Chossing between an obstetrician, nurse, midwife, family care doctor and a direct entery midwife can be a major decision. This article provides you information to think about and questions to ask.
So you are going to have a baby. You have started thinking of names, checked on a crib and have been reading the do’s and don’ts of your pregnancy diet. Now is the time to pick a care provider. The choice between a doctor, nurse-midwife and lay, or direct entry midwife is a very personal one. In fact the choice can vary from pregnancy to pregnancy, so where do you begin ?
It is important to first sit down by yourself or with your partner and decide what is important to you. Do you want to have the baby at home, do you want to have as little intervention as possible or do you want the epidural hooked up from the first sign of a contraction? There are some desires that limit your choice of care providers, however, not as many as you would think. For example, it is possible in some areas to find a doctor that will attend a home birth. They are usually working with direct entry midwife.
If you know that you want drugs during the labor to ease the pain, chances are you are going to have to go to a hospital. That being said many nurse midwives can get a doctor to order the medicine and still deliver your baby. So how do you decide ?
After you have thought about what you want and don’t want to happen during your delivery the next step is educating yourself about the difference between different types of doctors and midwives and what kind of people each is prepared to serve. Usually there are two types of doctors you can choose for prenatal care: obstetrician and family care providers. Obstetricians are the most common choice for care providers during pregnancy. Often this is who a woman goes to for the yearly gynecological exam and they may have a relationship with them.
Some ob/gyn doctors have individual practices while other work in groups. Each has it’s benefits and drawbacks. If there is a single doctor you know that you will see the same doctor every visit. This puts a lot of women’s minds at ease, however, what happens if your doctor is unavailable when you go into labor? Often you will have to go to a doctor that you have never met. Many times, in these types of practices, there is nowhere to call after hours if you have a question.
If the doctor works in a group setting many times you will have a different doctor ever visit and you may or may not be able to pick a primary doctor. Even if you can choose a primary doctor many times, when labor starts you are going to have to see which ever doctor is on call. Often group settings have a doctor on call 24 hours a day to answer questions. Many group settings also have nurse practitioners who will see you most visits and often they are not qualified to answer all of the questions that may arise. Ob/gyn doctors are trained especially for childbirth and woman’s health issues, they are trained to watch for things that may go wrong. With this is mind it is easy to see why many feel that this type of doctor treats every pregnancy like a sickness. Not all ob/gyn doctors are like this and many are very liberal about what choices woman have. If there are any high risk factors such as multiple miscarriages, diabetes or irregular test results it is important that you find a obstetrician to manage you prenatal care.
Family practice doctors are trained in all around health. They may be who you see for routine physicals and when you are sick and they may be your child’s care provider. Family practice doctors can be in individual or group practice in the same manner as the ob/gyn doctors and those same strengths and weakness may appear. One benefit to a family care provider is that you may have a strong relationship to the doctor. You may feel very comfortable around them. This is very important in the delivery room. If you do not feel comfortable around the person delivering you baby you may become more nervous which could lead to a more difficult birth.
Family practice doctors are able to handle low risk pregnancies and some minor complications. If, during labor a major problem arises you would most likely have to see an obstetrician you may have little to no relationship with. That being said, it is important to keep in mind that during a major problem you are likely to be unconscious and even more likely to not really care if you have a relationship with the doctor, your biggest concern will be your baby. Even with a ob/gyn a high risk doctor may be brought in if a problem arises during labor.
A nurse midwife often works in a hospital or birthing center. Some certified nurse midwives will attend home births. A certified nurse midwife has attended nursing school to become an RN and then received even more training about birth. Nurse midwives are more likely to attend to you during your entire labor. Often, with doctors, you will see nurses until it is time to push. Nurse midwives are usually more open to natural childbirth options. Most nurse midwives have the philosophy that hey are there to help you deliver your baby. Nurse midwives almost always work in conjunction with a doctor and many times you will have met the doctor you would have to see if a problem arouse. They are usually available to answer questions more readily than a doctor. They are not able to deliver if there are any complications or risk factors.
Many people like the security of knowing there is a doctor “around the corner” if he/she becomes needed. A nurse midwife is able to provide, in a sense, the best of both worlds. This is especially true if they work in a birthing center that is designed to make you feel at home.
Direct entry midwives are a very reliable option. Some doctors will tell you that it is dangerous to have your baby at home and if you agree then there is no reason to have your baby at home. If you do not, please do not let someone scare you out of your decision. These women receive training from other midwives usually as an apprentice. It is important, however, to check the training of any lay midwife. In many states direct entry midwives are tested for knowledge. They have to show they have attended a certain number of births and have many hours of training. If you live in a state that has these requirements make sure that your midwife is certified. If you meet a midwife who has the attitude they can handle any situation and they would never go to the hospital turn the other way and run. While it is true that many women have had their babies at home for centuries, the hospital is a benefit of living in modern times. While I do not believe all or even most births need to take place in a hospital, problems do arise and your midwife has to be able to acknowledge that they may need to bring you if an emergency comes up.
Almost all direct entry midwives will take your calls with questions day or night. In states where direct entry midwives are illegal it is still possible to find qualified people. Many midwives in these states have gone to states where they can be certified in order to receive their certification. It is very important you make sure your midwife has had years of training. If she tells you she has been a midwife for a year move on. Most women apprentice for years before they begin to practice on their own.
The last step is to talk to many providers. Interview them. Most doctors and midwives will let you schedule an interview meeting for free. If they won’t they probably are not what you are looking for to begin with. Ask them where you would deliver your baby. Tour the facilities. Do not settle on the first person you talk to just because you didn’t not like them. If you are unsure what you want talk to different types of providers at the beginning. Ask to speak to some of their clients. It is most important that you feel comfortable during your delivery. If someone is not answering all of your questions or not letting you express how you want things done, switch providers, even if it is one month before you deliver. Remember you (and your partner) are having the baby and you need to be somewhere you are respected and comfortable.
By April Adams
