Know Your Birthing Experts: OB/GYNs, Midwives and Doulas – What’s the Difference?
January 12, 2018
Pregnancy is a time of decisions, from baby names and nursery colors to the expert care you’ll have in the delivery room. If you’re choosing an obstetrician, midwife or doula – or even all three – the first step is understanding the differences among these birthing specialists.
Obstetrician/gynecologists are by far the most common choice for birthing in the US. These physicians specialize in managing pregnancy, labor, delivery and care immediately after birth. Obstetrics/gynecology is also a surgical specialty, meaning these specialists have been trained to do surgery and perform cesarean sections, circumcisions and other surgical procedures such as hysterectomies.
Is there a difference between an OB and a GYN? Yes, though many physicians are both and thus designated as OB/GYNs.
- Obstetrics is the care of pregnant women and the unborn baby, labor and delivery and care immediately after birth.
- Gynecology is the care for ailments of the reproductive organs (uterus, fallopian tubes, cervix, ovaries, vagina) as well as related problems in the bowel, bladder and urinary system.
- Obstetricians limit their practices to pregnancy and childbirth; 90% of gynecologists also deliver babies.
Your OB/GYN can help you create a care plan which might include pain medications and labor induction – or more natural options – and provides care throughout pregnancy, monitors your progress during labor, handles the delivery and provides post-delivery care -- including routine visits.
Do some women have to have an OB/GYN? A pregnancy that’s considered high risk due to medical conditions (high blood pressure, epilepsy, heart disease, diabetes, previous pregnancy complications) requires the care of an obstetrician or OB/GYN or a maternal-fetal medicine specialist, which is an OB/GYN with additional training in pregnancy complications. Women having twins or other multiples, or who develop premature labor or preeclampsia, also require the care of an OB/GYN or maternal-fetal medicine specialist.
Education: The obstetrics/gynecology medical specialty requires four years of medical school beyond undergraduate schooling and then four years of residency training for a total of 12 years or more of education, plus certification by the American Board of Obstetrics and Gynecology.
The term midwife means “with woman.” A certified nurse midwife (CNM) is an advanced practice registered nurse with training in nurse midwifery, or the care of women throughout their lifespan, and especially for pregnancy, delivery and postpartum care.
Are midwives becoming more popular? Yes. Since 1989, the percentage of midwife-attended births has risen nearly every year. In 2014, CNMs attended 8.3% of total US births.
The midwifery care model is designed for non-complicated pregnancies, when the mom-to-be desires childbirth that is as natural as possible with options for pain management and little medical intervention (labor induction, fetal monitoring and episiotomy).
Expectant mothers who choose the midwifery model have access to a wide range of services, including hydrotherapy, water births, aromatherapy, nitrous relaxation and massage therapy – as well as preconception counseling and newborn screenings.
- Perform regular exams throughout pregnancy
- Assist with birthing plan decisions, such as whether or not to use anesthesia
- Teach breastfeeding
- Teach infant soothing techniques
- Provide postpartum medical care to women and newborns
- Recommend coping strategies
- Provide well-woman care, including Pap smears, throughout a woman’s lifespan.
Can I have both a midwife and an OB/GYN? Yes. Most midwives work in hospitals in collaboration with OB/GYNs. When a patient’s pregnancy becomes complicated or when there’s a multiple birth, midwives collaborate care with an OB/GYN and often remain on the medical team and with the birthing mother.
Education: To become a certified nurse midwife, practitioners must obtain a bachelor’s degree and complete a graduate degree midwife program accredited by the American College of Nurse-Midwifes (ACNM) Accreditation Commission for Midwifery Education. Midwives are regulated by the state in which they practice.
A doula, pronounced “doo-la,” comes from a Greek word meaning “woman servant or caregiver.” The Doulas of North America (DONA) describe this profession as being similar to serving as a travel guide in a foreign country.
The doula’s role is as birth attendant. They offer emotional and physical support before, during and after childbirth. Put simply, doulas believe in “mothering the mother.” A doula can be considered a consultant and resource, not a clinician, who encourages and supports communication between birthing mothers and their health care teams.
Can doulas deliver babies? No. Doulas do not provide medical care or in any way replace an OB/GYN or midwife. Doulas do not act as a midwife assistant, diagnose medical conditions, perform clinical procedures, prescribe or administer treatment or make medical decisions for a birthing woman.
- Provide birth education, preparation and birth planning
- Suggest positions and changes to ease pain
- Comfort with massage, reassure and encourage laboring mothers
- Help negotiate birthing preferences with the health care team
- Photograph or video the birth
Does a doula replace my partner in the delivery room? Rather than replace a partner or spouse, the doula reinforces the partner’s role in childbirth by providing advice and support. A doula may help a partner know what to do, and may step back so the partner and birthing mother can experience important moments together.
Education: Becoming a Certified Labor Doula (CLD) requires enrollment in the Labor Doula Traditional Course and completion of a Labor Doula training class with the Childbirth and Postpartum Professional Association (CAPPA), the international certification organization for Doulas, Childbirth Educators and Lactation Educators.