What is an OB? What is a Midwife?

I am often asked in my day-to-day conversations, “Why would someone go with a midwife instead of an OB?” Or “What is the difference between a midwife and a doula?” I find that inaccurate impressions are common. The ins and outs of pregnancy care providers is a new topic for many expectant parents, and often people turn to one professional for help that would be better provided by another. Working with the best care providers for you is one of the most important decisions you will make during your pregnancy! What is an OB? What is a Midwife? provides an orientation to the following care providers, their training, and what they do during prenatal visits and birth.

I have listed the birth professionals above from those with the most extensive training to the least. They can be broadly grouped into two categories, primary care providers and others. Primary care providers, often referred to as “your care provider” are trained to deliver babies. MFMs, OBs, GPs, NDs, DOs, and Midwives are primary care providers. The other birth professionals support pregnancy and birth in a variety of ways, but do not deliver babies.

There are additional providers who may play a very valuable role in your pregnancy and postpartum such as endocrinologists, physical therapists, acupuncturists, massage therapists, counselors, psychotherapists,and others. These professionals provide specific inputs addressing specific concerns, and while some individuals may practice primarily with pregnant and postpartum women, these are not specifically birth professions.

Impact of Primary Care Providers

There is both an art and a science to perinatal care before, during, and after pregnancy. Most providers will agree on the science – the clearly evident truths about markers of health status for mothers and babies. There is wide variation among the art – helping families craft healthy lives, making decisions based on evidence that cannot control for the many factors that may impact results, bringing intuition and speculation into discussions about the unknowable future, providing the space and reassurance that helps birth progress well, and so on. It is wise to choose your care provider for both their grasp on the science and their skill in their art. It is also important that they practice the art of perinatal care in a way that fits with your beliefs and desires. If you and your care provider have completely different beliefs about women, pregnancy, or birth, there will most certainly be clashes when decisions need to be made. Some people believe birth is a climax life experience, others believe it is a burden and a hardship. This is just one example of the many different beliefs surrounding birth. It’s natural for you to enter pregnancy without knowing what your beliefs are or understanding who to choose for your doctor or midwife. This article will help you gain some perspective. You can also turn to your gut feelings about how a particular individual provider makes you feel. And it is always OK to switch to a new provider if you have that option, even late in your pregnancy, and certainly between pregnancies.

Your primary care provider will have a huge impact on your birth. They may or may not also have a huge impact on your pregnancy and postpartum.

Some care providers spend extensive time during your pregnancy helping you understand and create a healthy pregnancy, answering your questions, and discussing your fears, concerns, hopes, and desires. They are very supportive. They also have an expectation that you will share pertinent details about your life, and that you are willing to be proactive about your health. Others providers simply monitor your health and your baby’s health and make recommendations based on their assessments. Some providers feel that their job is to educate and your job is to make decisions which they will respect and support. Others feel that their job is to make recommendations which they expect you to follow.

During the final weeks of pregnancy, your care provider’s philosophy regarding risk will determine their recommendations. Some care providers believe that pregnancy is a natural healthy process and that interventions lead to unnecessary complications unless they are medically indicated. These providers, for example, would encourage you not to induce your labor unless there was specific evidence of a problem with you or your baby. Other care providers believe that pregnancy involves some risk, sometimes in an unpredictable way, and that using interventions preemptively based on statistics, before specific concerns arise, offers a measure of control that prevents unnecessary tragedies. These providers, for example, would recommend induction at 41 weeks based on evidence that the rates of stillbirth increase around 42-43 weeks. The former providers may recommend increased monitoring, perhaps even daily, of your baby’s heart rate and reactivity after 41 weeks, and induction only if the increased monitoring revealed reason for concern.

During your birth, your care provider’s approach to labor management will affect some of the following:

  • Recommendations for IVs, vaginal exams, eating and drinking in labor, and method of fetal monitoring.
  • Recommendations for if or when to use additional interventions.
  • Use of a deep water tub or shower for labor or water birth.
  • Freedom to birth in any position or requirement/strong suggestion to be on your back.
  • Hands-off birthing or active delivery of the baby via pressure on either mom’s perineum or on the baby’s head.

