Choosing a Pregnancy Practitioner
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
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."