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Midwife Frequently Asked Questions
By an allied health world contributing writer
Published: February 3rd, 2010
What is the difference between a nurse-midwife and a doula?
A doula is there for the laboring woman from an emotional standpoint whereas a nurse-midwife is there as the primary care provider who monitors the mother and the fetus, assesses the status of labor, can do cervical checks and actually assist the woman in giving birth to her baby. There are two types of doulas: birth doulas and postpartum doulas. When hired to do so, birth doulas provide laboring women who have chosen not to have an epidural or other drug, with emotional support and physical comfort measures (non-medical). They provide support to pregnant women before, during, and immediately after childbirth. Doulas also serve as a liaison in communicating with the patient, patient’s partner, and medical team. They advocate the laboring woman’s wishes and help ensure her birth plan is carried out. Doulas are most useful for women who are not seeing a midwife for their care.Postpartum doulas can be hired to help a new mother care for her newborn as well as help the family adjust to the new addition, provide information on breastfeeding, and just provide overall emotional support. Since adding a baby to the family can be a huge adjustment, postpartum doulas can help offer an extra set of hands. Postpartum doulas can be hired for just one or two visits or on a regular basis for more than a three-month duration.
Doulas can be privately hired by pregnant women, work as hospital employees, or volunteer at hospitals. The cost of a doula can range from $200-800 per delivery. Birth doulas are by the woman’s side her entire labor, which can last anywhere between 5 hours to over 24 hours.
It is not required to have a degree of any type to become a doula. Typically these individuals have a passion for helping laboring
women so they take a two-day workshop and pass an exam to become certified as a doula. The initials a certified birth doula obtains are CD and the initials a certified postpartum doula obtains are PCD. Doulas of North America (DONA) is the governing organization that offers these certifications.
Do midwives typically advocate a more “natural” approach to delivery?
Midwives can see all types of patients from pregnant women who wish to have all natural deliveries without using an epidural, to those who want an epidural, to non-pregnant women who need an annual exam. Traditionally, however, midwives favor a more natural approach to labor with as few drug interventions as possible. Research has shown that a woman’s labor can progress more quickly if she has emotional support during labor, and that medical interventions which disrupt the natural process, such as inductions, often lead to operative deliveries, such as cesarean section, and additional complications.Midwives tend to support a natural, physiologic birth. Also, many nurse-midwives advocate natural means to pain prevention in labor such as using a birthing tub and birthing ball. The birthing tub can be a huge pain reliever and the baby comes into a quiet environment and seems to be calmer. Moms who deliver in the birthing tub also tear less due to the counter pressure of the water.
Learn more about the midwife degree.
Research has shown that an episiotomy, the surgical incision to a woman's perineum which is performed during delivery to "hasten" the birth of the baby, only shortens the delivery process by ten minutes and frequently leads to further extension of the cut, as well as to much pain and discomfort for weeks to months after delivery. In most cases, it is a medically unnecessary procedure. Therefore midwives are taught how to minimize tearing during delivery so that the woman does not need an episiotomy and will have minimal tears to her vagina and perineum.
Are home births common for midwives?
Approximately 3% of nurse-midwives attend women at their homes or in birth centers. Even for those women who prefer all natural deliveries, most births take place in a hospital setting so that if complications were to arise, obstetricians and pediatricians are available, along with any necessary equipment that may be needed. Approximately 1% of all births in the U.S. occur outside of the hospital. Other midwives, such as Certified Professional Midwives, only attend births outside of the hospital.What is a midwife’s role during active labor?
For those women who want a natural delivery without the use of an epidural or other drugs, a midwife helps with the “labor sitting”, and typically the delivery of the baby as well. Labor sitting involves offering support and encouragement to women in active labor. This can involve helping them change positions, get in the birthing tub, and getting in and out of bed to help labor progress. Oftentimes women are not educated on which positions help push the baby down the birth canal and the knowledge a nurse-midwife has can greatly help assist in moving the labor along.How many “patients” does a midwife see in a day?
This can vary greatly depending on if a nurse-midwife only sees pregnant women or also does annual exams and infection checks. Every office uses a midwife’s expertise a bit differently. Most midwives see between 10-30 patients per day. Some nurse-midwives have technicians or nurses that are responsible for any follow up phone calls to patients and writing prescriptions, which frees the nurse-midwife up to see more patients.Learn more about the midwife schools.