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Choosing a Pregnancy Practitioner

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Obstetricians: Skill in High-Risk Cases, and Often More

Debbie Hall, 40, has five children, and all of them have been delivered by an obstetrician. Having been a respiratory therapist and witnessed some emergency births, she says she wouldn't dream of doing it any other way. "I just wanted to be certain that I was going to be under the best care and that the doctor I chose had the skill to handle an emergency," Hall says. Her wish list did evolve, however, to value bedside manner as much as skill, and when she moved to Irvine, Calif., before her fourth child was born, she found an obstetrician from church and PTA acquaintances who fit the bill.

"He asked questions not just about how I was feeling, but how my marriage was going, how the other children were -- it wasn't just walk in and walk out," Halls says. "He made me feel like I was the only patient he had that day." The doctor's skill and personal qualities were particularly important during her last pregnancy since test results showed a 1-in-50 chance of neural tube defects (such as spina bifida) -- a complication that had caused her to miscarry years earlier. Her doctor spent considerable time explaining what the results meant and weighing her options, and although the baby turned out healthy, her peace of mind throughout the pregnancy remained in check.

Obstetricians' four-year medical residency prepares them to treat a full range of conditions -- they have special training in prenatal care, labor, birth, high-risk pregnancy, and surgery. They are typically certified by the American Board of Obstetrics and Gynecology, and some get advanced training in a subspecialty like infertility (called reproductive endocrinologists) or high-risk pregnancies (called maternal-fetal specialists or perinatologists). Obstetricians typically resort to more technology, drugs, and surgical techniques than family physicians or midwives, but frequency rates for intervention procedures such as epidurals and cesarean sections vary by provider and institution. Obstetricians also are becoming more flexible, particularly in competitive markets, to support nontraditional requests from couples, such as the use of music, different childbirth positions, and doulas, says. John Larsen, MD professor of obstetrics and gynecology at George Washington University.

Midwives: The 'Girlfriend' Approach

A full year before she even got pregnant, Holly Sanders, 38, knew she wanted to deliver at The Maternity Center, a freestanding birthing center staffed by midwives in Bethesda, Md., after hearing about friends' experiences there. "Initially it was sort of a gut-level reaction," says Sanders. "I knew I wanted to have natural childbirth, and I've always found hospitals off-putting. I felt like birth was not a sickness but a beginning, and my own comfort level was being in a birthing center with midwives and the hominess that environment offered."

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