Your care providers beliefs about women and about birth will affect:

  • The amount of reverence, calm, assurance, and encouragement they exhibit and provide.
  • The language they choose to use, which can impact fear or confidence.
  • Their approach to conversations about possible interventions: providing options and education or making decisions and expecting your cooperation.

The demands of your care provider’s job, and their training and skills will impact:

  • How much labor support they are able to provide. Examples of labor support include, assurance and encouragement, suggestions for managing pain, positions that encourage labor progress.
  • Which interventions they can personally do rather than rely on another doctor or nurse.
  • How much time they can spend in your room.

All primary care providers in a hospital setting, midwives and doctors alike, can care for women who choose to use or not use an epidural. Most birth centers are not equipped for epidurals, and epidurals and most intravenous pain medications are not available at home. I find that many people have the impression that they cannot have an epidural if they work with a midwife. This is not true! Hospital based midwifery clients are welcome to choose an epidural. I also find that some people believe that you must have an epidural if you work with an OB. This is also untrue! Some OBs have very little experience with unmedicated birth, while others work regularly with women who do not want pain medications. Shop around to find a care provider who fits with your preferences.

It is important to consider the nitty gritty of how your care provider choice will impact your pregnancy and birth. Choosing the best care provider for your unique situation and desires is crucial! Sometimes that means choosing a team of providers in order to meet the full scope of your needs. I will introduce the various birth professions to help you begin this important process.

The information below pertains to general models of care. Each individual provider is unique. You may find a family doctor who practices much like a midwife, or a midwife who practices much like an OB. You will need to interview specific providers or talk to other families about their experiences to find the best provider for you.

Guide to Birth Professionals

What is an MFM?

“MFM” refers to Maternal-Fetal-Medicine. MFM doctors provide care for very complicated pregnancies. They may perform intra-uterine surgery for babies with significant problems during pregnancy, or help a woman with a seizure disorder have a healthy pregnancy. For more information on the situations an MFM doctor can help with see the web site for the Society for MFM. MFM doctors serve both as primary care providers during pregnancy and birth for those families who need them, and as consultants for families who are under the care of an OB. OBs are also equipped to provide care for families with complicated pregnancies, but they may consult an MFM specialist.

MFM Training

MFM doctors complete 4 years of medical school, a 4 year residency program in obstetrics, and then an additional 2 years of specialized training in extremely high risk pregnancies.

What is an OB? What is an OB/GYN?

“OB” stands for Obstetrician. “OB/GYN” stands for Obstetrician and Gynecologist. Obstetricians and Gynecologists are medical doctors who specialize in women’s reproductive health. Specifically, obstetricians specialize in pregnancy, birth, and the period just after birth, and gynecologists specialize in the health of the female reproductive system across the lifespan. Advanced training for these two specializations usually occurs together and it is very common for one doctor to be both and OB and a GYN, usually referred to as OB/GYN. OB/GYN’s are surgeons. They are equipped to provide preventative and non-surgical care, and they are also skilled at performing surgeries such as c-sections, tubals, and other surgeries involving the female reproductive system. Many doctors who choose to specialize in obstetrics and gynecology enjoyed surgery as a medical student, and chose this field for its rare combination of very relational care and surgical care. Many other surgical specialties have limited patient care and a lot of hours in the operating room. OB/GYNs, in contrast, develop relationships with their clients over the span of pregnancy or throughout life-span well woman care and they practice surgery as well. OB/GYNs provide pregnancy care for both healthy and complicated pregnancies.

OB/GYN Training

OB/GYNs complete 4 years of medical school, and then a 4 year specialized residency program. Their formal training emphasizes an understanding of pregnancy and birth complications and the medical interventions used to manage them.

What do OBs do?

OBs do prenatal care and deliver babies. They also provide postpartum care for mothers. They deliver babies almost exclusively in hospitals or hospital-based birth centers.

Typically prenatal visits with an OB are 5-15 minutes long. They include monitoring your and your baby’s health though physical exams (measuring the height of your uterus and listening to the baby’s heart rate), labs (urine analysis and blood work), and additional tests and scans (such as an ultrasound or amniocentesis). OBs also answer your questions during your appointments, though conversations are brief. OBs usually see their patients once a month for the first two trimesters, every other week until 36 or 37 weeks, and then weekly until the baby is born. As a general rule, OBs approach pregnancy care as a process of screening for potential problems and intervening if necessary. They also take a preventative approach to risk management and rely on tools such as induction of labor to prevent anticipated complications.

