obgyn, midwife or doula?

April 14, 2017


OBGYN, midwife or doula? Pregnant women have a lot of options when it comes to the childbirth professionals they want on their birth team. Learn the differences--and similarities--among these three birth attendants and how they can augment your birth team.



The OBGYN (obstetrician/gynecologist) is by far the most common, and sought after person to deliver your baby. An OBGYN is a medical doctor who can provide prenatal care, perform surgery, prescribe medication and deliver your baby. Means of delivery can include using assistive devices, such as forceps. OBGYNs typically work in hospital settings only. 



When it comes to midwives, there are two main types: Direct-Entry Midwife and Certified Nurse-Midwives (CNM). The main difference is that a CNM must have worked as a registered nurse prior to obtaining additional education in midwifery. CNM's are also referred to as "advanced practice nurses." Though both are highly educated in childbirth, there are some other notable differences.

CNM's typically work under a physician, meaning they can do more in terms of drugs for pain management. This also means, however, that they may not be able to spend as much time with their patient as is typically assumed with the "midwife" title. CNM's generally work in a hospital or birth center, and are legal in all states. 


Direct-Entry Midwives can work independently, and can therefore spend more time with their patients during prenatal care visits and can usually be present for the entire labor and delivery. A Direct-Entry Midwife can become certified to obtain the CPM credentials (Certified Professional Midwife). 


Both CNM's and Direct-Entry Midwives (or CPMs) care for the mother during pregnancy, labor, delivery and postpartum. They are trained to detect complications and can execute emergency care if needed. They also both provide care around family planning. Legality of a Direct-Entry Midwife or CPM will vary based on state. 


California, among other states, licenses midwives. A "licensed midwife" must have received specific training in childbirth. Only someone possessing a midwifery license may be called a licensed midwife. They may not practice medicine, perform surgery or forcibly deliver a baby. A Licensed Midwife or Certified Professional Midwife (CPM) is a great option for a home birth, though a CNM can perform an at-home birth as well. 



A certified doula has also received training in assisting during births. Their main role on the birthing team is more on the physical and emotional side of things - to help mothers relax, stay focused and make birthing a satisfying experience. Typical doula services may include helping with a birth plan, preparing mom-to-be and the family for labor, aromatherapy, meditation, and breathing techniques. Doula comes from a Greek word that means "servant", indicating the role of birth doulas. Postpartum doulas help the new mom after the birth at her home.



So...OBGYN, midwife or doula? You can have any or all the above. Selecting the right birth team members depends upon many factors:



Should you anticipate any difficulties with your baby's birth, indicated by carrying multiples, previous premature births, gestational diabetes or other potential complications, hospital-based birth can keep medical equipment and professionals handy. But that doesn't mean you must forgo a midwife and/or doula.



Some women feel only a medical doctor is qualified to deliver their baby. In some cases, that is 100 percent correct; however, until recent centuries, most women delivered at home just fine, aided by an older relative. Some women feel like a doula or midwife views birth as more of a family event than a medical experience. Still others want a MD, midwife and/or doula present.



Select anyone you want for your birth team, but in a hospital setting, you've got to ensure early on that your obstetrician welcomes outside help. Some may only grudgingly admit midwives and doulas. 


Also, ask early in your pregnancy about photography. Though not part of your birthing team, the birth photographer can take one task off the shoulders of your birth team so they can focus on the birth. Some hospitals do not permit birth videos, but allow a birth photographer to snap still shots of your baby's arrival. Keep in mind that if complications arise, superfluous people (such as the newborn photographer) will have to leave the room. 



Me personally? I was born at home, and would like to go the home-birth/midwife route when that day comes. If we decide that's not the best option at the time, I'd opt for a birth center. I will have a birth photographer there as well. And, I'm also one of those people who wants to save the placenta for encapsulation! But, that's a WHOLE other story/blog we'll save for another day! 


Ultimately, this is a very personal decision. Do your own research, and go beyond the letters listed after someone's name. It's really important to meet with whomever you are considering for your birth team to make sure that your personal beliefs around labor and delivery line up, and that you feel comfortable with them delivering your baby. Talk with other moms and your medical provider to discover who you should include on your birth team: OBGYN, midwife or doula. Or, maybe it's a combination!


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abra klinger

Los Angeles, California based newborn photographer, serving the greater LA area. Offering newborn (my favorite!), maternity, kids (watch me grow) and family sessions.


Reach out if you're interested, or just have a question - I'd love to chat! 

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