The Obstetrician, The Midwife, The Nurse & The Doula

Choosing the care providers who will be present and support you through your pregnancy, labor and delivery is key to achieving the birth you desire. This week, Deb Flashenberg, a Mother’s Advocate Blog veteran, joins us to clarify the difference between obstetricians, midwives, labor and delivery nurses, and doulas.

As a doula and Lamaze certified childbirth educator, I’m often asked:

“What is the difference between a midwife and a doula? “

“Does my obstetrician work with my midwife?”

“Why would I choose a midwife over an obstetrician?”

“Isn’t a nurse like a doula?”

I finally realized that the best way to educate the women I work with was to create a comprehensive resource that covers what each does, how each might help her through pregnancy, labor and birth, and then attempt to demystify the world of birth professionals.

First, it’s important to understand the definitions of these terms, what each profession is ultimately responsible for.

Obstetrician (OB/GYN): A physician (doctor) who delivers babies, and is in the practice of obstetrics — the art and science of managing pregnancy, labor, delivery and the puerperium (the time immediately after birth).

You will see your OB/GYN or members of his/her practice throughout pregnancy, although exactly who your care provider will be at delivery ultimately depends on who is on call during your labor. During labor, the obstetrician 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, your OB/GYN would perform the procedure.

Midwife: A midwife is a trained professional with special expertise in supporting women through a healthy pregnancy and birth. Midwives also work with each woman and her family to identify unique physical, social and emotional needs. When the care required is outside of a midwife’s scope of practice or expertise, the woman is then 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 of 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 Nurse: Nurses in this field provide care to women who are in labor, women who have recently delivered, and women who may be having complications with labor. They also work with doctors to develop a plan that aids 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. Some doulas also provide emotional and practical support during the postpartum period.

Unless a doula has additional training, she is not a medical professional, and will not perform medical procedures on the laboring mother 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. A doula will also labor with a woman at home, before the transition to a hospital or birth center is made.

Now, back to the original questions:

What is the difference between a doula and a midwife?

As described above, the doula acts as emotional, physical and informational support for the mother. While the midwife may offer many of those same qualities, it is the midwife who will actually deliver your baby and perform necessary medical examinations throughout your pregnancy, labor, delivery and postpartum period. Midwives are also available to work with a woman outside of pregnancy, and can perform “well woman” yearly exams throughout a woman’s life, as well.

Does my obstetrician work with my midwife?

Yes, sometimes a practice has both obstetricians and midwives. But if your current OB/GYN does not work with midwives, you cannot have both as care providers. If a midwifery practice does not have an obstetrician as part of the group, there will be an outside doctor who backs up that group.

Why would I choose a midwife over an obstetrician?

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. Obstetricians are not as likely to give you as much personal care and time, and may move to medical interventions more quickly.

Isn’t a nurse like a doula?

Many 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 your birthing preferences with this person.

I hope that laying out this cast of characters makes it easier for you to make decisions about your birth — including the model of support you will receive, and who you would like to be present. After all, it is your birth.

Debra Flashenberg CD (DONA), LCCE is a graduate of the Boston Conservatory of Music. She spent most of her life performing, and was introduced to yoga through a choreographer in 1997. Soon after embarking on the path as a yoga teacher, she founded the Prenatal Yoga Center in New York City, where she continues to instruct prenatal yoga and train prenatal yoga teachers. Debra decided to also take her skills and passion for supporting normal birth outside of the yoga room, so she became a certified labor support doula with DONA and a certified childbirth educator with Lamaze International. For more information, please visit the Prenatal Yoga Center online.