Finding the Right Doctor for Your Prenatal Care and Delivery
This is your body and your baby. Having a baby is a really personal and very emotional experience. You don’t just want anybody to be in the driver’s seat for this experience. When you are pregnant, you want to put the health and well-being of you and your unborn infant in the very best of hands.
However, the decision you make in the doctor or other professional that will care for you through your pregnancy, will usually also determine how your delivery will go. This is not a decision to take lightly.
Most women simply continue with their OB/GYN (obstetrician/gynecologist) when they find out that they are pregnant, not realizing that this means that they have a hospital delivery in their future, and not necessarily with the doctor treating them at each appointment.
Medical doctors don't do home births and they don't deliver in birth centers, if you go with a medical doctor for your prenatal care, a hospital birth is on the horizon and you doctor will already be expecting it. Also, most doctors are on call at their local hospitals. When it's time to deliver, your doctor may or may not be working at that time. And even if they are, they most likely will not be there for your entire delivery.
If this is what you imagine for your delivery, then great! But what if it’s not?
Until you know all of the facts, and what all of your different options may be for prenatal care and delivery, you may want to consider doing your research and keeping your options for a provider open.
What do you think is the most common place to give birth?
These are medical doctors that received a medical degree along with a specialty in women's health, pregnancy, labor, delivery, and gynecological issues. They are trained to view pregnancy as a medical condition, and have a medical solution for everything from "infertility" to a wrapped umbilical cord, to help you through the entire process from conception to holding your new baby in your arms.
These professionals generally deliver babies in hospitals and have very clearly defined methods, using modern day medicine and technology, for handling any situation. They expect you to put your full trust in their expertise, even if they were not the doctor that was originally seeing you, to make all decisions regarding your care and the birth of your baby when you are in their hands.
The care of a doctor generally includes regular visits, regular ultrasounds and bloodwork, medication if needed, a hospital birth, and possibly emergency treatments and surgeries like genetic testing, glucose testing, an induction, an epidural, an episiotomy and even a cesarean section. All or most of their care is typically covered by your insurance provider and therefore will cost you little to nothing for your prenatal care.
These individuals are trained health professionals in the specific areas of maternity care, labor, delivery, and postpartum care. There are many types of midwives. Certified Nurse Midwives (CNMs) are registered nurses with graduate education in midwifery. Certified Midwives (CMs) have a Bachelor’s degree with graduate education in midwifery. Certified Professional Midwives (CPMs) having training in midwifery and had to pass a certification test. They had a little medical training, but not much.
Midwives offer labor and delivery services in your home, in birthing centers, and in hospitals, although CPMs can only practice in your home and may not prescribe or administer medications.
They have been trained to view pregnancy as a human condition. They believe that your body can conceive naturally, that it knows how to function during pregnancy and care for a developing infant, and that you can even labor and deliver all on your own without intervention.
Midwives typically do not use medicine if not necessary, will try to avoid any unneeded interventions, and are simply there to guide and support you through the process of pregnancy, labor, and delivery naturally.
Services and Insurance
In some states, if you choose to deliver in the hospital, they can be the one that actually delivers your baby. In others, they can only be your support system, and can ensure that you are treated fairly and that nothing happens that you don't wish to happen. They are there only as an advocate for you. However, in other states, midwives are not allowed in hospitals at all. You will have to check your state or hospital regulations.
Most of the time, midwives are used to deliver in birthing centers or in your home. CNMs can prescribe and administer fluids and medications if they are needed. What you can expect from a CNM is in-office or in-home prenatal visits, regular measurements and heartbeat checks, and more of a therapist kind of environment where you are welcome to ask questions. They also offer diagrams, helpful books, advice, and sometimes even birthing/nursing classes. CNMs are usually covered by your insurance, and any ultrasounds would be contracted out. The birth is generally only covered if you birth in the birthing center, but an at home birth would be a typically reasonable out-of-pocket cost.
CMs and CPMs, though their care can look very similar, cannot prescribe or administer fluids or medications. They are not covered by insurance generally because they are not a medical professional, and would require a full out-of-pocket cost for their services. Every midwife is different in how they charge, and you can usually make payments. Any labs, medications, or ultrasounds would be contracted out, and your birth is generally an at home birth. Although they are not medical professionals, they are very skilled and very knowledgeable. If anything were to happen, you would have a plan in place for a local hospital.
At one point in time, giving birth in a hospital meant being shuffled from room to room several times through the process for situations such as checking in, laboring, delivering, and even postpartum care. In some hospitals, this is still the case. However, hospitals are evolving and updating their facilities to better care for and comfort the women in their care. In some hospitals there are only a couple of rooms, and many others, just one for the whole process.
Where hospitals used to immediately whisk the new baby away from its mom to care for it in a separate nursery, many hospitals now care for infants right in the same room with the mother, also allowing the babies to stay there close to mom in a crib. Hospitals are also now providing private bathrooms, areas for family to stay and sleep in the room with the mother, and many even provide an option of using a midwife when you are admitted.
