Differences between OBs, Midwives and Doulas : their roles and how they work together in NYC.


Types of Providers:

Midwife - medical professional who helps with care from preconception, abortion, birth control, pap smears, bimanual exams, birth, postpartum, breastfeeding and menopause. They attend to patients at home, clinics, birth center or hospital. In hospitals, midwives are required to be connected to an OB.

Doula - non-medical professional who provides emotional support and comfort techniques. Doulas work in all settings – hospital, home or birth center. Doulas can be specifically for preconception, birth, postpartum, miscarriage, loss or abortions.

OB / OBGYN - works at clinic, birth center or hospital

  • OB or obstetrician - physician who delivers babies (OBGYN is just another common name for an OB; they are the same).

  • GYN or gynecologists - physician who specializes in female reproductive organs. Note, all obstetricians are trained gynecologists, but not all gynecologists are obstetricians

Maternal Fetal Medicine Specialist - OBGYN who has done extra education and training in order to attend to high risk, complicated pregnancies and births


A few difference between OB care and midwifery care:

  • OBs can perform surgery, and manage high-risk/complicated births as well as low-risk clients
  • Midwives offer birth services for low-risk clients, and generally do not work with high-risk pregnancies

  • OBs usually actively manage care while midwives will usually offer fewer interventions

  • Prenatal care with an OB will often involve more ultrasounds and tests than prenatal care with a midwife


Midwives tend to view birth as a natural biological process with focus on the health of the birthing parent and baby, finding and resolving issues early on, and the intersection of emotional, physical, and mental health in pregnancy and birth. Midwives are there to guide the birth and keep things safe while allowing baby and parent(s) to follow their own instincts, interfering as little as possible.

Medical models of birth focus on the treatment and diagnosis of complications, and employ much more frequent interventions. Medicalized births generally involve more protocol constraints and less freedom – for things like visitors and movement during laboring/pushing, for example – than do midwife-assisted births, and medicalized births often involve interference with progression of labor, often owing to hospital insurance rules.

It’s important to remember that these philosophies can also vary from provider to provider, so interviewing or just chatting with your possible provider(s) to get a sense of their personal methodologies is essential.


Types of Midwives

  • There are multiple paths that midwives take to receive training and licensure, and although they are more similar than they are different, the distinction is especially important to recognize in terms of insurance coverage and cost. Below are descriptions of the the various types of midwives, and some general information about what the distinctions between midwives mean, their training, and how they work.
  • The varying types of care work can be daunting, but it's important to remember that all midwives are focused on women's birth care, and have all received training in the field; it's only price and legal licensure by state that varies.
  • Choosing a midwife and/or doula to fit yourself and your needs is what counts; speak to multiple people, ask any questions you have about pre/post-natal care and birth itself, and choose someone you trust and who services fit within whatever financial guidelines you may have. If you can, ask around for recommendations! Word of mouth goes a long way!


Certified Nurse Midwife (CNM):

  • Certified, registered nurses (during or prior to midwifery training)

  • Graduated from a nurse-midwifery program, and passed the midwifery board

  • Practice in all birth settings

  • Legally recognized in every state (in 18 states, they are allowed to diagnose and treat without supervision; the rest require a collaborative practice with a physician, and insurance reimbursement is mandatory)


Certified Midwife (CM):

  • Graduate of a recognized midwifery program, who has passed the midwifery board

  • Practice in all birth settings

  • Legally recognized in NY, NJ, RI, DE, MA, MI

  • Sometimes called Direct Entry Midwife (DEM)


Certified Professional Midwife (CPM):

  • Newest type of certification (introduced in the 1980s); licensure is changing, and varies by state; many states have active bills currently to grant CPMs legal recognition

  • Certification is not reliant on academic degree, but proof of competency, work experience and specialized education. These midwives take an exam in addition to completing an apprenticeship  

  • Meet qualifications set by the NARM (North American Registry of Midwives) standards (and are still required to take the science classes required for nursing programs; many also have other doula and childbirth training)

  • Practice only in homes and birth centers

  • Required to receive additional non-hospital education and experience

  • State licensing and practice laws vary; some states don’t recognize any midwives (CMs or CPMs) without a nursing degree, while others are in the process of changing licensing laws to include CPM’s


** (Price varies greatly based on factors such as experience level, insurance, location of birth, etc, so it is important to discuss this with your care provider and your insurance company.)


