Birth Series - Part 2A; Midwives and Doctors and Doulas, Oh My!

The saddest thing I hear from moms is "I didn't know that was an option". It kills me. It makes me angry. It drives me to write heavily researched blog posts about birth. Because in birth, while nothing is ever certain and your birth plan can change in an instant, you always have options. The first option you have is who to give birth with. You might think that it's either a doctor or a midwife but you'd be wrong. Mamas today are lucky enough to have a combination of birthing experts at their disposal in various mixed and matched forms! Whohoo to choices!

Let's start with the basics. A Certified Professional Midwife (CPM), a Certified Nurse Midwife (CNM), and a Certified Midwife (CM) are medical professionals that assist you in birthing your baby in low risk pregnancies. A Doctor is a medical professional that delivers your baby in low risk and high risk pregnancies. A Birth Doula is someone that supports you emotionally and physically throughout your delivery in low risk and high risk pregnancies. 

MIDWIVES - I once heard a midwife say "Midwives don't delivery babies, women deliver their own babies." Midwives encourage a woman to listen her body and intuition, to have trust in the baby and that the baby knows what they are doing, and give limited interventions. Appointments are usually between 45 minutes to an hour in a birthing center or the client's home with an emphasis on the physical, emotional, and mental well being of the mother. A typical appointment will involve getting the mother's blood pressure, checking her cervix and the position of the baby as well as listening to the baby's heartbeat. A midwife will also discuss issues like transfers (most midwives work with an OB/GYN and an affiliated hospital where they will transfer the mother should that be needed) as well as any medical issues i.e the testing and treatment of gestational diabetes. They can also perform Pap smears and the necessary blood work. CNMs are legally allowed to practice midwifery in all 50 states however each state has it's own licensing and practice laws for CPMs. For example, in California the midwifery training is overseen by the Medical Board of California! You can go here and see exactly what kinds of midwives are legally allowed to practice in your state. Midwives have a lot of training - they're required to attend births, give prenatal and postpartum exams, and pass certification tests. They also follow the same timetable as OB/GYNs in regards to appointments.

DOCTORS - An OB/GYN is a doctor with specialized training in obstetrics as well as a trained surgeon. The appointments are usually about 15 minutes in a doctor's office with an emphasis on the mother's weight and blood pressure as well as the baby's size, positioning, and heartbeat. A nurse within the practice will most likely be the one to take down weight and blood pressure of the mother as well as draw any blood for blood work. A doctor has extensive training, doing 4 years of residency within a hospital. They are required to attend not only vaginal births but also births delivered via cesarean section. A doctor may also perform ultrasounds and they follow the same timetable as midwifes in regards to appointments. 

BIRTH DOULA - A birth doula is not a medical professional but rather a support system for the mother during birth. A typical appointment will involve discussing your ideal birth plan and what your hopes are should this plan need to change. They offer insight and evidence-based information as well as referrals for birth related needs.

So now that you know who is who, you need to decide what kind of birth you want. This is where you can mix and match - it's not all or nothing. You can make this experience all about what you need - one of my mama friends gave birth in a birthing center with a midwife but continued to see an OB/GYN throughout in case a transfer needed to happen because she wanted to be familiar with the doctor. Another friend delivered in a hospital with a doctor, a midwife, and a doula present - talk about teamwork! You're going to have to do a bit of research but DO IT! Interview several different care providers and ASK QUESTIONS! You can ask the OB/GYN if they have any midwives they work with and you can ask midwives if they are affiliated with a hospital and know any good OB/GYNs that work with them. I guarantee you that midwife will know some birth doulas or visa versa. It's important to ask the tough questions - this is your body and your baby! Ask midwives about transfer rates and doctors about emergency cesarean rates as well as medical intervention rates. If that midwife says she has a 50% transfer rate or that doctor delivers 95% of babies via c-section, you might want to consider looking around.  

Tomorrow we're going to continue on this topic and talk about what you should expect from each profession and what cases might cause you to lean towards one care provider more than the other. I'll be breaking down each profession to help you decide which one might be right for you. An informed mama is a powerful mama!

Did you do any research before you settled on your care provider?