The Doctor, The Midwife, The Nurse and The Doula

23 Feb The Doctor, The Midwife, The Nurse and The Doula

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.

  • Kate
    Posted at 11:29h, 01 May

    What a great post! You’ve totally hit on all of the big questions that birth professionals get asked.

  • Sonya
    Posted at 23:00h, 13 June

    Thanks for explaining all this. It is really valuable to first time Mom’s and everyone.

  • HappiestDoula
    Posted at 18:31h, 07 September

    Thank you for writing this easy-to-read guide about the labor support team. I have forwarded your link to my readers (and clients) hoping they will find it as useful as I do.

  • realist12344
    Posted at 05:52h, 05 March

    To keep perspective and give everyone due respect; an Obstetrician has spent an additional 40,000 hours (after college) of their life dedicated to delivering your child In a manner to be as healthy as possible as well as keep you alive. During this time they sacrifice their 20’s, 30’s and sometimes personal life in the process. Doulas and especially midwives are excellent practitioners however are not physicians and an excellent midwife knows when to admit you to a hospital. A natural birth at home with loved ones and a midwife is ideal but if your baby gets sick and suffers it is negligence, ON YOUR PART, in 2016 with the science and research we have available (which your midwife and doula have not spent 40,000 hours memorizing). I’m an anesthesiologist and I see women trusting their practitioner over their OB, and it is difficult to watch–and it’s always a well educated Mom wanting the best, natural birth for their child. Find a hospital! One that has OBs and midwives working together as a team and when the birth is uncomplicated your midwife will deliver independently. However, in an acute situation, modern science will present you with an alternative (a dedicated OB who sacrificed their life for you, and yes it will be the trained Physician on call most likely because things will go bad at 2am not during the day) and your child will thank you for having common sense when they graduate college.
    Don’t be so quick to discredit those who care most and proved it by dedicating their lives at an early age to keeping you and your loved ones healthy.

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