Being Pregnant
Doctor, Doula, Midwife, Nurse: What Do These People Do?
What exactly does a doula do?
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:
Doctors
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
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.
Nurses
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.
Doulas
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.
photo: Mamaloves/Flickr
Ready to plan your birth? Here’s help with our Top Ten Reasons You Should Hire a Doula
Go Back To Being Pregnant
13 Comments
Amy Tuteur, MD commented on Jun 29 11 at 2:54 pm“OBs are trained to do c-sections and some have special expertise in caring for high risk pregnancies.”
That is an extremely limited explanation of obstetricians.
As an obstetrician, I can tell you that we are medical doctors trained in ALL aspects of reproductive care including well woman care, family planning, gynecological issues, normal pregnancy and any pregnancy complications. We are trained to do everything a midwife can do PLUS anything else a woman might need in gynecology or obstetrics.
Some midwifery advocates mistakenly imply that obstetricians are only trained to do surgery when the reality is that surgery (both gynecologic and obstetric) is just a small fraction of what we do.
mbaker commented on Jun 29 11 at 10:57 pmAmy, that is complete bull. For example, I have spoken to many women who have been told by their obs that nothing can be done if your baby is breech before you go into labor which is just not true. My first baby was breech at 30 weeks and I switched to a midwife because I was told that by my ob. Luckily I knew from my research that that was not true. My midwife scheduled an inversion but luckily my baby turned on his own. When I had to switch to an ob during my second pregnancy due to complications one of the first things I asked the ob was what he did when a baby was breech. When he said that he would check the mother out to see if an inversion was possible I knew I had chosen the right ob.
Rachel J. commented on Jun 30 11 at 12:18 amI think it’s pretty obvious that the author was highlighting the differences in care providers and focusing specifically on labor and birth, not saying that OBs only know how babies come out when it’s surgical/assisted.
In my city CNMs don’t usually choose or get to spend much more time with a laboring mother than do the OB’s. Having talked with some of them I think this has more to do with the requirements of the practice (see 20 patients/day, regardless of births occurring). But the care is definitely less reactive, more wait and see (with less interventions, as long as the overseeing doctor is okay with it) and office visits, while still short, are often a little more informative and educational.
I sure hope the nurses in birth centers have more experience with unmedicated births. That’s the only option at a birth center :)
ceridwen commented on Jun 30 11 at 11:03 amYes, I certainly didn’t mean to exclude everything an OB can do; there are things I left out in the other fields as well– midwives work on family planning, etc. With all due respect to the incredibly valuable training and work of OBs (I have one, I love her); I think many in both the midwifery and obstetric professions would agree that OBs don’t do ‘midwifery training and more.’ These are two different models of care. Though these are bullet-point guides intended to help on the most basic level, it’s worth adding that it’s hard (and a bad idea) to generalize too much about these categories, as individual doctors and midwives have their own way of practicing. There’s much variation. I know doctors who do practice a more midwifery-style care, and midwives who work in busy hospitals with lots of patients and don’t always stay with women throughout labor and make use of epidurals and other medications on a regular basis. As always, it’s important to find a care-provider you feel good about and who suits your specific health/pregnancy needs.
Emily Schaffer commented on Jun 30 11 at 2:25 pmI would add that the author forgot to mention anything about the roles of a postpartum doula. A postpartum doula is a certified person that care for the entire family when they are back in their home (if hospital birth). They typically begin assisting a few days after the birth. Many have vast backgrounds in Lactation, massage, Holistic Health and are full of helpful knowledge. They are trained to detect early signs of postpartum depression as well. They will teach you helpful skills like swaddling, attachment parenting techniques, getting on a routine, how to get more sleep, etc.. Some will even cook healthy meals for you, do laundry and tidy up the house. To find a certified postpartum doula go to: http://www.dona.org. To learn more about how a postpartum doula can help your family, go to http://www.emilyschaffer.com or http://www.BAbabyplanner.com.
Amy Tuteur, MD commented on Jun 30 11 at 7:05 pm“These are two different models of care.”
No, they’re not. That’s just the marketing language that midwives use. Childbirth works exactly the same way whether your provider is an obstetrician or a midwife.
“OBs don’t do ‘midwifery training and more.”