During your labor and birth your OB typically checks in on you for a few minutes every few hours. They rely on your nurse to alert them to anything that needs their attention They keep track of the course of your labor and wellbeing (yours and babies) through nursing chart notes and information from electronic fetal and contraction monitors. OBs place orders for any pharmaceuticals or procedures you need or desire such as IV’s, medications, or epidurals, and they perform procedures, such as vaginal exams, breaking your water, or placing internal monitors.

Your OB will usually check on you more frequently during the pushing stage, and may do vaginal exams to assess the movement of the baby with your pushes. When the nurses think birth is imminent they will call your OB, and your OB will then stay with you until the baby is born – typically about the last 5-15 minutes of your pushing stage. Typically, OBs are more management oriented, and therefore feel that the best positions for birth are those that allow them optimal ability to intervene if needed. They usually prefer that women are on the hospital bed, either on their back or lying on their side. Some OBs are also quite comfortable with the hands and knees position.

After your baby is born, OBs will stay in your room until your placenta is delivered, or leave briefly and come back in when the nurses think your placenta is ready to be delivered. If there is anything out of the ordinary, such as heavier bleeding, they will also stay until all is well. If any stitches are needed, your OB will do the stitching, either before or after your placenta is delivered.

OBs also supervise and/or provide assistance to midwifery patients if any care beyond the scope of midwifery is needed. This includes consultation and procedures such as vacuum or forceps assistance and c-section.

OBs often work in group practices, or share call with other private practice OBs. This means that your OB may or may not be the OB who is available when you go into labor and have your baby.

What is a Family Doctor?

“GP” stands for General Practice. There are few GPs today, but many people of childbearing age now grew up seeing their family’s GP for well-child visits and health concerns as they grew. The practice that has now replaced general practice is primarily family medicine. A family doctor practices family medicine, which is focused on proving long-term care for patients and their families across the life-span. Some family doctors deliver babies, whereas others see their pregnant patients for the first trimester and then refer them to midwives or OBs. In regards to perinatal care, a family doctor is sort of the middle ground between a midwife and an OB. Family doctors are equipped to provide care for healthy pregnancies and they often can spend slightly more time with you during your appointments than an OB, but less than a midwife. As someone who may have known you for a long time, and who can continue your care far beyond pregnancy, they are in a medical practice focused on relationships with the entire family. They can continue to care for both you and your baby after your birth and throughout childhood and beyond.

Family doctors complete 4 years of medical school and then a 3 year residency focusing on each of the following areas: obstetrics, pediatrics, general surgery, and critical care or intensive care.

What does a Family Doctor do?

Some family doctors provide prenatal care and deliver babies. They usually practice primarily in community doctor’s offices and deliver babies in hospitals or birth centers.

Most family doctors spend about 15 minutes with you during a prenatal visit. They perform similar tests to those that a CNM would perform and order other tests only as necessary from specialists, such as an OB/GYN. They tend to have a greater emphasis on a healthy lifestyle than most OBs, and they may spend time discussing diet and exercise and the needs of other family members such as siblings.

During birth your family doctor will be present with you about the same amount as an OB – checking in every few hours and coming in for delivery during the final minutes of your pushing stage. They tend to be more focused on monitoring rather than managing birth, and are in general more likely to limit intervention to the cases where it is clearly necessary rather than utilizing intervention for speculative prevention. If advanced intervention is needed (such as vacuum or forceps assistance or c-section), many family doctors will refer or work with an OB/GYN, though some will perform these interventions themselves. This distinction often depends on the size of the community or hospital and the availability of OBs.

Family Doctors often deliver babies for the specific people they care for in pregnancy, meaning that you doctor will likely be there when you have your baby. Others work in group practices, or share call with other private practice doctors, which means that they may or may not be the doctor who is available when you go into labor and have your baby.

What is a Midwife?

Midwives are women who provide primary care for healthy pregnant women and well-woman care across the life span. Worldwide they are the most common maternity care providers, though in the US they serve a minority of families. There are three types of midwives with different types of training, and each is regulated differently by different states and countries.

What is a Certified Nurse Midwife (CNM)?

