2. Professional Roles

Family Practice Physicians (2, 3, 4, 5)
Family practice physicians are generalists providing the majority of care for America’s underserved rural and urban populations. They provide comprehensive healthcare for acute and chronic ailments for people of all ages – from newborns to seniors. Family physicians complete a three-year residency program after graduating from medical school. As part of their residency, they receive training in six major medical areas: pediatrics, obstetrics and gynecology, internal medicine, psychiatry and neurology, surgery, and community medicine. Some family physicians undertake additional training in obstetrics, enabling them to provide advanced surgical and medical obstetric care. Family physicians may consult with specialists for the management of patients with pregnancy complications.

Around half of US counties lack an ob-gyn; in these areas, maternity and obstetric care is more likely to be provided by family physicians. While in some rural areas, family physicians provide 100% of obstetric care, in urban areas, obstetric care is more likely to be provided by obstetric physicians. Only 15% of family physicians attend births; some may be specially trained to perform caesarean sections. Family physicians typically attend only hospital births; very few planned home births are attended by family physicians.

Midwives (6, 7, 8, 9)

Midwives can be nationally certified and are variably licensed by each state. Current midwifery credentials in the United States include certified professional midwives (CPM, licensed in 32 states), certified nurse-midwives (CNM, licensed in 50 states) and certified midwives (CM, licensed in 5 states). CPMs are certified nationally by the North American Registry of Midwives (NARM). CNMs and CMs are certified nationally by the American Midwifery Certification Board (AMCB).

CPMs primarily attend birth in birth centers and homes. CNMs/CMs also attend birth in birth centers and homes, but primarily attend birth in hospitals. CNMs/CMs scope of practice additionally includes prescribing and a breadth of primary, sexual and reproductive healthcare. “Direct-entry midwifery” refers to midwives that are not primarily prepared as nurses. “Lay midwifery” typically refers to midwives without formal training and is often used pejoratively.

All midwives work collaboratively with other care providers. If health issues develop over the course of care, they may consult with a specialist (obstetrician, neonatologist, pediatrician, etc). They follow practice guidelines for consultation, co-management and/or transfer of care to an appropriate specialist. They are trained to provide emergency care until additional assistance is available.

Despite multiple educational pathways and certification methods, the underlying philosophy of midwifery is foundational to all: pregnancy and childbirth are both physiologic and profound experiences, the client is an autonomous partner in care, and midwifery care is based on the ethical principles of justice, equity, and respect for human dignity.

Obstetricians (10, 11)
Obstetrician-gynecologists provide the majority of obstetric care in the United States, particularly in urban areas.

Obstetrics and gynecology are disciplines dedicated to the broad, integrated medical and surgical care of women's health throughout their lifespan. Obstetrician-gynecologists complete four years of medical school and a four year residency with advanced training in medical and surgical care specific to women’s health. This study and understanding of the reproductive physiology of women gives obstetricians and gynecologists a unique perspective in addressing gender-specific healthcare issues. Obstetrician-gynecologists provide care for both uncomplicated and high-risk pregnancies and deliveries.

Obstetrician-gynecologists may choose a scope of practice ranging from primary ambulatory healthcare to concentration in a focused area of specialization. They typically attend births only in the hospital setting.

Pediatricians (12, 13)

Pediatricians are primary care providers who care for the physical, mental, and social health of children from birth to young adulthood. Pediatric care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. Pediatricians typically attend hospital births only when there is an indication that the baby may need specialized medical care due to a pregnancy or delivery complication.

A pediatrician’s training includes four years of medical school education and an additional three years of intensive training devoted solely to all aspects of medical care for children, adolescents, and young adults.


Neonatologists (14)
A neonatologist is trained specifically to handle complex and high-risk neonatal patients. If the newborn is premature, or has a serious illness, injury, or birth defect, a neonatologist may assist at the time of delivery and in the subsequent care of the newborn. If a problem is identified before the baby is born, a neonatologist may become involved to consult with the obstetrician in prenatal care during pregnancy.

Neonatologists are medical doctors who have completed at least 4 years of medical school, three years of residency training in general pediatrics, and three years of additional training in newborn intensive care.

Neonatologists generally: diagnose and treat newborns with conditions such as breathing disorders, infections, and birth defects; coordinate care and medically manage newborns born premature, critically ill, or in need of surgery; ensure that critically ill newborns receive the proper nutrition for healing and growth; provide care to the newborn at a cesarean or other delivery that involves medical problems in the mother or baby that may compromise the infant’s health and require medical intervention in the delivery room; stabilize and treat newborns with any life-threatening medical problems; and consult with obstetricians, pediatricians, and family physicians about conditions affecting newborn infants.

