From the moment you pee on a stick and get a positive indication staring back at you, you are filled with options and decisions ahead. One major decision is, who will be your care provider for this time? Will it be an OB or a midwife? What the heck is a doula? What is the difference between them all?
I will begin by saying that I am a doula. As a doula I am used to people not 100% grasping what I actually do. Often people *think* they know what a doula does and I get the response, “oh yeah, you catch babies in bathtubs in homes right?” So if I am getting that response from family and friends, that tells me a large amount of the public probably doesn’t know what all of these roles actually do. (By the way, doulas absolutely do not catch any babies, let alone ones in the tub, we will get to that!)
Let’s break this down. First with definitions:
OBs are specialized physicians and surgeons that care for pregnant, birthing, and postpartum people. They are in charge of prenatal care, attend births, and care for the early postpartum time of their patients. They can work with low risk or high risk patients. OBs are the only providers that can care for high risk patients, can make use of medical tools (forceps/vacuum) applicable to the patient, and perform surgery (cesareans/extensive repair). Many times they are gynecologists as well, and may do women reproductive health care services. OBs practice in the hospital setting.
There are different certifications of expertise with midwives. They will be broken down further in just a moment. Overall the commonality is midwives care for pregnant, birthing, and early postpartum people. They work with low risk patients. Some midwives will also do reproductive health care for women as well. They may practice in or out of the hospital setting. Often times midwives in the hospital also work with OBs. Should a patient cross over to high-risk, they will transfer care and usually still follow along in supporting these families. Also, should surgery become necessary during delivery, the midwife is very likely to accompany the family in the OR and after.
Now for the break down of two of the types…
Certified Nurse Midwife:
These midwives have a nursing degree, and they complete graduate level midwifery education. They then must pass a national certification exam. Certified nurse midwives typically work in the hospital setting and may be a part of a practice with obstetricians as well.
Certified Professional Midwife:
This designation is given to midwives who complete the accredited certification process and pass an exam through NARM. Their studies include out of hospital care. They typically are practicing at home-birth or birth center settings. Please note changes are coming to Michigan for CPMs as licensure is on the horizon.
Doulas are a non-medical support person for a family during pregnancy, birth, and in the early parenthood times. They bring support and comfort physically, emotionally, and educationally. They do not provide medical health care for families. Doulas work with low-risk and high-risk families. They can support completely un-medicated births to surgical births (and everything in between), and usually support in hospital. There are currently no national regulations of doulas. Different certifying organizations exist for doulas. Metro Detroit Doula Services aligns with ProDoula and the standards they set. All of our doulas are current with certification.
As you are doing your research and navigating what matters most to you in your experience you may want to learn a little bit more about what the models of care look like!
Models of care:
OBs and midwives all have their personal philosophies and also their model of care can vary. They all have the same goal of helping parents have a healthy, safe, and positive experience. Although how their practice functions, and their perspectives may vary greatly.
It doesn’t hurt to think about where you would like to give birth and the type of surroundings you want to birth in. Whether in a hospital, at home, birth center, or free-standing birth center, you can then move on to which provider may serve that type of birthing place.
OB model of care:
OBs’ philosophies are different practice to practice and doctor to doctor. OBs can be generalized to view birth more medically. But, some OBs may be willing to be hands off and let things go more naturally or some may practice a more expectant management type of care. Many OBs have very short windows of time for their patient visits as they may take on large client loads. It is not common to find a practice where there is only one doctor. Many times there is a minimum of two but often larger groups that rotate on-call time for attending births.
When meeting with them throughout pregnancy typically the appointments are shorter with the actual OB. Keep in mind everyone practices a little different as well and bedside manner will vary per individual. Finding out how the potential OB feels about birth and how they like to function as a practice is helpful knowledge before beginning care.
