What is a Monitrice?

I’ve had a few inquiries about monitrice services in the past few weeks. People are rightly confused about the difference between a doula, monitrice, and midwife. In short, a midwife is your primary care provider during your pregnancy. A doula is a labor support person. And a monitrice is an interesting blend of these two roles.

A monitrice’s primary role is that of labor support. Just like a doula, a monitrice offers continuous, hands-on support during labor. Unlike a doula, whose scope of practice generally prevents her from providing any clinical services (by their certifying organizations), a monitrice will perform limited clinical assessments such as monitoring the baby’s heart rate during labor, mom’s vital signs, and assessing cervical dilation. This means that the monitrice is usually employed to labor with you at home–before going to the hospital. It would be very unusual for someone to hire a monitrice if they are planning a homebirth–I would imagine this would blur roles a bit.

That being said, some doulas will come and labor with you at home. But if your goal is to labor at home as long as possible, you may prefer the reassurance of the assessments a monitrice performs.

The best candidates for hiring a monitrice rather than a doula are first-time mothers and women planning VBACs (vaginal birth after cesarean), in my opinion. It can be very tempting to leave earlier for the hospital in both of these situations, and once you get to the hospital too early, you may very well find yourself confronted with interventions you were hoping to avoid. I’ve even heard an OB tell his patient, who was planning a VBAC after two cesareans, that if she showed up at the hospital before 7 cms dilation, her chances of success go downhill considerably. He practically sold my services for me.

There are few avenues of study for monitrices, and no widely recognized certification that I know of. Most monitrices are either midwives who do some doula work (like me), or apprentice midwives who have learned some clinical skills. You will want to ask specific questions about where your (potential) monitrice gained her clinical skills and what her practice guidelines are. For instance, it is all well and good to say that she monitors fetal heart tones during labor, but does she know how to do it properly and what she’s listening for?

I believe (because I am cynical like that) that some women may seek out a monitrice who is also a midwife with the intention to downplay how far along in labor she is and get a midwife for a doula’s fee. My contract is exceedingly clear: if, as your monitrice, I am forced to assume the role of midwife due to a quick birth, you will be charged my full midwifery fee. I have no intention of doing homebirths on the sly in this way.

Though everyone has their own pricing structure, my fees as a monitrice are higher than my doula fees. One reason for this is that it is more time consuming. As your monitrice, I am with you from the end stages of early labor through the first hour or so postpartum. When I’m your doula, I providing phone support, but only meet you at the hospital once you’re well into active labor. I see you more frequently prenatally–generally monthly until the last month, and then twice during the last month. Additionally, I am an IBCLC (international board certified lactation consultant), so you get a high level of breastfeeding support from me, including two postpartum appointments in your home. Most importantly, though, you are paying for my clinical experience in order to safely assess you and baby during the time we are together.

As I’ve said before, homebirth is not the right decision for every family–for a variety of reasons. But hiring a monitrice may help bridge the two worlds, so that you can increase your chances of having a low-intervention birth in the hospital.

Here are some statistics regarding utilizing doula services (which, naturally, translates into monitrice services):

  • 50% reduction in the cesarean rate
  • 25% shorter labor
  • 60% reduction in epidural requests
  • 40% reduction in oxytocin use
  • 30% reduction in analgesia use
  • 40% reduction in forceps delivery

http://www.childbirth.org/articles/stats.html (Admittedly, the primary source here is old, but there are more current studies to be found in a basic Google Scholar search.)

Update: I am no longer offering doula or monitrice services to anyone other than previous midwifery clients who transferred care to a planned hospital birth. There are many good doulas available in Denver. For more information see my Resources post.