The Baby Manual

602 - OB, Midwife, or Doula?

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Dr. Carole Keim takes listeners through one of the earliest and most important decisions in pregnancy: choosing the right support team. In this solo episode, she explains the differences between obstetricians, certified nurse midwives, and doulas, helping parents understand the unique role each plays during pregnancy, labor, delivery, and postpartum recovery. Dr. Keim also walks through the typical timeline of prenatal visits, ultrasounds, testing, and vaccines, giving expectant parents a practical overview of what to expect from the first positive pregnancy test through delivery.

With her warm and reassuring approach, Dr. Keim also explores what labor and birth are really like beyond what’s often portrayed in movies. She discusses birth plans, labor support, cervical checks, fetal monitoring, inductions, C-sections, and postpartum healing, while emphasizing that every pregnancy and birth experience is different. Parents will come away with a clearer understanding of how to build a supportive birth team and how to prepare emotionally and physically for welcoming a new baby. 

Key Moments

  • 00:00 Introduction to OBs, midwives, and doulas
  • 02:17 Pregnancy tests and scheduling the first prenatal appointment
  • 03:35 The 8–12 week visit, ultrasounds, and viability checks
  • 05:35 The 20-week anatomy scan and fetal development
  • 07:53 Glucose tolerance testing and gestational diabetes screening
  • 10:16 Vaccines during pregnancy: Tdap, flu, COVID, and RSV
  • 12:29 Breech babies, turning procedures, and planned C-sections
  • 14:58 Routine late pregnancy visits and induction discussions
  • 16:15 Certified nurse midwives vs obstetricians
  • 20:07 What doulas do during pregnancy, labor, and postpartum
  • 24:23 Birth plans, labor positions, and creating a calming environment
  • 27:13 Labor monitoring, cervical checks, and delivery interventions
  • 31:59 Postpartum healing, recovery, and spacing pregnancies
  • 35:23 Final thoughts and additional resources for parents

    • __

    How to choose an OB or midwife 

    • OBs, family doctors, and midwives can deliver babies
    • Group practices are pretty standard nowadays; meet your main doctor/midwife but also meet the team who might be delivering (either other people in the office or a laborist)
    • Personality fit is a big deal
    • Obstetricians and family doctors are medical doctors.  Their training involves 4 years of undergrad, 4 years of medical school, and 4 years of residency (12 years total).
    • There are two types of midwives: lay midwives and CNMs.
      • Lay midwives are those who have experience delivering low-risk babies out of the hospital, typically at home.  They have no certification or licensure requirements, and no formal medical training.  Home births with a lay midwife are by far the most dangerous and I have seen some bad outcomes and cannot ethically support them.  When I speak about midwives during this episode, I am not including lay midwives.
      • CNMs are required to have a bachelor’s degree in nursing (4 years of undergrad), then 2 years of graduate-level nurse midwife training (6 years total).
      • The main differences are the knowledge base and the approach to care.
        • Doctors
        • Nurses
        • OBs, family doctors, and midwives can see you during your pregnancy and can deliver babies vaginally.
        • Only OBs can perform c sections and take care of high-risk pregnancies (moms under 18yrs or over 35 years, those with health conditions, those with prior c-section, twins/triplets
        • Birth location
          • OBs deliver in hospitals because it is the safest setting
          • Midwives can deliver at hospitals, birth centers, and/or at home depending on the local regulations

            • Timing of appointments  

            • In the US, the number of weeks starts at the beginning of your last period, so when you miss a period and test you are 4 weeks pregnant
              • Ovulation and fertilization happen at 2 weeks, so you aren’t actually pregnant until then, but we are counting from LMP
              • In the US, the due date is at 40 weeks
              • In other countries they may count dates starting at conception/ovulation, so the due date is at 38 weeks
              • Initial appt: 6-8 weeks or whenever you find out you’re pregnant, whichever is later
              • First trimester (until 12 weeks and 6 days): you’ll be seen 2-3x; initial confirmation appt, 6-8 weeks for dating, 10-12 weeks for NIPT. Blood testing and urine testing for STIs, drugs, ultrasound for dates, hear heartbeat, NIPT (check out the genetics episode 503)
              • Second trimester (13 0/7 to 27 6/7): appts about every other week, anatomy scan, testing for gestational diabetes, further genetic testing and/or ultrasounds if indicated.
              • Third trimester (28-40 weeks): appointments every 2 weeks, then weekly starting at 38 weeks.  Check urine for protein (a sign of pre eclampsia) at each visit.  GBS screen.  RPR on admission to hospital.
              • Postpartum: 2 weeks and 6 weeks
              • High-risk pregnancies will be seen more often.  A pregnancy can become high risk at any time.

                • Doula

                • What they can do: emotional support, physical comfort during labor and delivery.
                • What they can’t do: anything medical, including deliver babies.
                • Reasons you might want one: to keep you as comfortable as possible during labor; they can get you food/water/ice chips, rub your feet or neck if you want, call the nurse for you, crowd control, can articulate your preferences while you’re in labor, possibly also attending to partner during delivery
                • Reasons you might not want one: expense, privacy, not needed if you have a support person

                  • Birthing options / Birth plans

                  Birth plans

                  • How you want your birth experience to be
                  • Birth is a very tenuous process and doesn’t always go according to plan.  A birth plan is a nice outline of preferences, if you have any.
                  • If you are planning a vaginal delivery, keep in mind that your birth team has the main objective of having a healthy mom and baby.  If your provider says that something needs to change during labor or delivery, there is usually a medical safety reason for that change.

                    • Scheduled C-Sections

                    • Reasons you might be scheduled for a C-section: repeat, breech baby, twins/triplets, high risk for underlying medical conditions in you or the baby.  Scheduled C-sections typically have a shorter birth plan:
                      • music in the operating room
                      • one support person in there with you
                      • will the support person go with the baby or stay with mom when the C-section is over?
                      • Even if you’re scheduled for a C-section, you might go into labor early and need an urgent or emergent C-section before the scheduled date.

                        • Scheduled inductions 

                        • Reasons you might be scheduled: post dates, pre eclampsia, gestational diabetes, specific high-risk pregnancy reasons
                        • There are a few ways to induce labor, including medication taken by mouth or placed in the vagina to help open the cervix, IV medication called pitocin which causes your uterus to contract, and placing something such as a stick that absorbs fluid and expands or a balloon that is placed by your provider in the cervix to help it open
                        • Less to plan, but the same as for vaginal delivery.
                        • Mixed evidence as to whether scheduled inductions are more or less likely to end in C-section

                          • Vaginal delivery

                          • If you fully go into labor naturally, meaning you have contractions every 3-5 minutes lasting 1 minute each and your water breaks, you may need no intervention at all.
                          • Areas to plan:
                            • People who will be there
                            • Environment: music, smells, lighting, etc
                            • Comfort measures / pain relief - birth ball, shower, tub, squat bar, etc
                            • Words to use or to avoid
                            • Position for labor/delivery
                            • Mirror during delivery
                            • Plans for the placenta
                            • Newborn procedures: skin to skin, eye drops, vitamin K, Hep B, circumcision, timing of first bath, breast/bottle/both
                            • Who is allowed after baby is born and how they will be notified

                              • Check out The Baby Manual on Amazon.  It will give you peace of mind when your new baby arrives.  

                              __ 

                              Resources discussed in this episode:

                              • The Holistic Mamas Handbook is available on Amazon
                              • The Baby Manual is also available on Amazon

                                • __

                                Contact Dr. Carole Keim MD

                                • Website: CaroleKeim.com
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                                  The Baby ManualBy Dr. Carole Keim MD
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