Understanding the Roles of Medical Professionals Who Support Mothers During Pregnancy, Labor and Delivery, and Postpartum
There is a multitude of medical professionals who can support women during pregnancy, labor and delivery, and the postpartum period. Professionals who help pregnant women and new moms include obstetricians, perinatologists, reproductive endocrinologists, midwives, doulas, lactation consultants, and chiropractors. It’s not unusual for a woman to receive help from several of these professionals during her journey to motherhood, as support needs differ based on each mother’s unique pregnancy experience.
Obstetricians (OB-GYNs) are physicians (MDs or DOs) who specialize in women’s health and pregnancy. OB-GYNs attend medical school for four years after college, followed by four years of residency training in obstetrics and gynecology. Although some OB-GYNs are in private practice, most are part of hospital-affiliated group practices. OB-GYNs are trained to manage all pregnancies and deliveries, including cesarean sections (C-sections). Although some women are followed by OB-GYNs throughout pregnancy, others, such as those being managed by midwives, may need to establish care with OB-GYNs only if complications arise. OB-GYNs normally have a rotating call schedule in which they share night and weekend calls with other members of their group. Mothers traditionally have follow-up visits to their OB-GYNs 4-6 weeks after delivery, but, based on recent American College of Obstetrics and Gynceology (ACOG) recommendations, the standard of care for the first postpartum check in the U.S. will soon be within 2-3 weeks of birth.
Perinatologists are doctors who are maternal-fetal medicine specialists. They are OB-GYNs who have completed an additional three years of fellowship training, after their obstetrical residencies, to be able to manage “high-risk” pregnancies. Pregnancies which are “high-risk” include those with diagnoses of birth defects, certain types of twins, gestational diabetes, and/or a previous history of preterm labor. In some regions, perinatologists follow mothers as a consultant throughout pregnancy and in others, perinatologists assume all medical care of their pregnant patients. Deliveries with risk factors usually occur in hospitals with neonatal intensive care units so that neonatologists can be on hand to assess and stabilize newborns, if need be, and to ensure that mothers are not separated from their babies after birth.
Reproductive endocrinologists (REs) are physicians who help women with infertility. To become a fertility specialist, one must first train to be an OB-GYN and then complete three additional years of fellowship training in reproductive endocrinology. Commonly used fertility methods offered by RE professionals in the U.S. include in-vitro fertilization (IVF) and intrauterine insemination (IUI). OB-GYNs, perinatologists, or midwives provide the medical care of pregnancies that are conceived via fertility treatments, but most REs will continue to follow their patients throughout pregnancy as well.
Midwives are professionals who receive special training in the management of pregnancy and labor/delivery. Certified nurse midwives (CNMs) are an alternative to OB-GYNs for low-risk pregnancies, deliveries, and postpartum care. CNMs are registered nurses who complete an additional 2-4 years of midwife training and must maintain licensing and board-certification. It is increasingly common for CNMs to work alongside OBs in hospitals and hospital-affiliated birthing centers, and many now practice independently.
Other types of midwives include certified professional midwives (CPMs) and lay midwives. CPMs graduate from midwifery programs and are credentialed by national midwife associations to provide birthing services in home settings. Lay midwives learn their skills via apprenticeships and participate in home births as well. Educational, experience, and licensing requirements for CPMs and lay midwives vary greatly from state-to-state. For example, in Ohio there are no specific requirements to become a home-birth midwife and CPMs and lay midwives are not regulated. In comparison, CNMs in Ohio are held to strict licensing and credentialing requirements, which include maintenance of board certification. It is important for mothers who are considering a home birth to research their states’ requirements for midwife training, licensure, and certification.
Doulas are professionals who provide emotional and physical support to mothers during pregnancy, labor, and delivery. Although they are sometimes mistaken for midwives (and often work alongside midwives) they have a different role. Doulas help moms to explore options for laboring experiences, create birth plans, and plan for the postpartum period. Examples of doula responsibilities during labor include being advocates for moms, helping mothers try different laboring positions, and assisting in comfort via methods such as relaxation and massage. Doulas can also be hired after delivery to assist with newborn care, breastfeeding, and household tasks so that mothers can have time to rest and recover. Some doulas work with mothers from early pregnancy through the end of the postpartum period, while others are hired for support solely during labor and delivery.
Lactation consultants (LCs) help mothers to make milk and breastfeed. Some LCs are international board-certified lactation consultants (IBCLCs), which means that they have received additional lactation training and have passed a board exam. LCs and IBCLCs can anticipate risk factors for breastfeeding problems, such as insufficient glandular tissue, pre-eclampsia, or a history of breast surgery. They also assess latch, teach hand expression, and ensure that milk is transferred from mom to baby. It is important for first-time breastfeeding moms to get assistance from an LC or IBCLC within the first 24 hours after delivery. Although mothers traditionally see LCs and IBCLCs in outpatient clinics after discharge, home-visiting LCs and IBCLCs can be found in many large metropolitan areas. Pregnant women can also make appointments with LCs and IBCLCs during pregnancy to be able to anticipate problems with lactation, set goals, and make individualized breastfeeding plans.
Like doulas and LCs, chiropractors are professionals who can help new moms both during pregnancy and postpartum. Chiropractors (DCs) complete four years of chiropractic school after college, are board-certified and must maintain licensure in the state(s) they practice in. DCs work with pregnant women to make sure that the ligaments and muscles of the pelvis are prepared for birth, assist in optimal fetal positioning, and promote maternal wellness. There is an increasing number of DCs who specialize in pregnancy and women’s health, and some of them offer additional in-office therapies to enhance health and wellness, including acupuncture, prenatal massage, yoga, and Reiki.
Choosing a Pregnancy Support Network
It’s important for mothers to choose pregnancy-related healthcare professionals who they connect well with, trust, and feel safe with, as pregnancy is one of the most emotionally and physically demanding periods of a woman’s life. Pregnancy support networks should be tailored to mothers’ unique needs, which may change month-to-month, and in some cases, day-to-day. Thankfully, there is no longer a “one size fits all” approach to pregnancy and postpartum professional support, and women have many options for choosing the best individuals to help them during the transition to motherhood.
Author Bio Jessica Madden, MD, is a board-certified pediatrician and neonatologist who has been taking care of newborn babies for over 15 years. She is currently on staff in the neonatal intensive care unit (NICU) at Rainbow Babies and Children’s Hospital in Cleveland, Ohio, and has experience working in NICUs in the Boston Children’s Hospital and Cleveland Clinic Children’s Hospital networks. She is also the Medical Director at Aeroflow Breastpumps. Dr. Madden provides in-home newborn medicine and lactation support through Primrose Newborn Care, a small business that she opened in 2018. In her free time she enjoys traveling, yoga, reading, and spending time with her four school-aged children.