Midwifery model of care:
The midwifery model of care can often be viewed as having more patience & confidence in the birthing process. While also being more open to allowing/supporting things to unfold as naturally as possible. Midwife means “with woman” and their care strives to really make the birthing person the center of their care. Midwives may have longer appointment times with you and may be able to engage in longer conversations. Bedside manner, just like OBs, varies by individual. Midwives serve the lower risk pregnancy population which the CDC says accounts for approximately 85% of all birthing people. These days midwives are easier to find than before!
Midwives in the hospital setting tend to work in groups of 2 or more and rotate on-call time as well for attending births. CNMs typically have OBs they turn to, or may be part of an OB practice, for if their patient needs additional care. CPMs may have a partner, group, or may serve as individuals. Their client load may be smaller which allows more time to tend to patients and be available for their births. They may or may not have a referral source for care that is beyond their scope.
Now after defining all the the different roles and learning a little bit of how they function, how can you decipher which profession is a right choice for you and your care?
Midwife or OB?
In my experience I believe aligning with your health care provider can set you up for a more positive experience. So figuring out what your birth philosophies are and what matters to you most is a good place to start.
You then want to ask your potential or current care provider questions about their philosophies and approaches to birth. If there seems to be a lot of overlap of your thoughts or your provider understands your goals and encourages them, you probably have a good fit! If you don’t align, it doesn’t always mean it’s a bad fit, it may just mean someone will be compromising along the way. Will it be you or your care provider? How important is that compromise to you?
So where does a doula fit into all this?
Doula support would be something in addition to your medical care. Remember, they are non-medical. Doulas are the ones who are there to listen, process, and offer information when questions arise through pregnancy, during labor, and during those postpartum days, weeks, or months.
Labor doulas join families in pregnancy. They field phone calls, and help their clients process feelings and thoughts supporting them emotionally. They are always available to answer questions, promote understanding, and listen to what is going on in the pregnant person’s life.
Pre-natally doulas meet together with their client to form a birth plan and discuss anything and everything to help them feel more confident in the birth that lies ahead. They have loads of resources. Once in labor the doula joins the family and is a positive person there to support the laboring person and their partner moment by moment, contraction by contraction. Sometimes it’s emotional encouragement like reminding the birthing person that everything is normal and they are doing a fantastic job! There’s also lots of massage, counter pressure, positions, and whatever hands-on comfort the doula can provide. Educationally doulas can walk clients through the B.R.A.I.N. acronym providing information to help the client make their own decisions. They are an awesome addition to the birth team!
Postpartum & Infant Care Doulas join families as soon as the baby/babies are born if the families wish to begin care then. The doula attunes to the families’ needs and helps ease that transition of early parenthood. Just like Labor Doulas, Postpartum & Infant Care Doulas build confidence and provide guidance & comfort.
The first focus is the newly postpartum parent and partner if there is one. Making sure all their needs are met. This can look like discussing feelings regarding the birth and transition into parenthood. Or going over the how-to’s of newborn care. Even making sure the mother’s water glass is always full!
Then the new baby is the next focus. Sometimes care can look like tending to the newborn so the parents can rest. Sometimes it looks like we are all in it together with the doula supporting the set-up of systems, guiding on infant care tasks, and infant feeding. Postpartum & Infant Care Doulas can offer their care on a live-in basis, in the daytime, or perhaps the most popular – over the night! Sleep deprivation is real and often feared! The doula can assist in sleep shaping, help parents maintain normalcy at night and get more rest – a win-win for everyone!
Tips for selecting your care and support:
- Envision your pregnancy and birth and what may be most important to you – if you are not sure your doula knows the questions to ask to help you figure this out.
- Decide on where you desire to birth.
- Discuss what matters to you most with your care provider or potential care provider that can catch babies at your birth place of choice.
- Want help finding a provider and with all things pregnancy and baby?- A certified doula is the best place to start!
- If a listening ear, comfort, and knowledge by your side the whole way sounds right, additional support from a doula is a great fit.
So now you can take a moment and sort out what makes sense for your family’s care. Use the tips mentioned for a little extra guidance on what to do next! If you know you want a doula already contact us today!
Authored by: Andrea Stainbrook