602 - OB, Midwife, or Doula?

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

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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 y