There are several alternative choices for the birthing process in general. Doulas and midwives are two options a pregnant woman may choose to include as part of her birthing plan. Midwives are trained to deliver babies in a hospital or home setting. Midwives do not, however, have medical training equal to that of a doctor, they cannot care for more complicated cases and they cannot perform cesarean deliveries. Typically, pregnant women who wish to employ a midwife for their pregnancy care should also employ a physician to work hand-in-hand with the midwife if needed.
There are two types of midwives: certified nurse midwives (CNM), and other midwives (CPM, CM) who are not CNM. Certified nurse midwives (CNM) are required to complete a formal academic training and commonly hold an RN or BSN degree. Hospitals usually employ only CNMs and not those who do not have a formal training. CM/CPMs do not meet the Global Midwifery Standards and are no accepted as midwives outside the US.
Doulas are different than midwives as they are not trained to handle the birthing process. Doulas work with pregnant women as a birthing partner, helping to guide her through pregnancy, labor and delivery. Doulas can work with the woman by attending lactation classes, birthing classes and breathing classes. Many women think of doulas as their pregnancy best friend. Doulas can also be certified as birthing assistants by the Doulas of North America or DONA Association.
Doulas and midwives offer support for pregnant women during pregnancy, but they are not medical doctors. If medical problems arise before birth, such as preeclampsia or high blood pressure, a medical doctor may be needed for advanced care. Birthing outside of a hospital setting may also present a problem if there are complications during the birthing process or after birth for either mom or baby.
Alternative care is quickly becoming more accepted in the medical community so some doctors now employ midwives to attend to patient care in office. During the birthing process, the midwife may be the primary caregiver, but a doctor is always apprised of the situation should the need arise.