How to find a midwife in NYC


List of Midwifery practices in NYC:

Midwives in the hospital:

Mt. Sinai West (has a birth center with midwives within the hospital as well *closing January 1 2019*)

Metropolitan Hospital: Village Maternity

Brooklyn Hospital

Bellevue Hospital

Maimonides Hospital

Methodist Hospital: Park Slope Midwives

Mt. Sinai East


Midwives at Birth Centers:

Birthing Center of New York

Brooklyn Birth Center


List of OB & Midwife groups at hospitals:

Dr. Hanna, Dr. Moritz

Downtown Women OBGYN

Dr. Bradley, Shulina & Nabizadeh

Dr. Guirguis


What does a Doula do?

Doulas are not medical providers, as they haven’t (necessarily) received any medical training; however, they play a vital and essential role in birth and reproductive care. They provide informational, physical and emotional support before, during, and after birth. Some doulas work with hospitals and birth centers, but generally they are hired directly by expectant mothers and families. Their job is to advocate for expecting parents and their wishes and provide as much support as needed.

  • A doula is usually either a birth doula, a postpartum doula or both. A birth doula provides prenatal support and support during the birth (vaginal or c-section). A postpartum doula assists in feeding, baby parent bonding, sleep schedules and general physical and emotional recovery from birth.

  • Receives formal training and certification through national organizations such as DONA (Doulas of North America International) / DTI (Doula Training International)

  • Price varies by practice and experience level. (especially how many births they’ve attended; the more experience they have the more they charge). Fee per birth typically ranges from a few hundred to a few thousand dollars, and insurance companies don’t usually cover the cost of doula services, but you may use your Flexible Spending Account to do so. Many insurance companies are beginning to recognize the benefits of doula services, and are beginning to cover the costs; it varies widely from provider to provider though, so you should call and ask. Postpartum doulas usually charge hourly witt cost depending on experience level, additional trainings such as lactation support and whether support is for hours during the day as well as overnight packages.

  • In working with a birth doulas, it is standard to have two prenatal meetings, support for birth at home and place of birth, and some amount of postpartum support, agreed upon in advance

  • With postpartum doulas it is common to have one prenatal meeting and after the birth they will be available as per your agreement with them.

  • Additionally, there are doulas who specialize in abortion, miscarriage, infertility, adoption, and stillbirth work

  • Doulas usually have additional trainings in Prenatal Yoga, Hypnobirthing or in Lactation support so you can choose one that’s right for your needs.


How to Find a Doula

  • Contact Love Child here!

Further resources!

  1. Doulas of North America International - https://www.dona.org/

  2. American Midwifery Certification Board - https://www.amcbmidwife.org/

  3. American College of Nurse Midwives - http://www.midwife.org/

  4. North American Registry of Midwives - http://narm.org/

Finally, the site below includes each state’s midwifery guidelines, plus information on contacting the various organizations that can get you connected with midwives of different kinds in different states, as well as information about licensing agencies in the various states:



Birth Centers: The Best of Both Worlds

If your pregnancy is categorized as low risk and you are hoping to give birth with minimal interventions, but still have access to emergency hospital services, a birth center is a fantastic option.

Why choose a Birth Center?

