Who do I choose? Forming Your Birth Team

Hello! When I started this blog a few weeks back I intended to do two posts (or one at the very least) a week… but Hurricane Irma had other ideas. I was without power for awhile, but me and mine are safe and getting back on track. I hope and pray that all of you who’ve been affected by the storms are safe and rebuilding. Hurricanes really are bitches. (And somehow they keep getting worse…. how ’bout that climate change? Never-mind, I don’t have time to do a political rant today.)

I do have some important things to share with you all about the kind of care you can choose for your pregnancy and birth. Believe it or not, you get a choice about the care you receive. Who do you want at your birth? Creating your own personal birth team can be a hard task. So I thought I’d help make it clear what each care provider does. Below are some questions I am asked on a regular basis:

“What is the difference between a midwife and a doula?”

“Why would I choose a midwife over a doctor?”

“Do I need a doctor and a midwife? Or does my midwife work for my OB?”

“Isn’t the Labor and Delivery nurse I’ll have at the hospital just like a doula?”

These are all great questions. I think sometimes Doulas or other birth workers (myself included) get tired of answering these questions because it’s easier to just say “yeah a doula is kinda like a midwife” and just move on. But that really isn’t benefiting the birth movement or the mother. Nor is it true. Everyone has their own job and special place in the birth world. First, let’s dive in and define who these people are.

OBSTETRICIAN: An Obstetrician is a doctor, first and foremost. He or she delivers babies and is in the practice of obstetrics, the art and science of managing pregnancy, labor and the puerperium, the time immediately after delivery.

OB/GYNs are amazing and essential to our world but like most doctors, they are accustomed to “fixing” something. Your doctor may be focused on the easiest and quickest way to get your infant into your arms. This is great for some, but others may want a more natural approach to their births. There is no wrong way. Generally if you choose an OB as your care provider you will see not just your chosen provider but also members of his/her practice throughout your pregnancy. This is great if you want quick answers to a question or don’t have a flexible schedule, because usually there will be someone on your OB’s team that can see you. During the labor, the doctor will come in and out to check on your progress and, as the definition above states, “manage” your labor. Obstetrics is a surgical field, so in the case of a cesarean, it would be your OB that would perform the procedure. If you do not want a cesarean, be sure to check your OB’s birth statistics. Some of them are excellent surgeons and turn to that option quicker than others.

******Dr. Bootstaylor at SEE BABY of Atlanta is an excellent obstetrician if you are looking for an OB in the Atlanta area*****

MIDWIFE: A midwife is a trained professional with special expertise in supporting women in maintaining a healthy pregnancy/birth, and offering expert medical care to a woman and her newborn throughout the childbearing cycle.

A midwife that has her own practice works with each individual pregnant person to identify their unique needs and what they want from their birth experience. All Midwives operate from The Midwives Model of Care which emphasizes the fact that pregnancy and birth are normal life processes. Midwives statistically have lower rates of interventions and provide the mother with individualized prenatal and postpartum care as well as hands-on assistance during labor and delivery. Midwives are not surgeons, So they cannot preform an emergency cesarean. Midwives, like doctors, may work in a group that rotates who is on call and who will see you for your prenatal visits. Some midwives work alongside doctors in their practices, while others work individually or outside the hospital setting. There are different types of midwives: Direct Entry Midwifes, Certified Professional Midwives, and Certified Nurse Midwives. Depending on their credentials and training, some midwives work in hospitals while others solely attend home births. Midwives are a better fit for some pregnant people because they often give more individualized support and allow mothers to birth at their own pace.

***If you are looking for a wonderful midwife who does at home prenatal care, I highly recommend Whitney Whitmoore, CPM. Contact her today. She’s amazing! www.georgiabirthalternatives.com ***

LABOR and DELIVERY NURSE: Nurses in the labor and delivery field provide care to women who are in labor or who have recently delivered, including those who may be having complications with labor.

Nurses work under doctor’s orders to develop a plan to aid in the safe delivery of healthy babies. They work in the clinical setting only and they work on rotating shifts. There is no way of knowing who will be your nurse during delivery. Nurses are wonderful and often are the professional you’ll see the most during a hospital delivery. They will have several patients they are taking care of, all within the same floor.