Really? What training do midwives have the obstetricians don’t have? I can’t think of a single thing.
ceridwen commented on Jun 30 11 at 7:15 pmI’d rather not get into a fight about this, as I am not attacking OBs in the slightest. There’s an interesting book I really enjoyed called “In Labor” by Barbara Katz Rothman, it may not be your cup of tea Amy, but she’s an academic who has studied these models of care and looked at the history of both obstetrics and midwifery. Her research shows some significant differences in approaches and training.
Annette Young commented on Jun 30 11 at 8:04 pmDr. Tuteur: I would like to ask you, with all due respect, how many births have you and your colleagues attended from start to finish? Therein lies the difference in your training.
Amy Tuteur, MD commented on Jul 01 11 at 5:50 pmI attended the births of my four children from start to finish and didn’t learn anything I hadn’t known before.
Nursing Student/Daughter of an OB commented on Jul 05 11 at 4:43 amI would just like to say that there are definitely different models of care practiced by nurses/midwives and OB’s. (To let everyone know, at least in Michigan, all certified midwives have to first complete a 4 year nursing degree before going to midwifery school, so they practice similar styles of care).
I am a nursing student currently doing my clinicals in a Labor and Delivery unit. The information and model I am being taught now is entirely different than that of my mother (who is an OB), who was taught in medical school. She recognizes the differences too, and when we both have free time in our busy schedules we discuss some of the differences in our two models.
Neither model is better or worse than the other, just different. It’s just like saying cats make better companions than dogs. It depends on the individual’s point of view and what she wants to get out of the relationship. Nurses/midwives and OB’s can all give you different approach. Its up to the mom to choose which healthcare professional will give her the best pregnancy.
Sarah commented on Jul 29 11 at 8:45 pmMI have a question relating to this topic: I just found out I’m pregnant with my first and am SO excited. Of course I have no idea what I’m doing, who I want to see. I
m freaked out. My sister has had three babies with a mid-wife here and she highly recommends her. BUT I called their office and they seemed to really want me to assure them that I wanted to go pain-med free. They said the mid-wife is very booked and only wants to take on clients who have the same sort of birthing values as she subscribes to. I totally understand that, her goal is to help women deliver naturally, but I can’t be sure I want a natural birth. It might be too hard! How do I find a middle ground. An OB/gyn who will not give me pitocin at the first sign of slow labor and also someone who will not make me feel pressured to get an epi. Is there such thing as a middle ground? I don’t want to feel rushed to hurry and I want lots of one on one help but I dont want to feel like I am expected to deliver naturally either. I feel like I am repeating myself a lot, sorry. Any advice? I am so confused!! And I have to make a decision!Sarah
Nikki commented on Aug 17 11 at 11:50 amWhat I would have to ask to a dr vs midwife is how many births have you seen with no interventions. No laying on your back to push, no breaking of water, no pitocin, no IV, etc etc etc… The answer (in Ohio) for a ob and a CNM is probably the same, very few if any at all. the reason for this (in Ohio) is that a CNM is not allowed to catch babies at home, therefore she too is required to follow hospital guidelines which require things like bedrest and iv, both counterproductive to childbirth. My point here is that you cant just lump all midwives together without understanding there are many different kinds.
@Amy, while I find that my many OB’s I have had over the years may have been trained in many of the same techniques as midwives, they tend to utilize different ones. Again, they tend to… not all obs force drugs and cut epesitiomies routinely, but this tends to happen more for ob’s vs midwives. It is unfair to say that ALL midwives support no main medications and ALL OB’s force drugs because this is not true. The point of this article and my comment however is to simply highlight that there ARE differences when it comes to the percent of women who get pain medications, epesiotomies, or c-sections when using a midwife or OB. That is an undeniable fact.
Tee commented on Feb 12 12 at 1:18 pmThat’s wfunerodl! I definitely want to have a doula when I have a baby. I’ve seen the research that they truly do reduce the pain that a mom experiences.
Add your take:
Note: Babble is a supportive, diverse community. We encourage a range of opinions,
but any unduly hostile comments will be removed.
Comments are delayed up to 15 minutes
Aela Mass 
Casi Densmore-Koon 
Rebekah Kuschmider .jpg)
CaitlinHTP (Caitlin Boyle) 
Michelle Horton 
Ceridwen Morris 
Katie 
Devan McGuinness 
The Walt Disney Company supports Babble as a platform dedicated to honest, engaged, informed, intelligent and open conversation about parenting. However, the opinions expressed on this site are those of individual parents/writers and do not reflect the views of Disney. In addition, content provided on this site is for entertainment or informational purposes only and should not be construed as medical advice, diagnosis, treatment, or safety advice.
13