Roles of Care Providers During Labor and Birth

Someone recently asked me if using a doula was really needed if you had a midwife.  How about if you plan to have a home birth? I thought I would share roles as determined by some internet sites (the title is a hyperlink to go to the site) for each type of job that the labor support folks offer. In our area it is not unusual for a midwife to have multiple women in labor. She can not be everywhere at the same time. It is not unusual for her to be on for 24 hours straight- so she may be eating and sleeping some of that time as well. In our area most nurses are assigned to two patients at the same time. Her role limits her contact with the mom during a lot of her labor. As far as home birth midwives, some come once labor is well established and others may send their apprentice initially to assess how you are doing if she has another mom in labor. Some will have a back up midwife in case more than one mom is in labor. A home birth apprentice at a birth acts more like the nurse in a hospital birth- assisting the midwife. She may have been a doula before, but her primary role is to learn the art of midwifery by assisting the midwife- not being the primary support to the mom. The doula has one role- to be there for the mom or couple. Her role is to be fully attentive to the emotional and physical needs of the mom. So look over the roles- they may differ within your practice, and determine who you want to have with you in labor. think about your needs and I am sure you will make the right choice for you.

homebirth midwife in labor

“If you choose home birth for delivery, your midwife’s role will begin long before your due date. A midwife will provide regular checkups and refer you to a doctor for prenatal exams, such as ultrasounds. Your midwife will see you throughout your pregnancy, tracking your baby’s growth and checking you for any possible complications. Because prenatal visits with a midwife are longer and more relaxed than in a traditional medical setting, you and your midwife will develop a much more personal relationship than is typical with a doctor.

When it’s time for your baby’s birth, your midwife will come to your home with any equipment that may be necessary during the birth. She will monitor you throughout childbirth, typically checking the baby’s heart rate with a hand-held Doppler, as well as monitoring the baby’s position and the progress of your labor. She will stay with you throughout your entire labor, helping to keep you comfortable and making sure your labor is progressing as it should. After your baby is born, your midwife will clean up any mess, examine you and your baby and help you to try to start nursing. She will stay for a little while to make sure you and your baby are happy and healthy. She will visit you a day or two after your birth for a postnatal checkup, as well.”

nurse in hospital

“L&D registered nurses provide care to women and their newborns during the antepartum, intrapartum, postpartum, and neonatal stages of this important life event. They assess each mother and baby and develop an individualized plan of care. L&D registered nurses collaborate with physicians and other health care providers to provide the best plan of care for each patient. They implement the plan of care by monitoring the mother and baby and by teaching patients about their care and topics related to women’s health and newborn care. L&D nurses evaluate the effectiveness of the care plan and modify it as needed to meet the changing needs of the mother, newborn, and family. They also provide psychosocial and emotional support to patients and families.

L&D registered nurses assume many different roles, including:

    • Antepartum Nurse – provides care to patients who have complications of pregnancy requiring hospitalization.
    • L&D Nurse – provides care to patients in labor who have uncomplicated or complicated deliveries.
    • Circulating Nurse – manages patient care in the Operating Room during a cesarean delivery.
    • Scrub Nurse – works directly with the surgeons during a cesarean delivery by passing instruments, etc, to the physicians.
    • Postpartum Nurse – provides care to patients who have recently delivered.”

midwife in hospital

“Midwives are primary health care providers to women throughout the lifespan. This means that midwives perform physical exams, prescribe medications including contraceptive methods, order laboratory tests as needed, provide prenatal care, gynecological care, labor and birth care, as well as health education and counseling to women of all ages. Women, children, and families have better lives because of the work of certified nurse-midwives (CNMs) and certified midwives (CMs). The American College of Nurse-Midwives is the professional association that represents CNMs and CMs.

Johns Hopkins says:

Our Certified Nurse Midwives support the safety and sanctity of birth in a hospital setting. For those individuals and families who choose to give birth in a hospital environment, our nurse-midwifery practice is an added source of support in creating a positive birth experience. During labor and birth, our Certified Nurse Midwives provide many services, which enhance the process of birth.

Under our program, you can expect our Certified Nurse Midwives to:

    • Be with you during the most active phase of your labor
    • Perform the delivery of your baby
    • Offer support and encouragement to both you and your partner
    • Evaluate your labor process and help you make any decisions, should intervention be necessary
    • Help your partner or family member take an active role to whatever degree is desired
    • Maintain ongoing communication and consultation with the back-up physician as necessary”

homebirth apprentice

“A midwife assistant is a trained or semi-trained professional who works alongside a licensed midwife. Individual responsibilities vary based on the midwife and location, but they generally include office duties, simple tasks involving patients like taking blood pressure and weight, or assisting with actual births. In many cases the midwife assistant is also a midwife apprentice, meaning that she is in the process of becoming a trained midwife herself.

The primary job of a midwife assistant is to aid the midwife in tasks that she is too busy to tend to. This may include secretarial roles like scheduling appointments and fielding patient questions. She may also do billing tasks like contacting insurance companies and filing claims. In some cases the midwife assistant may also handle simple tasks with patients like handling some appointments or attending appointments along with the midwife to learn the proper way of doing jobs like taking blood pressure, listening to the baby’s heart rate, and checking the patient’s weight.

Many times the midwife assistant will also attend births along with the midwife to handle certain tasks during labor and delivery. These may include tracking labor contractions, keeping information needed for the birth certificate such as time of birth, and helping make the mother comfortable. The level of responsibility and duties attending by a midwife assistant will depend on the assistant’s level of training and experience.”

doula at birth

“A doula, or a professional labor assistant, provides physical and emotional support to a woman and her partner during pregnancy, childbirth and the postpartum period.For instance, a doula might offer:
    • Suggestions on pain relief techniques, such as breathing, labor positioning and massage
    • Emotional reassurance, comfort and encouragement
    • Information about what’s happening during labor and the postpartum period
    • Assistance with breast-feeding
    • Guidance and support for loved ones

Often, however, a doula’s most important role is to provide continuous support during labor and delivery. Although research is limited, some studies have shown that continuous support from doulas during childbirth might be associated with:

    • A decreased use of pain relief medication during labor
    • A decreased incidence of C-sections and forceps deliveries
    • A less difficult childbirth experience

Keep in mind that while a doula might add another opinion to the mix when decisions need to be made about labor and delivery — a doula doesn’t provide medical advice as a midwife or health care provider would do or replace the role of your health care team. Also, most insurance plans don’t cover doula fees.If you’re interested in hiring a doula, ask your health care provider, childbirth instructor, family or friends for recommendations. You might also contact your local hospital or health department for a referral.When interviewing a potential doula, ask about his or her training, how many births he or she has attended, his or her philosophy about childbirth, what services he or she provides and the cost. Also, discuss your preferences and concerns about pregnancy, labor and delivery.Once you hire a doula, typically you’ll meet with him or her during your third trimester to plan for childbirth.”