Certified Nurse Midwives, CNMs, are advanced practice nurses who care for healthy women and babies throughout pregnancy and birth. They are primary care providers for both pregnancy and for well-woman care across the life span. CNMs can perform many of the procedures sometimes used during pregnancy and birth such as vaginal exams, breaking your water, and internal or external fetal monitoring. They refer clients to doctors (usually OBs) for more advanced procedures such as amniocentesis or detailed ultrasound. Most CNMs work either in hospitals or birth centers, and some CNMs offer homebirth services.

CNMs are licensed and regulated in every state, and are fully integrated into the medical care system. They can order labs and tests, diagnose and prescribe with some restrictions, and they can make referrals to appropriate specialists. CNMs and are the fasting growing profession in perinatal primary care in the US.

CNM Training

CNMs complete a 4 year BSN (Bachelor of Science in Nursing) and then continue their eduction through a 2 year MSN (Masters of Science in Nursing) program with a specialization in midwifery. Their training emphasizes promotion of health pregnancy and a thorough understanding of healthy birth physiology. The training of medical doctors focuses on pathology and medicine, and the training of CNMs focuses on preservation/promotion of health and monitoring health and wellbeing.

What does a CNM do?

A CNM provides prenatal care and labor support, and catches* (delivers) babies. They also provide postpartum care for mothers. Most CNMs work in hosptials or birth centers, and a few CNMs offer homebirth services.

Typically prenatal visits with a CNM are 20-60 minutes long depending on where their practice is based, in a hospital, birthcenter, or in private homebirth practice. Visits include monitoring your health and your baby’s health though a physical exam (often measuring the height of your uterus and listening to the baby’s heart rate). Midwives tend to be more hands-on and make evaluations about the baby’s size, position, and wellbeing by using their hands to gently feel your abdomen. CNMs also use labs (urine analysis and blood work) and additional tests and scans (ultrasounds or amniocentesis) on an as-needed basis. CNMs focus on answering your questions during your appointments, and they also check in with you about your feelings, stress management, diet and exercise, and other components of a healthy lifestyle. They are interested in your hopes and plans for your birth, and will help connect you to childbirth educators, doulas, or others who may help you prepare for birth. CNMs usually see their clients* (patients) on the same scheduled used by OBs and Family Doctors: once a month for the first two trimesters, every other week until 36 or 37 weeks, and then weekly until the baby is born. As a general rule, CNMs approach pregnancy care as a process of partnering with or mentoring healthy pregnant women to provide education and support during this season of great change and high physical demand. While they screen for potential problems, and intervene if necessary, health monitoring is only a small part of what they do. They take a preventative approach to risk management by encouraging optimal health, and rely on tools such as induction of labor only in the event that complications actually present, rather than as an approach to managing suspected potential problems.

During your labor and birth, your CNM is typically with you more than most doctors. She may stay with you for 15-20 minutes every hour or so. They provide labor support, helping you find effective ways to manage the intensity of birth, and offering reassurance and encouragement. CNMs also rely on your nurse to alert them to anything that needs their attention, and they spend enough time with you to have their own sense of your needs and wellbeing. As a general rule CNMs use less continuous fetal monitoring and fewer interventions in birth, though you may use any type of pain medication you wish (in the hosptial setting). If these medications are used, CNMs will follow the same safety protocols used by doctors, including continuous fetal monitoring and an IV. CNMs place orders for some pharmaceuticals or procedures you need or desire, such as IVs, medications, or epidurals, and they place perform some procedures such as vaginal exams, breaking your water, or placing internal monitors. CNMs consult with OBs if anything complicated arises, and they often partner with OBs to provide care if birth becomes complicated. Typically an OB would be called if a CNM felt there was a possibility of needing vacuum of forceps assistance, and CNMs cannot perform c-sections.

Your CNM will remain with you continuously during the pushing stage – often about 1-3 hours for a first-time mom, and shorter for subsequent births. Typically, CNMs believe that mom will naturally choose the positions best for her labor and her baby, and they recognize that restricting mom’s position may create an extra burden that makes birthing more difficult. Most CNMs are comfortable delivering babies in a wide variety of positions and places, including in a tub or warm water (waterbirth). CNMs can offer guidance and directed pushing if it is helpful.

