What’s in the job?
I wonder if most of us really know what the scopes of practice are for the providers we may choose for pregnancy, birth, postpartum, and for the baby. Keep reading to see if you really know what the jobs encompass.
As you go through the list I would like you to think about the language used, descriptors, and purpose of each type of provider. When we are approaching health care decisions especially who will care for us from pregnancy through birth, postpartum and for our babies, we need to make sure we are choosing the appropriate care for our individual needs and situation.
If anything strikes you or you would like me to add any provider types, please leave me a comment!
OBSTETRICS AND GYNECOLOGY (OB/GYN)
Obstetrics and gynecology is a discipline dedicated to the broad, integrated medical and surgical care of women’s health throughout their lifespan. The combined discipline of obstetrics and gynecology requires extensive study and understanding of reproductive physiology, including the physiologic, social, cultural, environmental and genetic factors that influence disease in women. This study and understanding of the reproductive physiology of women gives obstetricians and gynecologists a unique perspective in addressing gender-specific health care issues.
Preventive counseling and health education are essential and integral parts of the practice of obstetricians and gynecologists as they advance the individual and community-based health of women of all ages.
Obstetricians and gynecologists may choose a scope of practice ranging from primary ambulatory health care to concentration in a focused area of specialization. – from ACOG
Midwifery as practiced by Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) encompasses primary care for women across the lifespan from adolescence beyond menopause, with a special emphasis on pregnancy, childbirth, and gynecologic and reproductive health. Midwives perform comprehensive physical exams, prescribe medications including contraceptive methods, order laboratory and other diagnostic tests, and provide health and wellness education and counseling. The scope of practice for CNMs and CMs also includes treatment of male partners for sexually transmitted infections, and care of the normal newborn during the first 28 days of life. -from ACNM
Certified Professional Midwife
Based on the MANA Core Competencies, the guiding principles of the practice of CPMs are to work with women to promote a healthy pregnancy, and provide education to help her make informed decisions about her own care. In partnership with their clients they carefully monitor the progress of the pregnancy, labor, birth, and postpartum period and recommend appropriate management if complications arise, collaborating with other health care providers when necessary. The key elements of this education, monitoring, and decision making process are based onEvidenced-Based Practice and Informed Consent. – from MANA
Direct Entry Midwife (including Licensed Midwife)
- Not required to be nurses.
- Multiple routes of education (apprenticeship, workshops, formal classes or programs, etc., usually a combination).
- May or may not have a college degree.
- May or may not be certified by a state or national organization.
- Legal status varies according to state.
- Licensed or regulated in 21 states.
- In most states licensed midwives are not required to have any practice agreement with a doctor.
- Educational background requirements and licensing requirements vary by state.
- By and large maintain autonomous practices outside of institutions.
- Train and practice most often in home or out-of-hospital birth center settings.
To learn more detail about all types of midwives go to Citizens For Midwifery
Nurse practitioners (NPs) are registered nurses who are prepared, through advanced education and clinical training, to provide a wide range of preventive and acute health care services to individuals of all ages. Today, NPs complete graduate-level education preparation that leads to a master’s degree. NPs take health histories and provide complete physical examinations; diagnose and treat many common acute and chronic problems; interpret laboratory results and X-rays; prescribe and manage medications and other therapies; provide health teaching and supportive counseling with an emphasis on prevention of illness and health maintenance; and refer patients to other health professionals as needed.
NPs are authorized to practice across the nation and have prescriptive privileges, of varying degrees, in 49 states. Nurse practitioners perform services as authorized by a state’s nurse practice act. These nurse practice acts vary state-to-state, with some states having independent practice for NPs (not requiring any physician involvement), some with collaborative agreement required with a physician. -from ACNP
AAFP defines a family physician as, “a physician who is educated and trained in family medicine–a broadly encompassing medical specialty.”
Family physicians possess unique attitudes, skills, and knowledge which qualify them to provide continuing and comprehensive medical care, health maintenance and preventive services to each member of the family regardless of sex, age, or type of problem, be it biological, behavioral, or social. These specialists, because of their background and interactions with the family, are best qualified to serve as each patient’s advocate in all health-related matters, including the appropriate use of consultants, health services, and community resources. – from AAFP
The labor doula assists the woman and her family before, during, and after birth by providing emotional, physical, and informational support. It is not within the labor doula’s scope of practice to offer medical advice or perform any medical or clinical procedure.
During pregnancy, the labor doula’s role is to assist families in preparing a birth plan, to provide information about birth options and resources, and to provide emotional support.
During labor and birth, the labor doula facilitates communication between the family and the caregivers. She supports the mother and her partner with the use of physical, emotional, and informational support.
During the postpartum period, the doula assists the mother in talking through her birth experience, answering questions about newborn care and breastfeeding within our scope of practice, and referring the family to appropriate resources as needed. – from CAPPA
The postpartum doula provides informational and educational information to the family. Medical advice is not given; referrals to appropriate studies and published books are within the postpartum doula’s scope. The postpartum doula will determine ahead of time what duties she feels comfortable with performing for the postpartum family and she will share this information with the family prior to accepting a position with them.
CAPPA members do not perform clinical or medical care on mother or baby such as taking blood pressure or temperature, vaginal exams or postpartum clinical care. CAPPA standards and certification apply to emotional, physical and informational support only. CAPPA members who are also health care professionals may provide these services within the scope and standard of their professions but only after making it clear that they are not functioning as a labor doula, postpartum doula, or childbirth educator at the time of the care. For needs beyond the scope of the postpartum doula’s expertise, referrals are made to the appropriate resources.
