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Choosing a Gynae, Midwife or Doula: what’s the difference?

by | May 15, 2020

There are a number of different healthcare providers for pregnant women and postnatal moms. Natalie Nelson from the Genesis Birthing Clinic gives us a detailed rundown of the differences between gynaecologists, midwives and doulas.

If you have ever wondered what the difference is between a gynaecologist and a midwife,  you’re not alone. Over the last 15 years or so, there has been a trend of more moms moving away from having their babies with a gynaecologist and rather choosing a private midwife to deliver their babies instead. And then along comes the doula to confuse matters even more. In order to clarify exactly what these three types of caregivers do, let’s look at them individually.

Gynae vs Midwife vs Doula

Midwives and gynaecologists are both trained to look after pregnant women and deliver their babies, but there are definite and noteworthy differences between the two practitioners.

Gynaecologists

Gynaecologists are trained surgeons who focus on dealing with the functions and diseases specific to the female reproductive system. Some gynaecologists specialise in obstetrics – the branch of medicine that is concerned with childbirth. Obstetrics adopts a clinical view of pregnancy and birth. OBGYN training specialises in high-risk pregnancies that could become complicated during the course of the pregnancy and therefore need specific medical management. Obstetricians are medically orientated and perform caesarean sections and any other necessary surgical procedures during pregnancy and delivery. In South Africa, we tend to use the terms gynaecologist and obstetrician interchangeably.

Midwives

Midwives are also trained medical professionals who look after pregnant women antenatally, during labour and postnatally. They approach pregnancy from a more holistic point of view, seeing pregnancy as a normal, natural process requiring as little medical intervention as possible. Midwives are primarily specialists in natural, low-risk pregnancies and birth. They work closely with gynaecologists who support them and back them up, particularly when pregnancies complicate and when emergency c-sections become necessary. In South Africa, midwives qualify as nurses and opt to study midwifery as a specialisation.

Doulas

Doulas are not medically trained, but do have training in managing moms in labour, particularly from an encouragement and coaching point of view. The word doula originates from Greek and means ‘woman servant’ or ‘caregiver’. The role of the doula encompasses the non-clinical side of birth. Doulas use and suggest alternative methods of pain management like massage, reflexology, relaxation techniques and different labouring positions, which could be of great help during labour. Doulas also encourage partner participation and offer support and reassurance to birthing partners. Doulas act as advocates for moms, especially in hospitals where birth is viewed as a medical issue, and moms are often left to labour alone.

The benefits of having a doula are numerous, but the most significant ones include a reduction in pain relief medication, reduced medical interventions and fewer emergency caesareans. Not only do doulas assist during the birth, but they can help during the postpartum period as well. Unfortunately the saying ‘It takes a village to raise a child’ is no longer prevalent in our fragmented society, but thankfully postpartum doulas help to fill this gap.

Midwives and doulas work very closely together, often forming a birthing team.

How to choose the best pregnancy caregivers for you

Over the last couple of years, there has been a steady increase in preggy moms choosing private midwives as their primary caregivers. The increase in awareness that moms have the right to choose who they want as their pregnancy caregivers has most certainly contributed to this increase. With midwives specialising in caring for low-risk moms during their pregnancy and labour, it may be surprising to learn that between 80% and 90% of preggy moms are actually considered low-risk while giving birth.

It is safe to say that if you are a high-risk candidate, your only option is to have a gynaecologist take care of you and deliver your baby. However, if you are a low-risk candidate, it will ultimately come down to personal choice. Below is a table that summarises and compares the care offered by midwives and gynaecologists:

Difference in approaches to care between gynaecologist and midwife

Gynaecologist Midwife
  • Sees birth as a potentially pathological process, that needs to be managed
  • Sees the mom as a patient
  • Sees the birth as the work of the doctors, nurses and other experts
  •  Hierarchical system of care
  • Trained to focus on the medical aspects of birth
  • Professional care that can be perceived as authoritarian
  • Prenatal visits shorter and more to-the-point
  • Limited emotional support
  •  Ignores the spiritual aspects of birth
  •  Nurses ‘progress’ the mom, gynaecologist generally arrives in time to ‘catch’ baby
  • Readily uses interventions

 

 

 

  • Sees birth as a normal, life-changing event in a woman’s life
  • Sees the mom as an active participant in both pregnancy and labour
  • Sees the birth as the work of the mom; midwives are there to support
  • The care, though professional, is more informal
  • Sees birth as a holistic process encompassing physical and emotional aspects
  • Shared decision making between midwife and parents-to-be
  • Longer, more in-depth prenatal visits
  • Strong emotional support
  • Awareness of spiritual significance of birth
  • Is present and supporting the mom throughout labour and the birth
  • Avoids unnecessary interventions during labour
  • Takes psychological and emotional state of mom into account during labour
  •  Encourages the use of a doula

 

The choice is yours

The choice of your pregnancy and birth caregiver is most certainly a very personal one. Once you have investigated, weighed up your options and also considered recommendations from other new moms, choose wisely. Birth is a very special event in any woman’s life; one that will stay with you for the rest of your life, be informed, be confident, but most of all, be empowered.



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