After your baby is born CNMs will stay in your room until your placenta is delivered. If there is anything out of the ordinary. such as heavier bleeding, they will also stay until all is well. If any stitches are needed, CNMs will do the stitching after your placenta is delivered, calling an OB for assistance, if needed. CNMs often see you again about a day after your baby is born and at two and six weeks postpartum. These visits include physical care, and also cover mental health support and an opportunity to answer your questions.

Hospital based CNMs often work in group practices. This means that they may or may not be the midwife who is available when you go into labor and have your baby. In some practices you will definitely be with another midwife. In others, midwives and doctors share an on-call schedule and you may have a doctor or a midwife. All CNMs work with physician oversight, and a physician is always available if needed during your birth, although sometimes transport to a hospital is necessary if you were birthing at a birth center or home.

What is a Certified Professional Midwife (CPM)?

A CPM is a midwife who is certified through national standardized testing. Most CMPs either learn midwifery from an experienced midwife or enroll in two-year certification program. The CPM certification testing includes both written and skills exams to prove competency, and also experience requirements. CPMs are not registered nurses and do not have a formal medical background. CPMS are licensed and regulated in some states and can legally practice midwifery within a limited scope of practice (singleton births – births with only one baby, and no VBACs – vaginal birth after cesarean), whereas women without a CPM certification may not. In these states, CPMs are integrated into the medical system and may make referrals to other care providers as needed, order labs, and in some states may carry a restricted list of prescription medications, such as Pitocin and oxygen. In other states, CPMs are not licensed and the practice of midwifery is legal for anyone. In these states, CPMs may legally practice, but they are not integrated into the medical care system and sometimes can not order labs or make referrals to other doctors. They are not permitted to carry prescription medications. In yet other states, the practice of midwifery is illegal for CPMs and non-certified midwives alike.

CPM Training

CPMs may gain knowledge and experience through a variety of paths including accredited programs or apprenticeship. Most CPM candidates are required to provide primary care under supervision for at least 10 births and four pregnancies. For detailed CPM requirements see this page from the North American Registry of Midwives.

What does a CPM do?

CPMs do prenatal care, catch babies, and provide postpartum care for healthy women and babies. Most CPMs work in free-standing birth centers or provide homebirth services. Some CPMs also provide well-woman care across the lifespan.

Typically prenatal visits with a CPM are 60-90 minutes long. CPMs tend to minimize prenatal tests and screens beyond blood pressure, listening to your baby’s heart rate, and assessing growth, though they are aware of the full scope of prenatal screening and may recommend specific tests for each client. CPMs have well-developed skill with hands-on and intuitive assessment. They put a lot of emphasis on supporting holistic health and helping you prepare for birth. CPMs rely on their client’s active participation to promote healthy pregnancy and birth. They may recommend specific nutritional supplements, herbs, gentle exercises, counseling, and other tools to manage pregnancy discomforts, risk prevention, or relationship strife. These tools often that require you to take personal responsibility to implement them. CPMs often take time to discuss many aspects of your life during pregnancy, and may become a mentor through this process.

During your labor and birth your CPM is typically with you continuously once your labor is active. Many CPMs provide most of your labor support and hands-on care personally rather than relying on an assistant or an L&D nurse, though typically another woman in an assistant role is also present. CPMs intermittently monitor your baby’s heart rate throughout labor, and encourage labor progress by building your confidence, assuring privacy, and encouraging water and light food. CPMs believe that pregnancy is a normal and healthy event that unfolds in very diverse ways. They tend to let labor take its natural course and use very minimal interventions. If complications arise, CPMs typically turn to natural aids such as herbs or homeopathic remedies if possible, and transfer to medical care with a doctor if necessary. A transfer of care often requires transport to another setting, typically a hospital.

Your CPM will remain with you continuously during the pushing stage. They are comfortable catching babies in many positions and wherever mom is most comfortable.

After your baby is born, CPMs will stay with you for a few hours. During this time she will assist your with the birth of your placenta, your care, and with breastfeeding. Most CPMs also do an initial newborn health assessment, listening to their heart and lungs, and doing a little physical exam.

CPMs often work alone or in a small partnership with a few other CPMs. They typically attend the births of their own clients. Because they often work in birth centers and at home, CPMs can rarely accommodate the use of pain medications or epidurals.

