16. What's the Difference Between Obstetricians, Midwives, and Doulas?

Have you ever wondered what exactly an OB, a midwife, and a doula each do, and how they're different from one another? You're not alone! This is one of the most common questions I get from first-time mamas who are just starting to research their birth options.

In this episode, I'm breaking it all down so you can walk into your prenatal care feeling informed, confident, and clear on who does what.

Here's what we cover:

• What an obstetrician (OB-GYN) actually does and the surprising truth about how much time they spend with you during labor
• The difference between a Certified Nurse Midwife (CNM) and a Certified Professional Midwife (CPM) and why it matters
• What a traditional midwife is, and what questions to ask any midwife you're considering
• What a doula IS and is NOT
• How all three roles can work together beautifully as a team
• How to choose who's right for your birth based on your values and goals

Whether you're planning a hospital birth, a birth center experience, or a home birth, this episode will help you ask better questions and build a care team that truly supports you.

Questions? Come find me on Instagram @rise.birth, I love hearing from you!

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Connect with me on Instagram:
@rise.birth 

Transcript

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You're listening to Rise, a Christian birth podcast for encouragement, education, and biblical truth for birth without fear. I'm your host, Mana, childbirth educator, doula, and mom of three, here to help you rise above fear and prepare for a faith-filled birth. Welcome back. I'm so glad you're here. Today we are covering a question that I get asked all the time, and I mean all the time, especially from first-time parents who are just starting to research all of their options. And that question is: what is the difference between an OB and a midwife? And sometimes what is the difference between a midwife and a doula? Or what is the difference between all of them? What are all these things? A lot of women go into pregnancy kind of assuming that there's just one person who handles everything, like you go to the doctor and the doctor delivers your baby, done. And while that can be true, it's actually a much more nuanced picture than that. And understanding who does what can change the way that you plan for your birth and the way that you feel going into it. So whether you're trying to figure out who you want on your team or you just want to be more informed going into all of your prenatal appointments, this episode is for you. Let's break it down. So all three of these roles, obstetricians, midwives, and doulas, exist to support you through pregnancy and birth, but they do different things. They each have very different training and they play very different roles in your experience. So let's go one by one. An obstetrician or OB is a medical doctor who specializes in pregnancy, labor, birth, and the immediate postpartum period. So they completed medical school, they did a residency specifically in obstetrics and gynecology, which is why you'll often hear the title OBGYN. They are fully licensed physicians. What that means practically is that OBs are trained to manage complications. They can order tests, they can prescribe medications, perform surgeries, including C-sections, and handle high-risk pregnancies. If something goes wrong during your pregnancy or your labor, your OB is the one who steps in with the medical tools to fix it. That is their wheelhouse, which is so important. Now, here's something that I think surprises a lot of women. Your OB is actually not with you for most of your labor. In a hospital setting, your OB typically just comes in at the very end to literally catch the baby, handle any crazy complications, or um to kind of just check in periodically here and there. So if you've been picturing your doctor coaching you through contractions for hours on end, that's probably not going to happen. Usually that would be your doula or sometimes your nurse if they have the availability to be in your room a lot. But it's typically not going to be your doctor. OBs are well trained for high-risk pregnancies. So if you have a complication like placenta previa, placenta accreta, a history of preterm labor or something like that, then an OB would probably be an appropriate choice for who you want leading your care because they are trained for those sort of out of the norm, more complicated situations. If you are low risk, and especially if you're planning a natural birth, you still might choose an OB. Plenty of women do, and there are absolutely OBs out there who are supportive of low intervention birth. But it's worth knowing that OBs are trained in a medical model of birth, which tends to be more interventionist by default. Not always, and you can't make assumptions, and there's always outliers to every rule. But typically, that is what they've been trained in. They've been trained in managing labor, managing birth, medicating birth. Uh, it doesn't make them bad. It just means you want to communicate clearly about what your preferences are and find somebody whose philosophy aligns with yours. So if your plan is to, for example, have an elective induction, um, use pain medication as your primary pain coping tool, like an epidural, and feel as comfortable as possible, then an OB would probably be an appropriate choice to be leading your care. If you're hoping for a more natural situation, then you definitely would want to be communicating well with whichever provider you choose to make sure that you do have somebody who um understands what you're going for and whose philosophy aligns with yours. Next, let's talk about midwives because this is where things can get a little bit confusing. Not all midwives are the same kind of midwife. There are two main types of licensed midwives in the United States. So we have certified nurse midwives or CNMs, and then we have certified professional midwives or CPMs. They have slightly different training, different credentials, and they typically practice in different settings. So a certified nurse midwife is a registered nurse who went to nursing school and then went on to get