This is the first chapter of our free ebook Your Best Birth: Providers, Plans, and Being Proactive.
One of the best ways to ensure that your prenatal care, birth, and postpartum care go well is to find a pregnancy provider that you like, respect, and trust.
This is often easier said than done. Insurance, location, health issues, and other factors can limit your choices, so it’s best to approach this article through your own individual lens.
The first thing to keep in mind is that most obstetric practices in the US today work on an on-call schedule. This means that there is no guarantee that the person you see for your prenatal visits will also be the person present throughout your labor and delivery. For this reason, feeling safe and comfortable with both your individual provider and their general practice can can help you have a happier pregnancy and calmer birth.
Advice from an expert
To help you choose your prenatal care provider, we spoke with Emma Clark, CNM, a certified nurse midwife in Washington, DC.
Whenever possible, select your birth place first.
Often, says Clark, it’s more important to choose the place where you’re giving birth before you actually choose your provider, especially if you live in a place with multiple hospitals. Hospitals can vary widely in what they offer to birthing people, in terms of types of providers, level of care, and even the options within their facilities (Some hospitals have tubs and stools for labor, for example, while others don’t). Usually, a doctor will have privileges at one or more hospitals, which can affect if they can attend your birth there or not.
Schedule an interview.
You can absolutely interview a prenatal care provider before starting care with them. Make an appointment to see them in their office rather than in a clinical exam setting. After all, you’ll feel a lot more confident asking questions if you’re sitting with someone in your regular clothes, rather than a paper gown.
It’s important to know a little bit about what you want for your birth, says Clark, so you can make sure you and your provider are in alignment. This includes specialties, particular interests, (or things providers or hospitals don’t do), like vaginal birth after cesarean, multiples, and more. Ask lots of questions about issues that are important to you. For example, you might want to learn about your provider’s cesarean rate, approach to induction, thoughts on doulas and other support people, as well as their thoughts on pain relief options. Some of these things may be contingent on hospital policies, as well, so make sure that’s included in the conversation.
Ask lots of questions about issues that are important to you.
Don’t be afraid to share your hopes and anxieties with any potential provider, including past positive or negative experiences with pregnancy, reproductive or gynecological care. They should be open to discussing your individual situation and happy to share their perspective.
Use your community.
Chances are, you already have a provider where you’ve gotten well-woman care—your yearly exams, Pap smears, etc. Consider, though, that they may not be the natural choice to provide your obstetric care. Clark recommends that you do your research and ask around, as if you’re looking for a provider for the first time—you don’t have to stick with your normal gynecologist for birth: “They could be great in the office for well-woman care, but you may find they are not in alignment with your needs and wants for birth. If you can get some recommendations from someone, ideally a few different people in your community, that’s a good way to go to see who is out there and what they are offering.”
Do your research and ask around, as if you’re looking for a provider for the first time—you don’t have to stick with your normal gynecologist for birth.
More practices are offering monthly or quarterly “Meet the Provider” gatherings, where you can meet all of the people in a practice at one time. If you can attend, these are a great option for meeting people and getting the general vibe of a practice.
Listen to your intuition.
Along with feeling confident about their training, experience, and expertise, you should also get a good feeling from your provider. If something seems off, don’t ignore it. Think about their demeanor, body language, and communication style—doctors and midwives are busy people, but they should still strive to make you feel heard and respected, especially before labor begins. If you don’t feel in sync, do not be afraid to find someone else who you will feel better with. You can always change your mind, even after you have chosen a provider.
Remember that it’s a journey.
Pregnancy and birth are dynamic processes. Your feelings, ideas, wants, needs, and even your or your baby’s medical situation can change over the course of your pregnancy or labor. If things do change, it may affect who can provide care or your current provider’s approach.
Your feelings, ideas, wants, needs, and even your or your baby’s medical situation can change over the course of your pregnancy or labor.
As tricky as it may seem, try to stay open to the change and the experience it brings, both in developing a trusting relationship with your prenatal care provider/practice and in your own evolving ideas. For example, a provider who fits perfectly in the early days of testing and making it through the first trimester without puking everywhere may no longer be the best fit for you once you start considering your birth options and needs. Or, you may find the low-tech midwife practice may no longer work if you discover you’ll need a planned Cesarean.
Midwife or Doctor?
While the default provider for many people is an obstetrician, you do have multiple choices about your pregnancy and birth provider, including a midwife. Research shows that women who have a nurse midwife are less likely to experience an episiotomy (a cut made to widen the birth canal) and are more likely to breastfeed
The midwifery model of care is geared towards healthy, low-risk women. Midwives see pregnancy, labor, and birth as a normal biological processes that may or may not require intervention. Midwives also provide care and attention to the emotional, mental, and social aspects of the perinatal time period.
Individual doctors and midwives will have their own ways of practicing and working with their patients and clients.
The physician model of care is focused on preventing, diagnosing, and treating potential complications of pregnancy and birth. Physicians practice only in a hospital setting and can treat people with both low and high risk pregnancies.
These descriptions are generalizations, of course. Individual doctors and midwives will have their own ways of practicing and working with their patients and clients. You may find a doctor with a more holistic approach, or a midwife who practices more like a physician.
Other considerations include whether or not you have risk factors (like Type I diabetes or other health conditions). These may cause you to opt for a doc over a midwife or, as Clark noted, you can consider a collaborative physician/midwife practices where nurse-midwives can still provide the bulk of your prenatal and birth care.
The most common types of prenatal care providers practicing today in the United States.
A doctor trained in obstetrics and gynecology has completed medical school and a residency with a speciality in women’s health. They are trained and qualified to provide an array of reproductive and gynecological services, including cesarean sections. Some may specialize in other areas, like maternal-fetal medicine (MFM), fertility, or family planning. The vast majority of doctors practice exclusively in hospital settings.
Family Practice Doctors
Family-practice doctors are kind of like a combination of a primary care doctor, pediatrician, and obstetrician. They have completed medical school and residency with a specialization in family medicine. A doctor with a family practice can provide care to all members of a family throughout all life stages, from infancy to adulthood. Family practice doctors can, for example, provide prenatal care and birth care to a woman and then also give pediatric care to her baby. Family practice physicians mostly practice in hospitals—some are trained to do surgeries like cesareans, but some are not. They are more common in some areas of the US than others.
Nurse midwives, or certified nurse midwives (CNMs) are masters-prepared nurses who have completed both nursing school and an additional graduate degree in midwifery. They are qualified to work in all birth settings, including hospitals, homes, and birth centers. Nurse midwives can also provide other reproductive healthcare, like prescribing birth control. If you are birthing with a midwife in a hospital, you will still have access to physicians in labor, explains Clark.
Certified Professional Midwives
This type of midwife works exclusively in out-of-hospital settings like homes and birth centers. These midwives have completed coursework, an apprenticeship, and passed a national certifying exam to become a certified professional midwife (CPM). CPMs are licensed to practice in 33 states.
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