Midwife, Doula, Childbirth Educator & the Obstetrician: Working Collaboratively, Not Substitution.

Midwife, Doula, Childbirth Educator & the Obstetrician: Working Collaboratively, Not Substitution.

Denise Bolds MSW, CD(DONA)

December 10, 2015

As a certified birth doula, I get this a lot: “Denise do I
get a midwife or a doula? Should I take childbirth education classes? I have a
doula, I don’t need childbirth education!”

So many women don’t understand the roles and functions of
the midwife, labor doula, childbirth educator and obstetrician.  These four services are not interchangeable; in fact they are a collaborative.

A midwife provides clinical support to the woman during her
pregnancy and childbirth. A midwife can provide this service in a hospital, birthing
center or home. Health insurances coverage require authorization.  Many midwives note that there  are huge obstacles in obtaining reimbursement
from health insurance plans. A midwife fees are several thousand dollars. At a
birth, a midwife is present as the birth is immanent.  Midwives possess licensure/certification, has
liability insurance according to the laws of the state she is allowed to
practice in. There are some states in the United States that do not allow
midwives to practice. Midwives work with doulas and obstetricians, supporting
the teaching of the childbirth educator. A midwife is on call, depending on the
size of her practice.

A childbirth educator (CBE) is also a certified professional
providing education in reproductive health and the stages of pregnancy and childbirth.
 A CBE provides fortification of confidence
of childbirth knowledge to the prospective parents through education. Being
exposed to terms, definitions and scenarios opens the mind to familiarity,
reducing uncertainty. The CBE aligns with the actions and knowledge of the
midwife, doula and obstetrician. A CBE is not present at the labor or birth.
The cost of a CBE ranges from free to several hundred dollars. They can provide
education in a community, hospital or private setting. The CBE supports the
midwife, doula and obstetrician educating in the scope of reproductive health
and childbirth and is an enhancement to empowerment. A CBE is not on call.

A labor doula, also a certified professional, is insured
against liability and certified in CPR. A labor doula provides emotional,
physical and spiritual support along with education and advocacy to the mother,
her partner and family. A doula is present throughout the pregnancy (depending
on when contracted by client) offering support from the onset of labor, through
the birth and post partum. A labor doula practices the education of a CBE in
the paradigm of midwifery and obstetrics. The cost of a labor doula ranges from
volunteer to several thousand dollars and is not covered by health insurance.
The labor doula contributes as part of a team with the midwife and obstetrician
on education that is introduced by the childbirth educator. A labor doula is on
call for her clients.

An obstetrician is a medical school trained professional in
medical and surgical treatment of pregnancy, labor, childbirth and
complications therein. An obstetrician treats in paradigm of diagnosis. There
is clinical support that is structured in education that often the mother and
her partner are not aware of; or can go beyond the education provided in
childbirth education. An obstetrician treats within a time constraint that is
allowable by health insurance coverage and malpractice insurance guidelines.
Obstetricians provide services at birthing centers and hospitals, not home
births. The fees of an obstetrician are much higher than a midwife and birth doula
combined. If a cesarean section occurs, costs increases up to four times as
well as the risks associated with this intervention. Services are covered by
health insurance coverage.  The obstetrician
contributes in the team of doula, childbirth educator. An OB is on scheduled
call rotation.

When a client asks if it is possible to substitute a midwife,
doula, childbirth educator or obstetrician, inform her that collaboration is
key to teamwork.  A mother can obtain the
birth she wants if her pregnancy is healthy, her providers and support are all
on board with her wishes and the facility she chooses to give birth at is as