Congratulations on your pregnancy! Once you see that positive test, it’s time to start thinking about finding the perfect provider for you and your baby. For some women, this is something that has been done long before conception, but for many, this big decision often takes a back seat to picking out cribs and strollers. However, choosing a provider whose birth philosophy matches your own is crucial in having the birth experience that you want.
There are several different types of providers that care for expectant women, each with a different skill set, philosophy, and model of personal care before, during, and after birth.
Midwifery care is based on the idea that pregnancy and birth are normal, physiological processes in the body and should be treated as such. Women who are low risk or no risk (about 85-95% of women) benefit greatly from the care of a midwife. With midwifery care, pregnant women can expect prenatal visits that range from 30-60 minutes, during which they will assess the well-being of mama and baby, discuss ways to stay healthy including exercise and nutrition, and thoroughly discuss any questions or concerns. Midwives typically have lower rates of intervention including cesarean birth, anesthesia, continuous fetal monitoring, and induction of labor.
There are different types of midwives, whose training process and certification and/or licensure differ from one another.
Certified Nurse-Midwives (CNMs) practice primarily in the hospital setting, usually within a group practice. CNMs in Minnesota are able to practice out of hospital at home births or birth centers. Certified Nurse Midwives have education in both nursing and midwifery and are licensed with state and national organizations. CNMs who practice in hospitals are able to order pain medications and interventions during birth if requested or medically indicated. CNMs often have physicians readily available to them for consultation and referrals should a situation beyond their expertise arise.
Certified Professional Midwives, Direct-Entry or Lay Midwives attend births in homes and birth centers. The education path varies from accredited schools to direct entry, apprenticeship and years of study. The CPM credential is granted by the North American Registry of Midwives and requires a rigorous course of study and extensive clinical skills. CPM’s in Minnesota have the option to be licensed by the Board of Medicine. Many CPM’s work in conjunction with physicians when consultation is needed. In a home birth or birth center setting access to pain medications and some interventions may be limited, although all have back-up hospital transfer plans in place for medical emergencies.
Physicians are trained to deal with complications and diseases associated with birth. For women who are truly high-risk, care of a physician, either alone or within co-care with a midwife, is beneficial. While many physicians view birth as a normal event in a woman’s life, some tend to practice based on the medical management philosophy, which views pregnancy and birth as potentially pathologic (that something might go wrong). A physician practicing under this type of mindset is more inclined to practice preventive medicine. They may encourage testing, interventions, and medications to manage pregnancy and birth to detect problems before they arise. Prenatal visits with a physician typically last 10-30 minutes, during which women can expect assessment of themselves and the baby and discussion of questions or concerns.
There are two types of physicians that provide maternity care: family physicians and obstetricians/gynecologists (OB/GYNs).
Family practice doctors attend births in the hospital and may work alone in a private practice or within a small group. Their training involves the broad spectrum of care from infancy through adulthood, so a family practice physician could care for both mother and baby. Although they have extensive medical training, family physicians typically only care for women with uncomplicated pregnancies.
OB/GYNs most often practice in large groups, attending births at hospitals. They provide preventative care for women from the childbearing years through menopause and are trained to diagnose and treat serious complications of the reproductive system. OB/GYNs are surgeons and are the only providers who are able to perform cesarean surgery.
It’s important to remember that these are general characteristics of care providers. Each individual provider, doctor or midwife, has a personal philosophy of pregnancy and birth, bedside manner, feelings about medications and interventions, and set of skills.
In addition to carefully choosing your individual provider, pay close attention to the hospital or birth center culture at the place you plan to have your baby, especially if you have certain goals (ex. a water birth or a birth without pain medications). Different birth options such as water birth are not available at all locations; even if a particular location allows a particular birth option, it may not be available with all providers at that location, so it is necessary to ask what each provider can offer you.
An important consideration is knowing the rates of intervention, such as episiotomy, cesarean birth, or hospital transfer with each provider or within the practice, rather than looking at overall rates of a particular birth setting.
While it is ideal to choose a care provider early in pregnancy, that decision doesn’t have to be set in stone. If at any point you feel as though you and your provider are not a good fit, you don’t like the answers you’re getting to your questions, or you just plain change your mind, look into other providers or places to birth. With the many options available you owe it to yourself and your baby to find the right provider for you.
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