  • Birth Centers offer more pain relief options such as a jacuzzi and nitrous oxide (laughing gas) which is very common in Europe and U.K. but not offered in many NYC hospitals. 
  • Birth Center environments tend to be a bit more homey with lighting options, bigger beds and friendly furnishings. All their medical equipment is usually hidden in closets rather than displayed. 
  • Birth Center cesarian section rates tend to be much lower and they perform fewer interventions. 
  • Birth Centers allow for intermittent fetal monitoring or will conduct monitoring with a hand held doppler which means that your movement isn’t restricted. 
  • Birth Centers allow for a variety of pushing positions - squatting or all fours for example which tend to cause less tearing. Often in hospitals you are required to push laying down on your back or on your side. 
  • Birth Centers allow partners to stay overnight after birth. (This is not always the case with shared rooms in postpartum but is allowed with private rooms at hospitals)  
  • Birth Centers within a hospital still offer all the expertise and options a hospital would provide such as and epidural or NICU facility. Free standing birth centers are located a short distance from their partner hospitals. 

What’s the rush?

Birth Centers are in high demand and many care providers who have privileges at a birth center don't take clients after the first trimester. Some will take clients up to 20-22 weeks. 

Are you a good candidate for a Birth Center?

Ask yourself - 

  • Are you low risk?
  • Are you comfortable with trying alternate pain management techniques either in liu of or before an epidural?
  • Birth centers require that you are at least a few centimeters dilated before being admitted so you’ll have plan to labor at home for a bit until you’re in active labor before being admitted. 
  • Birth centers will dismiss you after 24 hours after birth which might be too soon for some, but can be a relief to others. 

How do I know if I’m low risk?

  • Singleton, term, vertex pregnancies, and the absence of any other medical or surgical conditions is defined as a low risk pregnancy.
  • If any conditions present in the course of pregnancy and is classified as ‘high risk’ appropriate steps will be taken by care providers to recommend or transfer care. For example, if baby turns breech close to term, midwives will often transfer care to OBs they have a relationship with and may also be present at time of birth. 

Are Birth Centers equipped to handle emergencies?

  • Yes
  • Your care providers will continue to monitor you closely but if any predictable issues occur, (pre-term labor, gestational diabetes), you may be required to give up the birth center option and give birth in L&D instead, with your same providers. 
  • When you check in to a Birth Center when in labor, if any of the tests are non-reassuring (high blood pressure, presence of meconium, fetal heart rate irregularity) your care provider will determine whether you’ll be able to give birth in the birth center or whether to transfer you to L&D. 
  • In case of an emergency (emergency c-section, postpartum hemorrhage or if baby needs NICU) during birth, you will be transferred to the L&D floors, again with your care provider. 

What if I change my mind and want an epidural?

  • You’ll be transferred to L&D and be able to get one. 

Where can I find a Birth Center?

There are many different kinds of birth centers - free standing Birth Centers and Birth Centers located within a hospital, right next to labor & delivery units.

Which care providers have privileges at Birth Centers?

If you’d like to give birth at a birth center, you have to work with a care provider who has access. Not all care providers are designated for the birth center, so please be sure to check with yours. 

  • You can work with an OB Practice, an OB & Midwifery Practice, a group of Midwives or a single OB. 
  • Below are a list of care providers who offer services at Birth Centers:

Dr. Katrina Bradley, Dr. Nabizadeh & Dr. Shulina at Mt. Sinai Birth Center & Hospital

Dr. Anna Rhee at Mt. Sinai Birth Center & Hospital

Dr. Gae Rodke, Mt. Sinai Birth Center & Hospital (doesn’t take insurance) 

Dr. Paka, Mt. Sinai Birth Center & Hospital

Village Maternity, Metropolitan Hospital (Birth Center) (backed by Village OB)

CBS Midwifery, Mt. Sinai Birth Center

Central Park Midwifery, Mt. Sinai Birth Center

Community Midwifery Care, Mt. Sinai Birth Center

Risa Klein Midwifery, Mt. Sinai Birth Center

Sarah Jensen, CNM, Mt. Sinai Birth Center

Sabine Jeudy, CNM Mt. Sinai Birth Center

Midwives at NYP Downtown Birth Center

Dr. Hanna, NYP Downtown Birth Center