What is a Direct Entry Midwife (Non-Nurse Midwife, Lay Midwife)?

Direct Entry Midwives (DEMs) are midwives who do not hold a certification or degree. Most DEMs learned midwifery through an apprenticeship, and some through self study or necessity. DEMs work very similarly to CPMs, although they are not integrated into the medical system in any state. In some states the practice of midwifery without a certification is legal and in others it is not.

Direct Entry Midwife Training

There are no specific training requirements for DEMs.

What is a L&D Nurse?

Labor and Delivery Nurses (L&D Nurse) are registered nurses who work in the labor and delivery unit at hospitals, in birth centers, or who assist homebirth midwives.

L&D Nurse Training

L&D Nurses may have completed a 2-year accreditation program or a 4-yearBachelors of Science in Nursing.

What does an L&D Nurse do?

L&D Nurses provide labor support during birth and immediate postpartum care. They carry out many of the tasks that midwives and doctors rely on to monitor your health during birth, such as taking your temperature and blood pressure, monitoring the baby’s heart rate, and creating chart notes about how you are coping and the length and frequency of your contractions. L&D nurses also provide labor support, offering you encouragement and reassurance, comfort measures, such as supporting you with pillows or bringing a heating pad, and helping with position changes. L&D nurses can also do vaginal exams if necessary in their place of work (in some places vaginal exams are done by the doctors and midwives only, except in urgent situations). If any interventions are ordered by your doctor or midwife your nurse will often be the one to carry out the order, such as starting an IV, or assist during any procedures done by your primary care provider such as breaking your water or placing an internal monitor.

L&D nurses generally work one-to-one with patients, while also providing additional help to one another. This means that your nurse is assigned to you for a shift, and will be the primary person checking on you during and after your birth. They will usually come into your room once every 30-90 minutes, and may stay from 2-20 minutes depending on your desire for labor support. When they are not with you in your room your nurse may be monitoring your labor from data generated by electronic fetal and contraction monitors. At times your nurse will be helping another nurse in another room and may be unavailable to you for a short time. During this time another nurse is always available if needed.

You typically cannot choose your L&D nurse ahead of time. Some L&D nurses have years and years of experience and some are brand new. Some love assisting with low-intervention, unmedicated births. Others love assisting with very complicated and highly managed births. In some hospitals, nursing assignments reflect these specialized skill sets and interests, and in others they are random. You may get a nurse who is perfect for you and your birth plan and you may not. If you ever have a significant clash with your nurse, you can ask to speak to the charge nurse and request a reassignment. This is sometimes possible, but is not a guarantee.

What is a Pregnancy Coach?

A pregnancy coach is any birth professional who is also a certified coach. Their coaching certification may be in life coaching, wellness coaching, or health coaching. Coaching is a specific positive psychology field in the practice of human behavior change. Pregnancy coaches help their clients make lifestyle choices that support a healthy and meaningful or joyous life before, during, and for about a year after pregnancy.

What does a Pregnancy Coach do?

Pregnancy coaches meet with clients to discuss their goals, hopes, challenges, and obstacles. They then provide education that may help clients reach their goals, and also strategize ways to achieve their goals step by step. Coaches are specifically focused on helping clients use their personal strengths to approach change their goals in a way that makes sense for their personality and their unique situation. Typically coaching is done over-time, meeting regularly on a weekly or monthly basis, often by phone.

What is a Pregnancy Consultant?

A pregnancy consultant is any birth professional who is limiting their practice to advice rather than practicing the additional skills of their profession, such as diagnosing, prescribing, clinical care, or hands-on support. They typically do not have additional training beyond the training for their particular birth profession.

What does a Pregnancy Consultant do?

Pregnancy Consultants meet with clients to discuss their goals, hopes and needs. They provide education pertinent to the unique circumstances of each client. Consulting is not simply about spitting out an answer to your question. It is about understanding the feelings or needs behind your struggle and meaningfully aiding your process with both information and ideas that are relevant and useful. Consulting is both an answer and an empowering process, facilitating clarity of your own personal decision. When you are thoroughly informed about your options, but a decision remains to be made, consulting can help you settle on a decision and lay plans that preserve good within all options. Clients often meet with their consultant just once, and often several times as needs arise.

What is a Childbirth Educator?

