The first line of the introduction to From The Hips, the pregnancy and baby book I co-authored, is something like, “We have a confession to make. We didn’t know what a doula was when we got pregnant.” I recall being surprised to learn that midwives take insurance and deliver in hospitals. And upset to discover that my doctor wouldn’t be with me during most of labor.
I am frequently asked, “What’s the difference between a doula and a midwife?” and “Are there midwives at the hospital who can help if my doctor isn’t with me the whole time?” These are all such good questions, I’ve decided to write a quick easy definitions for each of these key players. Here they are:
Most doctors who care for women throughout pregnancy and in labor are obstetricians (OBs) but some general practitioners (GPs) also known as family doctors deliver babies. OBs are trained to do c-sections and some have special expertise in caring for high risk pregnancies. The way the system is set up, most doctors check on patients when they arrive at the hospital or birthing center but are only with mom continuously at the very end of labor when mom is pushing and the baby is born. Doctors mostly work in hospitals and sometimes birthing centers.
Midwives also care for women throughout pregnancy and birth. They are not trained to perform c-sections so if one becomes necessary, a doctor is on back-up to do the surgery. (The midwife will stay with mom throughout). As midwives are less common in the US than in other countries, people are often surprised to hear that they prescribe medications, screen for pregnancy-related illnesses, order ultrasounds and other common procedures used in pregnancy and birth. The midwifery model of care emphasizes continuous support for mothers in labor, so midwives have more training in supporting moms through the pain of labor– they tend to be there throughout active labor. Perhaps because of this and various other factors midwifery care tends to involve fewer medical interventions than care under an obstetrician. There are different kinds of midwives– certified nurse midwives have been through nursing and midwifery school and may work in hospitals, birthing centers and at home births. Certified professional midwives tend to deliver at home, but the laws about where midwives practice vary from state to state. As with doctors, it depends on the individual, but insurance-coverage is often an option.
Labor and delivery nurses are trained to administer IVs, enemas, catheters and even sometimes check women to see how dilated they are. They also play a very important role in communicating between the doctor and mother. There are nurses who know a lot about coping with pain in labor and will be gentle, reassuring and full of knowledge and there are others who are less experienced or, due to staffing issues, simply don’t have the time to spend with each laboring mom. I know people who attend a lot of births who recommend bringing in cookies for the nursing staff as they are often working late, long shifts and appreciate being noticed. Of course, this comes back to you in the form of an extra pillow or cup of ice-chips… I like to think of it as a friendly move rather than a bribe 😉 You may have more than one nurse as labor can be longer than a single shift. Nurses in birthing centers tend to have more experience with un-medicated births.
There are labor support doulas and postpartum doulas. Labor support doulas have become more and more popular as studies show use of continuous support reduces the chance of medical interventions including c-sections and can even make labor a little shorter. They are also filling a gap left by our maternity care system– the need of mothers to have support and reassurance throughout. They’re also good at navigating the hospital (triage, etc) and have a vast knowledge of things like massage and positioning that can take the edge of the pain and help labor become more efficient. First time parents most often find labor support doulas helpful no matter what the circumstances are and whether mom is open to an epidural or not. The cost can be prohibitive. Doulas typically charge between $500 and $1,500 and up, depending on the level of experience. Doulas are very good at making sure labor and birth is an intimate experience for a couple, they do not elbow your partner out of the way but rather support him or her to help and be able to enjoy the moment.
In a perfect world I think every pregnant woman should have a doula, nurse, midwife and doctor and insurance should cover it all. They all wouldn’t be with you at the same time: The doula would help you with the pain in labor, the nurse would tend to things like IVs and monitoring, the midwife would be there for the birth and the doctor would be called in if a medical situation arises. But alas, our system requires that we pick a doctor or a midwife. We get a nurse, but she’s also tending to others. And we have to pay for a doula ourselves. I think it’s a flawed system but there are ways to work it: Cobble together the support you need so there’s the right balance of labor support and medical back-up care.
Ready to plan your birth? Here’s help with our Top Ten Reasons You Should Hire a Doula