Every pregnant woman needs an OB, right? Isn’t that what we do? We get pregnant, go to the doctor, and go to the hospital to have the baby. That’s the best way to manage a pregnancy, right?
Well, it’s one way to care for a pregnancy and birth. It is not, however, the only way. Women today have more options than ever before with regards to care for their pregnancy. Obstetrics, the most common choice for care, is a vitally important medical specialty for many situations. It comes as a shock, then, when people learn that it not the only option, nor is it the ideal for majority of birthing women. How can you know what provider is best for you?
Before Googling a list of local doctors or asking your friends about their experiences, take a look at the types of providers that are in practice. Each specialty has it’s own strengths, so not every specialty is right for every woman. Once you decide on the right type of provider for you, you can begin narrowing your search.
The majority of pregnant women in the United States today choose an OB/GYN for their prenatal and birth care. Most feel that a doctor is the best suited to handle anything related to the body, including birth. OB/GYN’s have a lot to oversee as medical professionals, especially since the nature of birth is so unpredictable. OB’s are trained in all possible pathology based complications during pregnancy, labor, and birth. They are also trained in management for those complications, with medical intervention and surgery being the primary solution.
Obstetrics and gynecology are both very demanding specializations of medicine, made moreso by the fact that they are the only specializations that are routinely combined under one practice. Both branches of OB/GYN (Obstetrics and Gynecology) are surgical specialties of medicine. Obstetrics specializes in high risk pregnancy, (women with preeclampsia, cancer patients, gestational diabetes, autoimmune conditions, etc.) pathology, and surgical birth. Gynecology is the specialty that deals with women’s reproductive health including endocrinology, surgical needs, and reproductive disorders.
Because obstetrics specializes in high risk pregnancy, its practice is very “hands on” with the labor process and this is referred to active management of labor. Obstetricians are trained to have as much medical control over their patient’s labors as possible and this is achieved through the use of procedures, medications, and surgery. Prenatal visits with an OB tend to be around 5-10 minutes each.
Together, OB/GYN is a combined discipline dedicated to the integrated medical and surgical care of women throughout their lifespan. OB/GYN’s tend to see pregnancy as a medical condition that requires intervention in order to be safe.
Midwifery is a unique specialization that is not well understood by the general population. The word “midwife” can conjure up images of everything from a medieval sorceress to a sub-par nurse. The reality is that the specialization of midwifery is intensely vital to the health of birthing women and their babies. Midwives are experts in normal (low risk) pregnancy and birth. They understand normal physiological birth so well that they can spot an abnormality long before it becomes a problem. Midwives practice with an essential combination of clinical skills and emotional support for the monumental life shift that comes with pregnancy.
The midwifery scope of practice is all encompassing for pregnancy and birth, meaning a midwife is a fully qualified care provider unto herself. Not only is the midwife qualified to care for women in pregnancy and birth, she is also qualified to do normal newborn care as well. (Obstetrics is trained solely in women’s care and the baby is the responsibility of the pediatric department). The World Health Organization recommends that all low risk births be cared for by a midwife, even in developed countries.
The Midwifery philosophy views labor and birth as a normal and uncomplicated life event that should only be interfered with if there is a problem. This is referred to as expectant management of labor. The midwifery model feels that birthing women are not sick, and pregnancy is not a disease, so a medical doctor is not necessary for low risk mothers. Midwives spend 30 minutes to an hour with their clients in prenatal visits, so they get to know the woman they are working with. Midwives can also provide well woman care throughout the entirety of women’s lives. There are a few different types of licensing for midwives, but they generally all operate with the same expectant management of labor approach.
- Certified Nurse Midwife (CNM) CNM’s have nursing degrees and they usually work in hospitals, though some CNM’s will attend home births. Some are surprised to learn that CNM’s are qualified to attend births where the woman has chosen to have medication. An OB is not necessary for medicated births unless a problem arises that falls out of the midwife’s scope of practice.
- Certified Professional Midwife (CPM) CPM’s are licensed through MANA (Midwives Alliance of North America), and the regulations for their practice vary by state. Most CPM’s attend home births and births in birth centers. CPM’s usually do not have practice rights in hospitals.
Family Practitioner (FP) Family practitioners will occasionally attend and do primary care for pregnancy and birth. FP’s will operate under a scope of practice similar to that of a midwife. Most practice expectant management of care, and if they regularly attend births, they will have hospital rights. Some will even attend home births.
There are more options than you thought right? So how can you choose the right type of provider for you? As you look around, keep a few things in mind.
- You are paying this person to provide a service to you. You are in the driver’s seat when it comes to your care and your choice of care professional.
- Your choice of care provider should be made thoughtfully and intentionally as it is the single greatest factor that will decide what kind of birth you will have. Say, for example, you are planning a natural birth. You can hire a doula, take all the classes, read all the books, do your positive affirmations, and be as prepared as possible for a natural birth. But if your doctor (who may be very nice) has an 86% cesarean rate and doesn’t like supporting unmedicated birth, the odds are still stacked against you. It’s better to find a provider whose approach is the same as yours than it is to try and change the mind of the doctor you have. You didn’t find the wrong doctor for you - you just may not be the best patient for that doctor.
- Finally, it’s never too late to change your provider. Doulas have known women who have switched providers in labor. (Good stories, I tell you!) If you are not comfortable with the provider you have for any reason, interview a couple of other providers. This birth is a once in a lifetime event. Having the right provider for you will be the single biggest factor that will determine what your birth is going to look like.
First, examine your own approach to labor and birth. Do you see pregnancy and birth as a normal life event? Or are you more comfortable with a specialist in all possible complications? Take a look at the philosophies of each practice and choose the type of provider whose philosophy aligns closest to yours.
Next, look up interview questions for your provider. You may want to print out a list like this one for midwives or this one for OB’s, and look through what is important to you. Not every question is going to be relevant to your situation, so filter through what matters to you and leave the rest.
- You may want to know if the provider is in an individual practice or a group practice.
- You may ask what their cesarean and induction rates are.
- Perhaps you’d like to know how long they plan to stay with you during labor.
- How many births have they attended?
- What complications have they seen?
- What tests to they require prenatally?
- What are their fees and do they take your insurance?
- How many women to they care for each month?
- Do they allow siblings to be present for a birth?
We as birth doulas are experts at knowing the providers in the area. We are glad to meet with you, discuss your desires, get to know you, and make recommendations based on your preferences. Since A Woman’s Design birth doulas have collectively worked with so many types of providers in several different settings, we know their practice style, bedside manner, and approach to birth first hand and we are glad to share that information with you.
Look up the providers you’d like to talk to and call to schedule an interview. Almost all providers do a complimentary initial visit. Make sure your partner comes along with you, as they should have a good relationship with your care provider as well. Then choose the one that suits you best.
Your choice of care provider matters a great deal. They are overseeing your safety during one of the most sensitive and vulnerable moments of your life: your birth. Make sure you choose carefully.