A childbirth educator is certified to teach expectant parents about the labor and birth process and early postpartum care. They provide classes either in group settings or privately with one couple at at a time. Childbirth educators emphasize information about the anatomy and physiology of labor, birth interventions and management, and techniques and ideas for coping with pain during childbirth. Childbirth educators are not qualified to give individual medical advice.

There are many different childbirth education philosophies and methods, and the content of courses varies greatly from one educator to another, and among the many groups who certify childbirth educators. Most educators and groups place a high value in evidence-based information. Some studies suggest that it takes about 20 years for new research to result in new practice standards. Unfortunately, a lot of maternity care practices do not reflect the most current scientific research. Childbirth educators, current in their field, are a fabulous resource for evidence-based information about your options in pregnancy and birth.

When it comes to teaching clients how to cope with the pain or intensity of labor, childbirth classes vary greatly. Some provide an orientation to how epidurals work and assume you will utilize anesthesia during birth. Others focus on intuitive birthing and focus on building your confidence and trust and reducing fear so that you can find your own unique way through birth. Still others focus on a detailed pain coping techniques such as deep relaxation, non-focused awareness, distraction techniques, or hypnosis.

Childbirth Education Training

Certified Childbirth Education programs vary greatly. Some programs are designed for nurses and require simply a weekend training and a few book reports. Others are designed for people without a healthcare background and may take as long as 3 years to complete through self-study and workshops. Childbirth educators are not licensed or regulated in any state, and anyone can be a childbirth educator.

What is a Doula?

Doulas are women who provide non-medical, hands-on help during birth and postpartum. Birth doulas provide labor support (reassurance, encouragement, suggestions, information) and comfort measures (counter pressure, massage, acupressure, operation of a tens unit, heat, cold, and water therapy). Some doulas are also well-versed in natural labor stimulation techniques, such as position changes and nipple stimulation.

Postpartum doulas provide hand-on help in your home after birth. They are well versed in baby care, baby feeding, postpartum physical recovery, and the common emotional journey after birth. Postpartum doulas can provide infant care while you rest or take a break, but they are not childcare providers. Rather, they help you build your own competency and confidence as a new parent. They also provide house help, such as light cleaning and cooking.

Doula Training

Most doula certification programs include a weekend workshop and several book reports. Doulas are not licensed and anyone can be a doula. Doula training is typically less comprehensive than childbirth education programs and focuses specifically on comfort measures. Doulas are a nationally recognized provider category, and certified doula services are sometimes covered by insurance.

What do Doulas do?

During your birth your doula will remain with you continuously. They may provide hands-on comfort measures, make suggestions, or offer encouragement and coaching through your contractions. Doulas can facilitate conversations with your care provider or provide information in order to make sure you have all of the information you need to make decisions for yourself and your family during your birth, but they cannot give medical advice. Doulas can also explain your birth plan choices to your nurse so that you can focus on your labor. Typically you choose your doula during pregnancy. She will meet with you before your birth to gain a detailed understanding of your preferences for your birth and any unique strengths or challenges that may impact how you give birth. You may interview several doulas and choose someone who is a wonderful match for your needs and goals.

Postpartum doulas typically come to your home for a contracted number of hours, anywhere from 2-12 hours per day, usually for a week to three months after birth. They answer your questions and help you get comfortable with baby care and baby feeding, as well as support your healing and wellbeing. Postpartum doulas offer some house help such as simple cleaning, meal preparation, or help with older siblings.

Your Birthing Dream Team: Putting it all Together

Now that you know more about the many people who can help you have a wonderful birth, it is time to start putting together the perfect team to surround you during your pregnancy, birth and postpartum. You may be beginning to search for your first care provider, or you may be realizing that a switch to another provider may be beneficial. This is time well spent! Your care provider choices can bring excellent support and skill into your life, helping you have a positive experience throughout your childbearing year. A mismatch between the support you are seeking and the approach of your care provider can mean disappointment, loss of control or a sense of violation or abandonment during the birthing process.

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* You may of noticed some change in language choice in my descriptions of CNMs and OBs (Catching or Delivering Your Baby, Clients or Patients). This is not unique to me. These are the terms that doctors and midwives often use to describe their work and the people they serve. They are reflective of differences between the midwifery model of care and the medical model of care.