However many things have not changed in hospitals. A mother admitted to the hospital for delivery is still placed on her back in a hospital bed under bright florescent lighting, she is given an IV in her arm, and she spends the next day or so laying on her back while laboring without the option to eat or drink throughout her labor.
If anything goes wrong, or doesn't go as the doctor had planned, medications and a variety of technologies come into play that may be out of the laboring mother's hands. Some of these include pitocin for inducing labor, tocolytics to slow down or stop labor, an epidural to relieve the mother's pain and calm her down, an episiotomy, forceps, or a vacuum to aide in delivery, a C-section to rescue a baby or mother in distress, etc.
Many women find that once they enter the hospital, they lose all abilities to make choices for themselves and their babies. However, there have also been many good stories from women that trust their doctors implicitly and are willing to go along with whatever is recommended during their stays. It would be wise to talk to a variety of women that are choosing to use your considered doctor and hospital before making a final choice.
A birthing center is essentially a cross between a hospital and your home. It is a professional health facility run by midwives providing a safe place for pregnant women to come for regular prenatal visits and when it comes time to deliver. This building is usually laid out like a hospital with a front desk and individual rooms for each woman, with the atmosphere of a personal home with more muted colors, rooms that look like your bedroom, and softer lighting.
Due to being run by midwives, the goal of any birthing center is to make women and their families comfortable, and to give each woman the birthing experience she desires. Many times this leans towards a more natural birth without medications, a great deal of fetal monitoring, and ultrasounds.
Birthing Centers tend to offer many ways to help a natural birth along including birthing balls, bath tubs for warm baths, birthing pools for water births, and the option to help birth along with walking or other more personal ways between husbands and their wives.
They do however have the option of medications and other medical interventions if desired. And if there is an emergency that cannot be fixed by a midwife, they usually work closely with a doctor and a hospital nearby where you can be taken. The idea is to give you more hospital-like service in a more comfortable home-like environment.
This is just about the most personal and intimate way to give birth, if you are comfortable giving birth in your own home. You are in your own environment, with your own food, personal comforts, and family. And most importantly, you are always in control of every decision made about the care of you and your baby.
For this option, much of labor is done before the midwife even arrives, giving you the ability to handle contractions and ways for helping along labor. Your midwife can be reached over the phone for support and encouragement if needed, but she generally arrives just before the baby comes.
You can choose the place, the position, and the way you would like to labor on your own. Many couples choose to light candles and play soft music. Most home births do not include medicines or IVs, much fetal monitoring, or any ultrasounds on the day of delivery.
Midwives will normally bring handheld devices to monitor the baby's heart beat intermittently though and make sure everything is on track. If an umbilical cord gets wrapped or the baby is facing the wrong direction, a midwife can simply fix it on the spot. However, if there's an emergency she cannot handle, she usually has a relationship with a local doctor and hospital where the mother and baby can be taken.
Many women fear home births because they are worried about complications that may arise, however the midwife has been specifically trained to handle just about anything that could happen. The likelihood that a laboring mother or infant need to go to the hospital during a home birth, on average, are lower than 2-3%, and the instance of mother or infant fatality is way lower than that.
If desired, newborn treatments and vaccinations can be given on the spot. But generally moms choosing homebirths would have declined those options anyways. The umbilical cord is cut, the baby is weighed, the placenta is checked out, and the midwife does everything natural that would be needed during any other delivery to make sure that baby and mother are safe before leaving.
Then for 6 more weeks, the midwife will come back to check on mom and baby and make sure mom is healing and baby is developing accordingly.
The debate between hospital, birth center, and home had been a long one. Do you lean towards the security of trained doctors and modern medicine, or for the personal experience of natural childbirth in the privacy of your own home? How this question is answered will be different for everyone.
And it doesn't even have to be either or with all of the options available to women now. You could see a OBGYN for your prenatal and birth at home. You could see a midwife for your prenatal and still choose to birth in the hospital. At any given moment in history any one of these was your only option, but there is no reason now that you should be forced into any choice you're not completely comfortable with.
Before you make a decision though, consider the pros and cons of each one. Talk to other women that have birthed at home, in a birth center, or in the hospital. Talk to moms that have had experiences with different doctors and different midwives for a more thorough perspective. Read a few books. Although you can change your mind at any time throughout your pregnancy, you'll want to have the right doctor by your side throughout the process.
And anytime you start to feel uncomfortable or not treated right, leave. The person you choose to care for you during this critical time should be someone you trust. If your provider is not making it easy to trust them, find someone else right away, even if you are weeks or days from delivery. It might mean the difference between a positive and negative birth experience.
Good luck! I'd be willing to answer any questions you might have if you'll just ask.
© 2014 Victoria Van Ness