BIRTH DOULA: A labor doula is a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth. (Post Partum Doulas provide emotional and practical support during the postpartum period. Some doulas wear both hats)

Unless she has additional training, a doula is NOT a medical professional and will not perform medical procedures on the laboring mother or the baby. (In the case of an emergency when no other qualified care provider is present a doula can perform samaritain services. But never assume your doula is qualified to do medical procedures. It’s not her job.) She will not be able to fix your IV or check your cervix. However, she will most likely be one of the most consistent elements of your labor experience. She does not change shifts, never leaves your side, and only deals with one client at a time. Doulas work for YOU. Not the hospital. The doula will also labor with you at home and come with you to the hospital or birth center.

So, now that I’ve beaten you over the head with definitions—back to the original questions:

What is the difference between a doula and a midwife?
A doula acts as an emotional, physical and informational support for the mother. She will keep you informed of everything that happens to you, and help you prepare emotionally for whatever is ahead. A midwife delivers the baby and performs the necessary medical examinations throughout pregnancy, labor, delivery and postpartum. Many midwives are also available to do “well woman” yearly exams throughout a woman’s life, not just working with her while pregnant, like an OBGYN. During pregnancy and birth, many women choose to have both a midwife and doula. They are often an unbeatable team.

Why would I choose a midwife over a doctor or vice versa?
Choosing your care provider is a very personal choice. It requires a good look at the model of care you would like for your pregnancy and delivery. (Consulting a doula is helpful when choosing what is best for you. She will have information on care providers in your area and can help you access your needs.) While both doctors and midwives try to offer the best care they can, the type of care they give differs. The Model of Care that midwives subscribe to reflects the idea that pregnancy and birth is a natural physiological process that should be inherently trusted. Doctors, on the other hand, use the medical model that focuses on the pathologic potential of pregnancy and birth. They both have the same desired outcome, but use different routes to get there.

When choosing your provider you should consider the style of care you personally prefer. Midwives will tend to be more present during labor; moreover, they will be more holistically based and allow more space for the labor to unfold naturally before moving to medical interventions. Doctors are not as likely to give you as much personal care and time and may move to medical interventions more quickly. But in the case where you have a health problem that complicates your pregnancy, you might prefer a doctor. He or she won’t wait around to see if that complication negatively affects your baby. On the other hand, if you want to labor at home or at your own pace without fear of intervention, a midwife might be the better of the two. Everyone is different. So choose what is best for you!

Does my midwife work for my doctor? Do I need both?

Sometimes a practice has both doctors and midwives. But no, midwives don’t work for a doctor. They often work together in groups. But if your current doctor does not work with midwives you cannot have both as care providers. You don’t need both. If a midwifery practice does not have a doctor as part of the group, there will be a doctor that backs up that group. However, if you choose a home birth, you will have just a professional midwife and should you need further medical assistance, you would be transferred to a hospital. Some midwives have privileges at a hospital, while others just have a relationship with a doctor and will no longer be your care provider should you be admitted.

Isn’t the Labor and delivery nurse just like a doula?

No. Labor and Delivery nurses are wonderful and can offer a lot of great advice for the laboring mom. However, you cannot expect your L & D nurse to provide the same comfort and assistance as a birth doula. They will have several patients they are monitoring at the same time and cannot offer consistent support. It isn’t their job to hold your hand. It is their job to monitor your medical needs. They work in shifts so if your labor exceeds 8-12 hours you will get a new nurse at shift change. Nurses are an essential part of your hospital birth team, but they work for the hospital. You may also find it appealing that you will get to know your doula before you deliver and you get to choose them! You will have little to no control over which nurse attends your birth. But you ARE guaranteed to have a nurse attend your birth in hospital. A doula isn’t provided. She is someone you choose for your team.

I hope this helps you or other pregnant people choose what kind of birth team they want for themselves. Knowing what each member of a team does is essential to getting the best care. And YOU do deserve the best care.