what is the difference between a doula and a midwife in ky

[katietieoh]

In ky a being a practicing midwife isn't even legal. I want to have a homebirth, but I want someone certified there to be able to see if anything is going wrong. Is there any cases where a doula (and only a doula) does a homebirth with someone. Do they have the right monitoring equiptment or w/e? thanks to anyone who can help!

[womenswisdom]

No, a doula does not have the necessary training or equipment to attend a homebirth. If she did, that would make her a midwife. The definition of a doula is someone who provides only non-medical support during pregnancy, birth and postpartum.

There are CPMs, DEMs and CNMs in KY and CNMs can legally attend homebirths there.

[amandasemele]

I live in Indiana, my last midwife was from KY. It is illegal here also. However all the midwives I have met from KY are more than qualified to determine anything that could go wrong. They would travel with you to the hospital and stay as a "friend" with you during labor. I am not sure what part of Ky you are from but I could name drop some wonderful midwives!!

[Adaline'sMama]

Originally Posted by womenswisdom 

No, a doula does not have the necessary training or equipment to attend a homebirth. If she did, that would make her a midwife. The definition of a doula is someone who provides only non-medical support during pregnancy, birth and postpartum.

There are CPMs, DEMs and CNMs in KY and CNMs can legally attend homebirths there.

This is simply not true. In KY CNMs must be under the supervision of an OB. There is no way you can have a licensed midwife attend your birth in Kentucky, as far as I know.

[womenswisdom]

My understanding is that APRNs, including CNMs, who desire prescriptive privileges must have a collaborative agreement, but those who do not have prescriptive privileges do not need to have one. There have been CNMs practicing homebirth midwifery in KY for some time.

Here is the specific statute addressing the requirements to practice as a CNM in KY:

http://www.lrc.ky.gov/krs/314-00/042.PDF

Note that the requirement for a collaborative agreement is only for APRNs who desire to prescribe.

[Adaline'sMama]

Interesting. I have never know anyone to have a CNM at their birth, nor known a CNM who was allowed to do homebirths in KY. Im sure they exist somewhere, but it is not commonly available.

[JamieCatheryn]

There are several midwives available, I homebirthed with one here in Louisville. Unlisenced doesn't mean they don't exist, Certified Professional ones, trained, experienced, and tested to be competant. But if they're "caught" they can go to jail. Doulas don't ever attend as care providers, if they did they'd be lay midwives. Rarely you'll find a montrice who does some monitoring and medical care but I don't know of any here.

[MarleneCPM]

Anyone who uses the title doula, should not be practicing midwifery. That being said, it does happen that some midwives in illegal states do feel more comfortable with a legal title such as doula, birth attendant or such. Using these titles will not save her butt from jail, if she is indeed caught practicing midwifery w/o a license, and it tarnishes the reputation of those who remain faithful to their said titles. But all that rhetoric does not help one actually find midwives in an illegal state! Also, it is not illegal for CNM's to do homebirths in KY. It may be near impossible to find one, but not illegal. Be assured there are KY midwives doing homebirths in KY! And midwives from surrounding states coming into KY to attend births. In fact, I occasionally do so myself.

It may help to call a doula, she may actually be an undercover midwife, or at least know of one. You could also try local sources such as LLL, home school or natural parenting groups, your local health food or herb store. Then there are more global online sources such as Birth Partners, FindAMidwife, Midwifery Today, Christian Midwives International,& MANA who can act as referral centers.

 I can understand you want some assurance of skill & competence in your midwife, but you can glean that from yrs of practice, training, and asking for referrals from previous clients, even w/o having a license. All CPM's must have an Informed Consent which covers her background, experience, skills & training. 

[Elizabeth Regan]

I personally know of one CNM in KY who legally attends homebirths on a regular basis. She has a collaborative agreement with an OB practice and she attends both hospital and homebirths. I have attended a homebirth with her and I work with other midwives who use her as a hospital backup. They are rare in KY due to the requirement of the collaborative agreement and also due to insurance costs, but they do exist.

All other midwives in KY practice without a license and do so at their own risk. Currently midwives are not being actively prosecuted, to my knowledge. There are Direct Entry Midwives or DEMs and there are CPMs. Training and experience varies widely among lay midwives and it is absolutely not true that all midwives are sufficiently trained and experienced enough to recognize and respond to complications. When deciding to have a homebirth, you should carefully interview potential midwives, asking them tough questions, such as what are the signs of various complications, how they would handle them, and how many times have the actually experience them. Be wary of someone who tells you that she has never seen a hemorrhage, or that she never transfers. I am a homebirther myself, planning my second homebirth after two cesareans this winter. I believe that it is every woman's right to choose their place of birth and their provider, but I am in favor of licensure for Certified Professional Midwives. It is important that the consumer has the protection that licensure offers.

As for doulas, I am a doula and no, doulas should never be offering clinical services. There are a few doulas who also offer monitrice services. These may include clinical services such as, fetal monitoring and cervical exams as a service to help you gauge when to go to the hospital, but a doula by definition does not offer these things. They are non-clinical support companions.

Hope this helps!

[PostpartumDoula]

Well said Elizabeth! Just one comment to add...a doula who acts as a monitrice is no longer doing "doula" work since the role of the Doula is non- medical in nature. Our role as doulas is a seperate yet very important role of physical, emotional, and informational support for the pre/postnatal woman and her family.