an advanced education and clinical training specifically in midwifery. CNMs are licensed healthcare providers who can do a lot of the same things that an OB can do for low-risk patients. So prenatal care, labor support, delivery, postpartum care. They can prescribe medications, they can order labs. Many CNMs work within hospital systems, even birth centers or alongside OB practices. You can also sometimes find some who attend home births. Then a certified professional midwife, or CPM, on the other hand, is trained specifically in out-of-hospital birth. So their training pathway is a little bit different. It's more focused on physiological birth in home and birth center settings. So CPMs are not nurses. They didn't go to nursing school first before going into midwifery. Their whole training literally is all about physiological birth from beginning to end. Everything that they learned is about taking care of pregnant women, taking care of women in labor, taking care of women as they're giving birth, taking care of infants as soon as they're born, they know how to screen for complications, and they know when to transfer care to uh an obstetrician if a patient goes from being low risk to needing some more support. CPMs are not licensed in all states. So the regulations around CPMs can really vary a lot depending on where you live. Outside of certified professional midwives and certified nurse midwives, you also have what's called a traditional midwife or a community midwife, which would be someone who didn't necessarily go through these licensure pathways, but who became a midwife more through experience and shadowing births and attending births with potentially other midwives. Um, there's a lot of debate about traditional midwifery and of course different pros and cons to practicing that way. For you as the pregnant mother, as you're weighing out all of your decisions, I think just with like with any other provider, the biggest thing is for you to be asking really, really good questions. If you're looking into a traditional midwife, they are almost certainly not going to be attending births in the hospital. So that would be more if you're considering home birth. So if that's you and you're looking at different home birth midwives, whether it's a CPM, CNM, or traditional midwife across the board, I would say for you, you're still doing the same thing. You're asking really good questions. You're asking about what kind of training they've had, what kind of experience they have. Uh, are they trained in emergencies? What would they do in case of a hemorrhage? What would they do in case of shoulder dystocia? What would they do in case of baby needed some resuscitation procedures? And I would be asking those regardless of what kind of licensure the midwife that you're speaking with has. What midwives in general tend to bring to the table, regardless of their specific credential, is a philosophy of birth that is rooted in trusting the natural process. So midwives are trained to support physiological birth. They tend to take a more hands-off, watchful approach, unless something requires intervention. They often spend more time with you during labor than an OB would. They tend to be more conversational about your preferences. So if you're pursuing a low intervention or unmedicated birth, midwifery care is often a really beautiful fit. Again, not always. And this is why you have to ask good questions. You can't just make an assumption that a midwife is going to be a better fit than an OB just because they are a midwife. You would still want to be asking them questions and seeing how they typically handle things. But in general, midwives are typically more comfortable with natural physiological hands-off birth than obstetricians. Birth centers are typically run by midwives, home births are attended by midwives, and then many hospital practices now also have midwives on staff who attend births alongside or instead of physicians for low-risk patients. If you are going to a practice that has an OBGYN and midwives on rotation, you can ask for their specific sort of rotation schedule so that you can have an idea of on any given day, if you go into labor, what's the odds that there's going to be a midwife present at the hospital and available for you? Because I know at least around here, sometimes they only have midwives, you know, during the day, on certain weekdays or different situations like that. So you can ask those questions too to get clear about who's on the clock all the time. And one thing that I do want to make sure to note is that midwives have protocols for when to transfer care or call in a physician. They're not trying to handle serious emergencies on their own. They they know their scope of practice. Part of their training is recognizing when something is beyond what they can manage and escalating that appropriately. So you're not choosing between safety and a natural birth when you choose a midwife. You're choosing a different model of care that's designed for low-risk physiological birth. So we talked about obstetricians, we talked about midwives. Let's talk about doulas. This is my world. So of course I have a lot of feelings about this one. A doula is not a medical provider at all. I'll just say that very clearly, right out of the gate. I think that's one of the biggest misconceptions. Even my mom, very, very recently, uh, we were talking, and I it came to my attention that this whole time that I have had this business, that she thought that I was doing midwifery. She thought I was catching babies. And uh Adula does not deliver your baby. Adula does not make medical decisions for you. They cannot and should not perform any clinical tasks. So they shouldn't be doing vaginal exams. They shouldn't really be taking your blood pressure or your heart rate or anything like that. That's not Adula's role. What Adula does do is provide continuous non-medical support to you and your partner throughout labor and birth. That support is physical, emotional, informational, and in my practice, spiritual, because I love to pray with my clients and for my clients as they are laboring and delivering. Physically, Adula might help you with position changes, counterpressure on your back, suggesting movement or different