Differences between OBs, Midwives and Doulas : their roles and how they work together in NYC.
Types of Providers:
Midwife - medical professional who helps with care from preconception, abortion, birth control, pap smears, bimanual exams, birth, postpartum, breastfeeding and menopause. They attend to patients at home, clinics, birth center or hospital. In hospitals, midwives are required to be connected to an OB.
Doula - non-medical professional who provides emotional support and comfort techniques. Doulas work in all settings – hospital, home or birth center. Doulas can be specifically for preconception, birth, postpartum, miscarriage, loss or abortions.
OB / OBGYN - works at clinic, birth center or hospital
OB or obstetrician - physician who delivers babies (OBGYN is just another common name for an OB; they are the same).
- GYN or gynecologists - physician who specializes in female reproductive organs. Note, all obstetricians are trained gynecologists, but not all gynecologists are obstetricians
Maternal Fetal Medicine Specialist - OBGYN who has done extra education and training in order to attend to high risk, complicated pregnancies and births
A few difference between OB care and midwifery care:
- OBs can perform surgery, and manage high-risk/complicated births as well as low-risk clients
Midwives offer birth services for low-risk clients, and generally do not work with high-risk pregnancies
OBs usually actively manage care while midwives will usually offer fewer interventions
Prenatal care with an OB will often involve more ultrasounds and tests than prenatal care with a midwife
Midwives tend to view birth as a natural biological process with focus on the health of the birthing parent and baby, finding and resolving issues early on, and the intersection of emotional, physical, and mental health in pregnancy and birth. Midwives are there to guide the birth and keep things safe while allowing baby and parent(s) to follow their own instincts, interfering as little as possible.
Medical models of birth focus on the treatment and diagnosis of complications, and employ much more frequent interventions. Medicalized births generally involve more protocol constraints and less freedom – for things like visitors and movement during laboring/pushing, for example – than do midwife-assisted births, and medicalized births often involve interference with progression of labor, often owing to hospital insurance rules.
It’s important to remember that these philosophies can also vary from provider to provider, so interviewing or just chatting with your possible provider(s) to get a sense of their personal methodologies is essential.
Types of Midwives
- There are multiple paths that midwives take to receive training and licensure, and although they are more similar than they are different, the distinction is especially important to recognize in terms of insurance coverage and cost. Below are descriptions of the the various types of midwives, and some general information about what the distinctions between midwives mean, their training, and how they work.
- The varying types of care work can be daunting, but it's important to remember that all midwives are focused on women's birth care, and have all received training in the field; it's only price and legal licensure by state that varies.
- Choosing a midwife and/or doula to fit yourself and your needs is what counts; speak to multiple people, ask any questions you have about pre/post-natal care and birth itself, and choose someone you trust and who services fit within whatever financial guidelines you may have. If you can, ask around for recommendations! Word of mouth goes a long way!
Certified Nurse Midwife (CNM):
Certified, registered nurses (during or prior to midwifery training)
Graduated from a nurse-midwifery program, and passed the midwifery board
Practice in all birth settings
Legally recognized in every state (in 18 states, they are allowed to diagnose and treat without supervision; the rest require a collaborative practice with a physician, and insurance reimbursement is mandatory)
Certified Midwife (CM):
Graduate of a recognized midwifery program, who has passed the midwifery board
Practice in all birth settings
Legally recognized in NY, NJ, RI, DE, MA, MI
Sometimes called Direct Entry Midwife (DEM)
Certified Professional Midwife (CPM):
Newest type of certification (introduced in the 1980s); licensure is changing, and varies by state; many states have active bills currently to grant CPMs legal recognition
Certification is not reliant on academic degree, but proof of competency, work experience and specialized education. These midwives take an exam in addition to completing an apprenticeship
Meet qualifications set by the NARM (North American Registry of Midwives) standards (and are still required to take the science classes required for nursing programs; many also have other doula and childbirth training)
Practice only in homes and birth centers
Required to receive additional non-hospital education and experience
State licensing and practice laws vary; some states don’t recognize any midwives (CMs or CPMs) without a nursing degree, while others are in the process of changing licensing laws to include CPM’s
** (Price varies greatly based on factors such as experience level, insurance, location of birth, etc, so it is important to discuss this with your care provider and your insurance company.)
How to find a midwife in NYC
List of Midwifery practices in NYC:
Midwives in the hospital:
Mt. Sinai West (has a birth center with midwives within the hospital as well *closing January 1 2019*)
Metropolitan Hospital: Village Maternity
Brooklyn Hospital
Bellevue Hospital
Maimonides Hospital
Methodist Hospital: Park Slope Midwives
Mt. Sinai East
Midwives at Birth Centers:
Birthing Center of New York
Brooklyn Birth Center
List of OB & Midwife groups at hospitals:
Dr. Hanna, Dr. Moritz
Downtown Women OBGYN
Dr. Bradley, Shulina & Nabizadeh
Dr. Guirguis
What does a Doula do?
Doulas are not medical providers, as they haven’t (necessarily) received any medical training; however, they play a vital and essential role in birth and reproductive care. They provide informational, physical and emotional support before, during, and after birth. Some doulas work with hospitals and birth centers, but generally they are hired directly by expectant mothers and families. Their job is to advocate for expecting parents and their wishes and provide as much support as needed.
A doula is usually either a birth doula, a postpartum doula or both. A birth doula provides prenatal support and support during the birth (vaginal or c-section). A postpartum doula assists in feeding, baby parent bonding, sleep schedules and general physical and emotional recovery from birth.
Receives formal training and certification through national organizations such as DONA (Doulas of North America International) / DTI (Doula Training International)
Price varies by practice and experience level. (especially how many births they’ve attended; the more experience they have the more they charge). Fee per birth typically ranges from a few hundred to a few thousand dollars, and insurance companies don’t usually cover the cost of doula services, but you may use your Flexible Spending Account to do so. Many insurance companies are beginning to recognize the benefits of doula services, and are beginning to cover the costs; it varies widely from provider to provider though, so you should call and ask. Postpartum doulas usually charge hourly witt cost depending on experience level, additional trainings such as lactation support and whether support is for hours during the day as well as overnight packages.
In working with a birth doulas, it is standard to have two prenatal meetings, support for birth at home and place of birth, and some amount of postpartum support, agreed upon in advance
With postpartum doulas it is common to have one prenatal meeting and after the birth they will be available as per your agreement with them.
Additionally, there are doulas who specialize in abortion, miscarriage, infertility, adoption, and stillbirth work
Doulas usually have additional trainings in Prenatal Yoga, Hypnobirthing or in Lactation support so you can choose one that’s right for your needs.
How to Find a Doula
Contact Love Child here!
Further resources!
Doulas of North America International - https://www.dona.org/
American Midwifery Certification Board - https://www.amcbmidwife.org/
American College of Nurse Midwives - http://www.midwife.org/
North American Registry of Midwives - http://narm.org/
Finally, the site below includes each state’s midwifery guidelines, plus information on contacting the various organizations that can get you connected with midwives of different kinds in different states, as well as information about licensing agencies in the various states:
https://mana.org/about-midwives/state-by-state