Doula, nurse, nurse midwife: What’s the difference?

People generally understand what a doctor is, and what a doctor’s job is during the birth process, but many are confused with the other people who can be a part of the birthing process. Just as the support person for the mother is not a fixed entity (could be husband, boyfriend, mother, ex-husband, baby daddy, sister, mother-in-law, cousin, father, brother or even just a friend) the cast of players in any given labor isn’t set in stone either. Some births may be attended by just a doctor, while others might have the full complement of obstetrician, midwife, doula, and labor nurses, all moving in and out of the same little hospital room. All types and variations can be utilized to support a perfectly healthy and safe delivery .

 

Midwives

Midwifery is arguably the oldest profession and the word “Midwife” originates from the old English word mid “with” wife “Women”. While the profession has changed in many ways through centuries, the concept of being “with women” has remained the same. The term “midwife” also covers a range of different care providers, from certified nurse midwives, who are registered nurses who have also completed special advanced training specifically in midwifery, all the way to lay midwives, whom have no medical background or credentials but enter practice following an apprenticeship to an established midwife. Lay midwives are more often found in, out of the way, rural locations were obstetricians are few and far between and only provide basic pregnancy monitoring and primarily do home deliveries. While certified nurse midwives can be found in any population setting. Generally, a Certified Nurse Midwife (CNM) is an Advanced Practice Registered Nurse who provides primary care around maternal, reproductive, and gynecological health to women of diverse ages throughout their lives. This allows them to judiciously access medical technology as needed, while avoiding the over-use of interventions and enables them to combine traditional skills and modern medicine in order to safeguard physiologic childbirth. In contrast, Direct-Entry Midwives, also called Lay Midwives, Licensed Midwifes, or Professional Midwives, practice midwifery, but they are not registered nurses, and are not certified by any accreditation organization for quality of knowledge or training. Aside from certified midwifes, many of the other types of midwifes may not be recognized in other States in the US. At Sunlife OBGYN  our Certified Nurse Midwife maintain the highest level of training and certification.

 

No matter what their level of certification, midwives have one thing in common: they’re trained in women’s reproductive health. While obstetricians focus mainly on the medical aspect of pregnancy and delivery, midwives focus more on a woman and baby’s pregnancy experience and then their first year together. After all, birth is a major life event and affects women in a variety of ways – mentally, physically, and socially. Midwives educate women and their families on how to maintain wellness before and after they give birth. Basically, midwives look at pregnancies and births that don’t have serious risk factors as natural life events, rather than medical ones.

 

This doesn’t mean midwives don’t monitor pregnant women carefully for signs that could turn into medical complications. In fact, midwives who detect minor medical issues often have the ability and authority to treat them, but they also often have established relationships and protocols for transferring the care of pregnant women with health conditions to obstetricians. At Sunlife OBGYN our physicians and midwifes work seamlessly to transfer the care of higher risk pregnancies to the doctors, or in some cases, work in close collaboration with the obstetrician under established medical protocols and frequent consultations.

 

So why go to a midwife for care when it’s possible to end up under the care of an obstetrician anyway? Midwives provide continuity of care, both by attending all prenatal appointments, and by staying with women throughout labor, straight through to early infant care. Women who feel strongly about natural birth or alternative birthing methods often feel more supported in that preference by midwives, and deliver vaginally more often. Beyond that, certified nurse midwives are medical professionals who are qualified to provide most prenatal monitoring and care, and to make recommendations for further care that goes beyond just pregnancy related issues. Midwives often do routine well women annual exams and pap smears, contraceptive management as well as treat minor gynecologic issues that comes up from time to time such as STD screening, breast examinations, detection and treatment of vaginal infections, etc. In Florida, state regulations allows certified nurse midwives to write prescriptions for medications and even own their own practice separate from a physician. Our certified nurse midwives at Sunlife OBGYN are even trained as surgical assistants. So even if during your labor process it is determined that a c-section is necessary for a safe and healthy delivery, you will still have a familiar face with you during this unexpected event.

 

Doulas

Doulas are not medical professionals unless they have independent medical training in another area. Many doulas are labor and delivery nurses or technicians but many also have no medical training whatsoever. Instead of providing medical care, doulas provide physical and emotional support before, during, and after labor. Doulas can share information about pregnancy, the process of birth, and newborn care with new parents, and help to make sure moms-to-be know their options as they’re going into labor. In almost all states and facilities, doulas are not allowed to provide any direct medical care even if they are a certified/liscensed/registered in another medical capacity.

 

Doulas can help new parents feel a sense of stability during labor, since they often arrive either with the patient or before the midwife/doctor. Doulas also generally stay with parents throughout labor and delivery, which can be especially valuable in a hospital setting, when shift changes may mean that your doula is the only face that stays constant throughout the process. You will often need to seek out and make your own arrangements for doulas in your area, but some hospitals and birth centers may offer doula services at an added service or additional charge.

 

Labor nurses

Labor nurses are entirely different figures from either midwives or doulas, though in some ways, their function can overlap with both. In hospital and birthing center settings, labor nurses can take on some of the monitoring that a midwife would do in a birth outside of a hospital setting. They can also give some of the support and education before, during, and after the birth, such as what a doula might provide.

 

This overlap doesn’t mean that labor nurses are equivalent to either, though. labor nurses don’t attend to each stage of birth in the way that either a doula or a midwife would. Unlike midwives, labor nurses are not trained to deliver babies, and unlike doulas, though labor nurses may provide some emotional support and education, their jobs are not defined by that.

 

Also, unlike either a midwife or a doula, labor nurses often have multiple patients at a time and may move from room to room during labor. Their shifts are independent of any individual woman’s labor, and may change mid-way through, or even multiple times, depending on the length of a particular woman’s labor.

 

Different medical needs, availability, and the preferences of new parents mean that no labor team is exactly the same, but they are all teams – every member plays a part. Having a good idea of what each team member brings to the field is the best way to make sure you’re choosing right when you’re picking your team.