Collaborative Practices - A Team Approach

Health care practices today are increasingly following the team model. An obstetrician will often work, for example, with a midwife, a physician assistant, and a nurse practitioner. A physician assistant (PA) is specially trained to provide some components of medical care and work directly under the supervision of a physician. A nurse practitioner (NP), also called an advanced practice nurse, provides primary health care. In a maternity care service, the NP might be an adult nurse practitioner (ANP), a woman’s health nurse practitioner (WHNP), an obstetrical and gynecological nurse practitioner , or a family nurse practitioner (FNP). PAs and NPs generally provide in-office care, bur usually do not attend births.In group practices such as these, you mayor may not have a choice of provider. Sometimes prenatal care is rotated among the many different types of practitioners and either a physician or midwife will attend your birth, depending on who is on-call when you go into labor. In other such practices you can choose your birth attendant the midwives and physicians see separate groups of women. This is based on you preference, your health, and whether your pregnancy is complicated by problems. Of course, in any of these cases, an obstetrician is always available for emergency care should the need arise.

Many women feel that collaborative practices offer the best of all possible worlds. In many of these practices, other health care personnel also are available to provide components of care. These may include, for example, a nutritionist, a childbirth educator, a massage therapist.

Doulas

A doula is an old concept and a new profession. A doula is somebody who provides support to the laboring woman and the new mother. Labor doulas are sometimes called labor coaches or monitrices. They are often on-call, like obstetricians, midwives, and other birth attendants, and will be with you for labor and birth. The advantage of a doula is that she (generally she) is especially trained or experienced in attending births and can provide excellent psychological and physical support. She can be great at massage, assisting with breathing techniques, helping with relaxation. She can often act as an advocate for you, intervening when hospital policies and your wishes seem incompatible.

The disadvantage of a doula, for some women, is that she is another professional. She is not a loved one and can interfere with the bonding that can occur during childbirth between a woman and somebody she loves. In well-staffed hospitals, nurses can provide the type of care that doulas provide. As midwifery, by definition, means “with woman,” many midwives provide the same type of support that doulas provide, as well as managing the labor and birth.

In some cultures men are prohibited from being present during child­birth, or are not allowed to touch the woman in labor. In such cultures, a female doula may provide invaluable support. Some partners travel or may be otherwise unavailable for birth and again, in this situation, a doula may be a big help. Well-conducted, controlled studies in a variety of countries and settings consistently have shown that a trained support person in childbirth has definite benefits in labor, including reduced use of pain medication, lowered incidence of vacuum or forceps delivery, and fewer cases of a 5-minute Apgar score below 7.

Support has been shown to shorten labor. Many doulas also provide care for mother at her home after the birth. Unlike a baby nurse, doulas focus on the physical and emotional needs of the mother. Some doulas provide only postpartum care.