You might just be learning about the distinctions between a doula and midwife when you read this new word: monitrice. What on earth is a monitrice? Here’s a guide to help you understand the distinctions between doula, monitrice and midwife.
A labor doula is a trained birth assistance who provides emotional, psychological and physical support to the laboring woman and her partner. Research shows that the presence of a labor doula is an invaluable aid to assisting the mother through the labor process. Overall there is less need for obstetrical interventions, medications and a reduction in surgical birth.
A doula’s training is usually acquired through a 4 day workshop, additional study, and attendance at a minimum of 4 births. Although doulas may be well-read in the field of maternal-child health, there is no medical or nursing training required as part of their experience. DONA, one of the national certifying organizations for doulas states that doulas should limit their involvement to the aspects of labor and birth described above, and that doulas should not advise their clients in ANY medical capacity.
A monitrice is a person who acts in all the ways a doula functions during labor and birth. ADDITIONALLY, she has nursing or midwifery or medical training in the field of maternal-child health. She may be a former labor & delivery nurse, a certified professional midwife in a state where this type of midwife is not legal, or a non-practicing nurse-midwife. She is trained in fetal monitoring, performing internal exams during labor, neonatal resuscitation and breastfeeding and postpartum care. A monitrice generally will stay with clients at home, functioning as their doula as well as medically assisting with the labor and communicating with the primaryhealth care provider, who could be a midwife or physician. Monitrices do not intentionally deliver babies on their own. They go into the hospital with the laboring woman when she is close to delivery, and continue to support her during the labor, but the woman’s midwife or physician then delivers the baby. After the birth the monitrice provides postpartum follow-up care, assessing breastfeeding and newborn concerns, and referring to lactation consultants and pediatricians when appropriate.
Midwives generally function as primary health care providers to pregnant and laboring women. They do have limits on who they can care for, but if the woman is considered low risk, midwives can see the woman for prenatal care, deliver the baby, and continue to see the woman for postpartum care and well woman gynecological care. Midwives are often employees of hospitals, occasionally they are independently owned. Most midwives who practice in hospitals cannot attend to their clients at home. They wait until their patients sound like they are far enough along on the phone and then counsel them to come to the hospital and assess them then (unless the client is working with a monitrice–then the Midwife will already know how far along the laboring woman is, because of the Monitrices’ expertise!) Some midwives have home birth practices where they do attend clients at home for labor as well as doing prenatal and postpartum care in the midwives’ office, but this is more rare.
Benefits to Working with a Monitrice
1. A monitrice is professionally trained in both maternal-child health as well as labor support.
2. A monitrice can work with you at home prior to coming into the hospital.
3. While at home, a monitrice can monitor your labor by listening to your baby’s heart rate, checking cervical dilatation and observing for normal
and abnormal labor patterns.
4. When your labor begins spontaneously, the monitrice can come to your home and work with you there until late active labor, so in many circumstances you can stay at home until 8 cm dilatation before coming into the hospital.
5. A monitrice is trained in normal newborn delivery & neonatal resuscitation in the event the baby comes faster than expected. She is also trained in fetal heart rate monitoring and newborn care and breastfeeding assistance.
6. A monitrice is trained in providing labor support for natural birth. She uses tools such as positioning, teaching abdominal breathing and deep relaxation, as well as other tools to facilitate a natural birth.
7. A monitrice has knowledge of labor and birth interventions. She can explain risks and benefits of labor medications and procedures such as epidural anesthesia and cesarean section.
8. A monitrice can speak to the primary health care provider and hospital nurses about your preferences and plan of care during the labor and birth process.
9. A monitrice can assist after the birth with the initiation of breastfeeding and evaluating normal and abnormal postpartum concerns.
10. A monitrice can evaluate newborns after mother and baby are discharged from the hospital and make appropriate referrals to lactations consultants and pediatricians in situations where mother and/or baby need further care.