Obstetrician? Doula? Midwife? Monitrice? Who knew there would be so many types of pregnancy care providers to learn about? When choosing a prenatal/birth provider it is important to know what all the options are and who is available near you. Let's take a look at some of the options.
Roughly 90% of births in the United States are attended by obstetricians; medical doctors whose specialty is childbirth. Most often doctors attend hospital births. Doctors typically have one of two designations: MD (Medical Doctor) or DO (Doctor of Osteopathic Medicine). Both types of doctors have at least 8 years of medical training plus internship, residency, and fellowships. They can all become surgeons. The main difference is that DOs are trained to perform osteopathic manipulation which includes hands on therapy to improve structure and circulation of the body, and relieve pain. DOs are often considered more holistic of the two, but both typically follow the medical model of care.
The word Midwife means "with woman." The midwifery model of care takes a community approach to childbirth. Nine percent of births in the U.S. are attended by midwives. Midwives are people who are not doctors who are specially trained in pregnancy and childbirth care. There are four types of midwives.
Certified Nurse Midwives (CNMs) are nurses with a bachelor's degree in nursing, and a master's degree in midwifery. They can practice in or out of the hospital setting, though most work in hospitals or birth centers.
Certified Midwives (CMs) have a bachelor's degree in another related field and have completed training in midwifery. CMs typically work in birth centers or in the home.
Certified Professional Midwives (CPMs) may or may not have a degree, but have completed a midwifery program including required hours of clinical experience. The are certified by the North American Registry of Midwives. Like CMs, CPMs typically do home-births, or work in birth centers.
These three types of midwives last must become licensed by the state in order to practice.
A Lay Midwife(LM) is an unlicensed midwife who may or may not have formal training. They usually gain knowledge through apprenticeships with other midwives in the community.
Check your state laws to know what types of midwives are legal in your state. Some states have no licensing requirements while other states have very strict laws restricting all types of midwives. States also have laws determining the scope of practice for midwives, which includes what types of medications they are able to carry and give when necessary.
Maine requires licensure for midwives and will license CNMs, CMs, and CPMs, all of whom are allowed to give medications related to childbirth needs and/or complications.
Obstetricians and Midwives are health care providers. They are trained in childbirth and know what to do if complications arise. Many states have laws restricting midwives from caring for "high risk" pregnancies.
Registered Nurses involved in childbirth typically work in hospitals or birth centers under the direction of a midwife or obstetrician. While they are advocates for you and your choices, they ultimately work for the facility and are responsible for carrying out physician orders and keeping you safe.
A doula is someone hired by you to be a support person for you and your partner. They can provide physical support by giving massages or helping you try out different positions, emotional support by listening to you and advocating for you, and educational support through providing childbirth education information and helping create a birth plan. They are used in hospitals, birth centers, and home births.
Though monitrices are less common than doulas they provide similar support. Monitrices have some level of medical training, such as nursing or midwifery, but are hired by you to be a support person in a hospital birth. This is more common for those who prefer midwifery care, but have high risk pregnancies that require them to see an obstetrician. The midwife can still provide some prenatal care, and be there to support you through your birth at the hospital.
There are a number of interpretations of the role of a birthkeeper, but the general idea is that they are a non-medical professional who holds space for natural labor. They are not licensed or certified and therefore can not provide any medical care or manage your birth. They are simply present to protect your space and to answer questions before, during, and after the birth process. Birthkeepers are often used for free births and/or wild pregnancies.
Hopefully this information helps you understand all the different people available to provide care and support for you during your pregnancy, birth, and postpartum period. Please reach out if you have any other questions related to this topic.