comfort measures that you can try. Um, so hydrotherapy, breathing techniques, vocalizations, birth balls, labor combs, all of these physical tools that can make a real difference in how you feel and how your labor progresses. Emotionally, a dua is there to help you feel calm, supported, grounded. Labor is so intense. Uh, it's a very vulnerable time. And having somebody in the room whose sole job is to be present with you and for you not to manage your medical care, not to chart, not to watch the monitors, that's really powerful. Your dua is with you from when you need her until after your baby is born. And that continuous presence is something that your medical team, like as much as they might want to, you might have the most amazing providers, but typically, especially in a hospital setting, they they just aren't able to be there for you the whole time the way that your dua usually is. I'm I've been asked before many times if I am considering midwifery or if I'm kind of being a doula for a while as I explore if I might be interested in midwifery. And the answer is no. I I'm really passionate about exactly what I do. And I actually want to feel that freedom to focus wholeheartedly on what my clients are experiencing emotionally and mentally and physically without having to worry about the medical side of things. I I love when we have a really trusted provider and a great provider of relationship where the parents and I can just know that those providers are watching out, they're watching the monitors, they're listening to the baby's heart rate, they're paying attention to signs of complications, and I can just totally focus on what is my client experiencing? How are they feeling? Do they feel confident? Do they feel scared? Are they suffering? And to be able to just be there for them in those moments and not stress about the medical side of things. Informationally, and this is such an underrated part of what doors do, a doola can help you understand what is happening and what is being suggested medically in labor and why, and help you think through your questions and remind you of your preferences and support you in having informed conversations with your medical providers. I always want my clients to feel like they have someone in their corner who can help them to feel less alone in those moments when decisions need to be made. And sometimes that really looks like advocacy too. So gently reminding my clients that they can ask for time to think about something and pray about it before they make a decision, reminding them that they are allowed to ask questions. They're allowed to ask what are the risks and benefits of this particular thing that's being suggested? What are the alternatives? What would happen if we didn't do anything right now? And just helping them to know that every decision that needs to be made is up to them and they're equipped and capable of making those decisions prayerfully and confidently. So here's what Adula is not. Abula is not a replacement for a midwife or an OB. We work alongside your medical team, not instead of them. Adula does not give medical advice. I'm always gonna say, talk to your provider, ask your provider. This is a question for your provider, because that's not my role. My role is to support you in being the one who makes informed decisions, not to make them for you or to tell you what to do. And Adula is not just for home birth or unmedicated birth. Doulas support moms in hospitals, birth centers, in planned cesareans. Uh, I have done all of those. Whatever your birth looks like, having a doula there can make a huge difference. So, how do these three roles work together? In an ideal world, your OB or your midwife handles your medical care, your doula handles your continuous physical and emotional support, and everybody's a team. Nobody's in competition with each other. And I have seen this work so beautifully in my own experience. When the whole room is working together, it can be such a peaceful, empowering experience. Understanding who does what helps you to set realistic expectations and to ask good questions. Your OB is not going to be holding your hand through contractions for 12 hours. That's going to be your partner or your dual. Uh, your midwife might spend much more time actively laboring with you, particularly in a home birth setting. If you have a home birth midwife, they might spend a lot more time with you there. And your dua is there for you no matter what happens. So no matter how your birth unfolds. If you are trying to figure out who you want on your team, my advice would be to start with your values and your goals. So, what kind of birth are you hoping for? Where do you feel the safest? What kind of support do you need? If you are low risk and want a highly supportive, natural, birth-friendly environment, it might be good for you to look into midway free care, whether that's in a hospital, in a birth center, or at home, depending on what's available to you and what feels right. If you need or want to be in a hospital and you want extra support inside that system, hire a doula. You can have an OB and a doula. That combination is actually really common and can be very powerful. So whatever you do, please, please make sure your care provider knows your preferences before you go into labor. Don't wait until you are having contractions to start having conversations about what you want. I actually have an online workshop that's kind of all about that and how to have those conversations with your provider. It's called the Autonomous Birth Workshop. And it is designed to help you learn how to advocate for yourself, navigate conversations with your care team, and go into your birth feeling prepared and confident, no matter what your setting is. So I'll definitely leave the link for that in the show notes. If you have questions, please feel free to shoot me those on Instagram at rise.birth. I love hearing from you guys and getting your feedback. It's so weird to me that there are actually people out there listening to me talk about birth. Because I love doing it. And yeah, if there's something particular you would love to hear in a future episode, let me know because you might just hear it in the future. Thanks for listening, and I'll see you next time.