.  They are trained to recognize any signs of maternal or baby distress.  If need be, obstetricians perform emergency surgeries such as the Cesarean section.  It is rare for an obstetrician to stay with a mom for the entire labor.  Typically, obstetricians are responsible for multiple patients and may only appear at the very end when the baby is being delivered.

2) Midwife

Midwives receive specialized medical training in the birthing and labor process.  There are several different certifications that allows someone to be called a midwife.  Here are a few of the major examples.

Certified Professional Midwife (CPM) - these individuals are certified by the North American Registry of Midwives.  In order to carry the CPM title, these professionals have to have graduated from an accredited midwifery educational program, acquire licensure from their state of practice and pass a written examination.  Lastly, they must undergo recertification every 3 years.

Certified Midwife (CM) - certified midwives are accredited by the American Midwifery Certification Board.  In order to be a certified midwife, you must have graduated from college, completed enough science courses and then complete a competitive Masters program.  After the Masters course, individuals have to pass a national exam. Recertification is required every 5 years.

Certified Nurse Midwife (CNM) - certified nurse midwives are accredited through the same board as the certified midwife (AMCB).  CNMs are similar to CMs except that CNMs have formal training as a nurse as well.  To be certified as a nurse, an individual must have completed an accredited nursing program either as at an associate degree or bachelor degree level.  They must also pass the NCLEX-RN exam.

Many certified nurse midwives can operate independently without obstetrician supervision in certain states.  They are able to order lab tests, diagnosis conditions and provide patient counseling as an obstetrician could.  It’s important to note that nurse midwives are also educated on when to involve a physician if a case becomes too complicated or requires more specialized expertise (such as C-section).  For healthy women, nurse midwives are a reasonable alternative to an obstetrician.  Some scientific research even suggests that picking a midwife decreases the amount of medication given to a woman during birth and reduces the likelihood of a C-section.  

3) Labor and delivery nurse

These are nurses that work in shifts on a pregnancy ward.  They may or may not have specialized training in pregnancy.  Typically, labor and delivery nurses do not have a long-term relationship with the mom.  They are there to help administer fluids, push with the patient if needed and provide medications if needed.  Typically, labor and delivery nurses will spend more time with mom during labor.  

4) Nurse assistant

Nursing assistants can be certified but not necessarily.  Nursing assistants work under the supervision of the labor and delivery nurse.  These individuals help with certain nursing tasks.  They may check your blood pressure or heart rate.  They may perform basic laboratory tests like blood sugar checks.  If a patient is requesting water or food, then a nursing assistant usually provides these services.

5) Resident physicians

In certain hospitals, resident physicians are on staff and participate in births.  Resident physicians have completed medical school but not postgraduate training required for independent practice.  These physicians work under the supervision of a fully trained obstetrician.  They are able to provide orders for nurses to act on.  Frequently, resident physicians will be active participants in any necessary procedures or surgeries associated with birth.

6) Perinatologist or a Maternal Fetal Medicine Specialist

These are obstetricians that have completed an additional three years of training in the form of a fellowship.  Maternal fetal medicine specialists are trained in high risk pregnancies.  In these cases, the mom may have an underlying medical illness that makes pregnancy very complicated or risky.  These illnesses include heart conditions.

So How Does a Doula Fit In?

If you noticed, every member of the birth team in the hospital has a medically oriented job.  They are trained to provide the medical care necessary for a safe pregnancy.  They are looking at the monitors and lab tests.  But, birth is much more than just a medical procedure!  

Many of your future clients have never given birth before.  They have never experienced the emotional and physical roller coaster that happens with birth.  Sure, there are people checking her heart rate, blood pressure and baby rhythms.  But, there is no one (except you!) who is looking out for mom and her partner’s emotional needs during birth.  

Doula’s are a spiritual guide, advocate, emotional support system for mom and partner all built into one.  You can ask questions your client may be too scared or preoccupied to ask.  You can give needed emotional support during the toughest times of labor.