The Doctor, The Midwife, The Nurse & The Doula

Addressing the most common questions and concerns of many expecting parents, but often times, their extended family.  We have so many mothers who walk through our doors wanting to have a natural birth administered by a midwife, but are lacking support from their family members.  It is understandable for parents, grandparents, aunts and uncles to be concerned for the well-being of you and your new family, but ultimately it is not their birth.  We believe that good information and the best up to date research is a great tool to ease the minds of concerned parties when it comes to your pregnancy.  Starting with the fundamentals....

The Doctor, The Midwife, The Nurse & The Doula
From The Prenatal Yoga Center

I wanted to share some questions with you that I am asked on a regular basis: “What is the difference between a midwife and a doula? “; “Does my doctor work with my midwife?”; “Why would I choose a midwife over a doctor?”; “Isn’t the nurse like a doula?” I figured the best way to answer all of these questions would be to finally sit down and map it out.

First, let’s understand the definitions of those terms and the job of each of the people mentioned.

Obstetrician: A physician who delivers babies and is in the practice of obstetrics, the art and science of managing pregnancy, labor and the puerperium, the time immediately after delivery.

You will see your OB/GYN or members of his/her practice throughout your pregnancy, although who your care provider will be at delivery depends on who is on call during your labor. During the labor, the doctor will come in and out to check on your progress and, as the definition above states, “manage” your labor. Obstetrics is also a surgical field, so in the case of a cesarean, it would be your OB that would perform the procedure.

Midwife: A midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy birth, offering expert individualized care, education, counseling and support to a woman and her newborn throughout the childbearing cycle.

A midwife works with each woman and her family to identify their unique physical, social and emotional needs. When the care required is outside the midwife’s scope of practice or expertise, the woman is referred to other health care providers for additional consultation or care.

Midwives operate from The Midwives Model of Care which emphasizes the fact that pregnancy and birth are normal life processes. Midwives statistically have lower rates of interventions and provide the mother with individualized education, counseling, prenatal care and postpartum support as well as continuous hands-on assistance during labor and delivery.

Midwives, like doctors, may work in a group that rotates who is on call and who will see you for your prenatal visits. Some midwives work alongside doctors in their practices, while some work individually or outside the hospital setting. There are different types of midwives: Direct Entry Midwifes, Certified Professional Midwives, and Certified Nurse Midwives. Depending on their credentials and training, some midwives work in hospitals while others solely attend home births.

Labor and Delivery Nurses: Nurses in this field provide care to women who are in labor or who have recently delivered, or for those who may be having complications with labor. They also work with doctors to develop a plan to aid in the safe delivery of healthy babies.

Labor Support Doula: A trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.

Unless the doula has additional training, she is NOT a medical professional and will not perform medical procedures on the laboring mothering or deliver the baby. However, she most likely will be one of the most consistent elements of the labor experience. She does not change shifts and only deals with one client at a time. The doula will also labor with you at home and come with you to the hospital or birth center.

Now that there is an understanding of what each professions offers, it may be clearer how they might or might not work together. So, back to the original questions:

What is the difference between a doula and a midwife?

As described above, the doula acts as an emotional, physical and informational support for the mother. While the midwife may offer many of those same qualities, it is the midwife that will deliver the baby and perform the necessary medical examinations throughout pregnancy, labor, delivery and postpartum. Midwives are also available to do “well woman” yearly exams throughout a woman’s life, not just working with her while pregnant.

Does my doctor work with my midwife?

Yes, sometimes a practice has both doctors and midwives. But if your current doctor does not work with midwives you cannot have both as care providers. If a midwifery practice does not have a doctor as part of the group, there will be a doctor that backs up that group. However, if you choose a home birth, you will have just a midwife; should you need further medical assistance, you would be transferred to a hospital. Some midwives have privileges at a hospital, while others just have a relationship with a doctor and will no longer be your care provider should you be admitted.

Why would I choose a midwife over a doctor?

Choosing your care provider is a very personal choice. It requires a long, hard look at the model of care you would like for your pregnancy and delivery. While both professions try to offer the best care they can to women, the path in which that support is offered differs. The Model of Care that midwives subscribe to reflects the idea that pregnancy and birth is a natural physiological process that should be inherently trusted, while the medical model focuses on the pathologic potential of pregnancy and birth. They both have the same desired outcome, but use different routes to get there.

You should also consider the style of care you personally prefer. Midwives will tend to be more present during labor; moreover, they will be more holistically based and allow more space for the labor to unfold naturally before moving to medical interventions. Doctors are not as likely to give you as much personal care and time and may move to medical interventions more quickly.

Isn’t the nurse like a doula?

Many of the Labor and Delivery nurses (L & D nurses) I have worked with are wonderful and can offer a lot of helpful advice for the laboring mom. However, I would not advise depending on your L & D nurse to provide the same comfort and assistance as a labor support doula. The L & D nurse often has several women they are monitoring at the same time and cannot offer consistent support since they work in shifts and breaks. You may also find it appealing to choose your labor support doula and have the opportunity to previously discuss you birthing preferences with this person.

Now that the cast of characters has been laid out, I hope this makes it easier to make decisions about the model of support you will receive and who you would like at your birth.