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| |    Practitioners Involved with Childbirth Training and range of practice by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. This article describes the roles and qualifications of the following professionals: Obstetrician Family Practitioner Certified Nurse Midwife Certified (non-nurse) Midwife Lay Midwife Doula Obstetrical Nurse Perinatologist Obstetrician: This type of medical doctor has completed four years of medical school, followed by at least four years of residency training in normal and high-risk obstetrics, and in other aspects of women's health care. Obstetricians must be licensed as a physician and may be board certified in obstetrics and gynecology. Obstetricians can do the full range of deliveries: regular vaginal deliveries, operative vaginal deliveries (vacuum and/or forceps), and cesareans. They usually deliver in hospitals. There is a huge range of philosophies about birth amongst obstetricians, from very medically oriented to very supportive of keeping things as natural as possible. To get more information, contact the American College of Obstetrics and Gynecology at www.ACOG.org. Family Practitioner: Training for this type of medical doctor includes four years of medical school, then at least three years of residency training in the full range of caring for the family, including pediatrics, adult medicine and obstetrics. All family practitioners (FP's) must be licensed as physicians and may be board certified in family medicine. Family doctors can do regular vaginal deliveries, and some with further training can do operative vaginal deliveries. In some parts of the country, family doctors also perform caesareans, but this is not common. Most collaborate with an obstetrician if the pregnancy or the labor becomes complicated. Family doctors can take care of the baby after birth, and can give regular medical care to you and to other members of your family. To get more information, contact the American Association of Family Practitioners at www.familydoctor.org. Certified Nurse-Midwife (CNM): A CNM is a Registered Nurse with at least two or three years more training in normal obstetrics and women's health care and often a Master's Degree. Every CNM must be licensed as a nurse and pass other exams to be certified as a nurse-midwife. Their extensive training for the care of healthy, low-risk women gives nurse-midwives a unique perspective on the normal experience of pregnancy, labor and birth. Most CNM's are oriented toward natural childbirth, and will stay with you through your labor, similar to a doula (see below), but can deliver the baby as well. Nurse-midwives can deliver babies in hospitals or birth centers, and some attend home births. They must practice in conjunction with a physician, in case complications develop. To get more information, contact the American College of Nurse-Midwives at www.acnm.org. Certified (non-nurse) Midwife: A certified midwife is a new designation for practitioners who have training similar to nurse-midwives and pass the exams for certified nurse-midwives, but have not been nurses first. Currently this certification is only recognized in some states. To get more information, contact the American College of Nurse-Midwives at www.acnm.org. Lay midwife: Not every midwife is a certified midwife. Lay midwives are experienced with childbirth and the care of pregnant women, but are not certified or regulated by the government in most states. This means that there is no requirement about specific training, nor tests to assess their competence. Some are quite experienced and conscientious. Lay midwives normally attend only home births, and are not credentialed to attend births in birth centers or hospitals. A lay midwife should have back up from a physician, in case complications develop. To get more information, contact the Midwives Alliance of North America at www.mana.org. Doula: A doula is a woman trained in the emotional and physical support of women in labor. A doula is usually hired by the family to be an extra support person for the woman and her partner in labor. Some doulas are certified by the organization, Doulas of North America (DONA.) Most doulas will meet the family before birth, talk about the birth plan, and then support the family through labor and birth, and sometimes beyond. Studies have shown that women attended by doulas have lower caesarean rates and use fewer epidurals than women with traditional labor support. Doulas do not undercut fathers during delivery: A study on the involvement of the father in doula-supported labors showed the same or more contact between the father and mother when a doula was present compared with when the father was the only coach. Doulas do not provide medical care to women in labor, and do not deliver babies. To get more information, contact Doulas of North America at www.dona.org. Obstetrical nurse: For hospital and for some birth center births, you will have a registered nurse (RN) assigned to you. The nurse will have completed nursing school and passed state board examinations to be licensed. In addition to providing nursing and medical care to you in labor, she may function as an additional coach. Often nurses have a few patients assigned to them and may not be able to stay at your side the way your partner or doula will. Some nurses are very supportive of natural childbirth and some are more used to epidurals. Perinatologist: A perinatologist is an obstetrician who has done a fellowship, for two or three years after residency, specializing in medically complicated pregnancies. These doctors usually act as consultants for obstetricians, and sometimes also practice obstetrics with a focus on women with medical problems or previous severe pregnancy complications. Some perinatologists (also called maternal-fetal medicine specialists) focus on ultrasound or prenatal diagnosis. Perinatologists always practice in hospitals, often in teaching hospitals that are set up to take care of severely ill babies. To get more information, contact the Society for Maternal Fetal Medicine at www.smfm.org.
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