CAPPA strongly recommends that members do not drive mother or baby unless there is a life-threatening emergency and an ambulance could not get to the family quick enough. – from CAPPA
Lactation educators fill an important function in educating and supporting families interested in learning about breastfeeding. This education may take place in the public, hospital, clinical or private setting. Lactation educators provide informational, emotional and practical support of breastfeeding. They may provide this service exclusively as breastfeeding educators, or may use their training to augment their support in other professions, in the cases of doulas, childbirth educators, nurses, dieticians, and postnatal or parenting educators. In addition to providing breastfeeding information, lactation educators offer encouragement, companionship, an experienced point of view, and foster confidence and a commitment to breastfeeding.
Breastfeeding education is not restricted to new families, but applies to the general public and medical staff as well. Due to the limited breastfeeding information given in standard medical and nursing training, and the rampant misinformation about breastfeeding that is so prevalent in our society, the breastfeeding educator serves as a resource for accurate, evidence-based information to the public and health care providers, as well as to childbearing families.
CAPPA does not issue Certified Lactation Consultant status, nor does the lactation educator program qualify a member to dispense medical advice, diagnose or prescribe medication. However, lactation educators provide a wealth of information about how and why to breastfeed; establishing a breastfeeding-friendly environment; basic breastfeeding anatomy and physiology; the normal process of lactation; deviations from normal; physical, emotional and sociological barriers to breastfeeding; overcoming challenges; and resources available (including medical referrals) for the breastfeeding family. They can also be a source of vital support, guidance and encouragement throughout the duration of breastfeeding. -from CAPPA
IBCLC (Lactation Consultant)
International Board Certified Lactation Consultants (IBCLCs) have demonstrated specialized knowledge and clinical expertise in breastfeeding and human lactation and are certified by the International Board of Lactation Consultant Examiners (IBLCE).
This Scope of Practice encompasses the activities for which IBCLCs are educated and in which they are authorized to engage. The aim of this Scope of Practice is to protect the public by ensuring that all IBCLCs provide safe, competent and evidence-based care. As this is an international credential, this Scope of Practice is applicable in any country or setting where IBCLCs practice.
IBCLCs have the duty to uphold the standards of the IBCLC profession by:
• working within the framework defined by the IBLCE Code of Ethics, the Clinical Competencies for IBCLC Practice, and the International Lactation Consultant Association (ILCA) Standards of Practice for IBCLCs
• integrating knowledge and evidence when providing care for breastfeeding families from the disciplines defined in the IBLCE Exam Blueprint
• working within the legal framework of the respective geopolitical regions or settings
• maintaining knowledge and skills through regular continuing education
IBCLCs have the duty to protect, promote and support breastfeeding by:
• educating women, families, health professionals and the community about breastfeeding and human lactation
• facilitating the development of policies which protect, promote and support breastfeeding
• acting as an advocate for breastfeeding as the child-feeding norm
• providing holistic, evidence-based breastfeeding support and care, from preconception to weaning, for women and their families
• using principles of adult education when teaching clients, health care providers and others in the community
• complying with the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolution -from IBCLE
A pediatrician is a child’s physician who provides:
- preventive health maintenance for healthy children.
- medical care for children who are acutely or chronically ill.
Pediatricians manage the physical, mental, and emotional well-being of their patients, in every stage of development — in good health or in illness.
Generally, pediatricians focus on babies, children, adolescents, and young adults from birth to age 21 years to:
- reduce infant and child mortality
- control infectious disease
- foster healthy lifestyles
- ease the difficulties of children and adolescents with chronic conditions
Click here for more information about the Physicians and Staff at the University of Maryland Children’s Hospital.
Pediatricians diagnose and treat:
- genetic defects
- organic diseases and dysfunctions
But, pediatricians are concerned with more than physical well-being. They also are involved with the prevention, early detection, and management of other problems that affect children and adolescents, including:
- behavioral difficulties
- developmental disorders
- functional problems
- social stresses
- depression or anxiety disorders
Pediatrics is a collaborative specialty — pediatricians work with other medical specialists and healthcare professionals to provide for the health and emotional needs of children. – from UMM (I could find no concise scope of practice definition on the AAP website but here is their Scope of Practice Issues in the Delivery of Pediatric Health Care)
Doctors of Chiropractic
Since human function is neurologically integrated, Doctors of Chiropractic evaluate and facilitate biomechanical and neuro-biological function and integrity through the use of appropriate conservative, diagnostic and chiropractic care procedures.
Therefore, direct access chiropractic care is integral to everyone’s health care regimen.
Doctors of Chiropractic, as primary contact health care providers, employ the education, knowledge, diagnostic skill, and clinical judgment necessary to determine appropriate chiropractic care and management.
Doctors of Chiropractic have access to diagnostic procedures and /or referral resources as required.
B. CASE MANAGEMENT
Doctors of Chiropractic establish a doctor/patient relationship and utilize adjustive and other clinical procedures unique to the chiropractic discipline. Doctors of Chiropractic may also use other conservative patient care procedures, and, when appropriate, collaborate with and/or refer to other health care providers.
C. HEALTH PROMOTION
Doctors of Chiropractic advise and educate patients and communities in structural and spinal hygiene and healthful living practices.