Neonatologists work mainly in the special care nurseries or newborn intensive care units of hospitals. In some cases, after a newborn has been discharged from the unit, a neonatologist may provide short-term follow-up care on an outpatient basis. Neonatologists coordinate care with the baby’s primary care provider (pediatrician or family physician).

Neonatologists practice in children’s hospitals, university medical centers, and large community hospitals.

Collaborating Professionals for Labor and Birth: Labor & Delivery Nurses, Anesthesiologists, Emergency Medical Technicians

Labor & Delivery Nurses
Nurses provide continuous nursing care in labor and postpartum. Nurses work with midwives and physicians and contribute to the coordination of care. Regulations permit nurses to manage labor in the hospital when the physician or midwife is not present. Managing labor includes assessments of maternal and fetal well-being, as well as progress in labor and making decisions and taking actions based on these assessments. They have training in newborn resuscitation and provide care to newborns.

A nurse’s role and scope in the hospital includes conducting assessments and taking appropriate actions, responding to emergencies, and supporting the patient. They also provide care to newborn babies after birth.

Anesthesiologists
Anesthesiologists provide care during certain types of anesthetic procedures during labor, birth, or postpartum. They assist in the management of pain during labor, as needed, or administer anesthetic for other obstetrical procedures that cannot be done by local anesthetic or a pudendal block. The scope of practice of an anesthesiologist is clinical care of the patient for anesthetic control and pain management. When cesarean birth is indicated, anesthesiologists are responsible for the anesthetic management of the procedure. They are not responsible directly for obstetrical clinical care.

Emergency Medical Services (15)

Although regulations and licensure requirements vary by state, the National EMS Scope of Practice Model provides consistent guidance on the general qualifications and scopes of practice of four defined levels of EMS care providers: Emergency Medical Responders, Emergency Medical Technicians, Advanced Emergency Medical Technicians, and Paramedics.  The scope of practice for these providers ranges from basic lifesaving interventions and transport to invasive and pharmacological interventions for acute out-of-hospital medical and traumatic emergencies.

Collaborating providers for pregnancy and postpartum (lactation consultant, nutritionists, health educators, social worker, genetic counselor, public health nurse)

Lactation Consultants (16)

Lactation consultants are professionals who provide clinical management of breastfeeding, such as feeding assessments and feeding plans based on the needs of infant and lactating parent, advice on medications and complementary therapies while breastfeeding. Their specialized training prepares them for lactation advocacy and research, as well. Internationally recognized board certification is available and affords the IBCLC credentials (international board certified lactation consultant).

Nutritionists (17)

Nutritionists take a key role in promoting healthy people by reviewing and assessing individual diets to ensure balanced approach to nutrition that will aid in overall health, as well as healthy pregnancies and postpartum. Nutritionists may also play a role in medical management of disease; for example, nutritionists work with patients with gestational diabetes and their providers to help optimize diet for blood glucose control.

Health Educators

Health educators provide in depth education on a variety of perinatal and parenting topics, often providing opportunities for patients to engage in learning related to perinatal and parenting issues. For example, childbirth education, infant feeding, contraception and infant development.

Social Workers (18)

Professional social workers provide services to individuals and families, addressing the full range of biopsychosocial–spiritual and environmental issues that affect well-being. Social workers may assist individuals in emotional or social distress, including navigation out of abusive relationships or into healthy relationships. They may also be asked to assist individuals in financial distress and in need of community resources, or to assist individuals who need assistance with legal, housing or employment issues. Social workers ensure a more holistic approach to health by addressing each person’s biopsychosocial-spiritual and environmental issues. Social work’s strengths-based, person-in-environment perspective provides the contextual focus necessary for client- and family-centered care.

Genetic Counselors (19)

Genetic counselors utilize information from individual and family histories, genetic laboratory testing or other screening to assess risk for genetic medical conditions or disorders in the patient, their offspring or family members. They are focused on providing client-centered care that includes addressing any responses to genetic counseling, including emotional. Genetic counselors also connect patients with resources in the community that provide medical, educational, financial, and psychosocial support and advocacy.

Public Health Nurses (20)

Public health nurses are registered nurses who perform home visits during pregnancy and continuing through infancy, sometimes through the child’s second birthday. During the home visits, the nurse is focused on education to support healthy pregnancy and parenting. The nurse may assess for pregnancy and postpartum complications in the birth parent. The nurse also monitors for healthy growth and development of the baby and child. Due to the longitudinal nature and continuity of care provided by public health nurses, they can be a source of support to the parents in regard to furthering educational achievement and employment. Family members and friends are also integrated into the outreach to promote supportive relationships and to encourage use of other community health and human services.