Choosing a Pregnancy Practitioner
Midwives: The 'Girlfriend' Approach continued...
Nurse-midwives generally rely on less invasive methods of pain
relief and labor management than obstetricians. They use about 12% fewer
interventions, such as episiotomies, epidurals, and electronic fetal
monitoring, and their rate for cesarean sections was 8.8%, compared with 13.6%
for obstetricians, according to a recent study. Midwives also encourage couples
to make birthing plans, provide more hands-on care during labor, such as
massage, and teach women "that birth can be gentle, quiet, and
respectful," says Jan Kriebs, a certified nurse-midwife who practices with
physicians at University of Maryland Medical System in Baltimore. "It's the
woman's job to give birth and ours to support her."
Births by certified nurse-midwives also are considered safe for
most women. A nurse-midwife's limitations vary depending on experience, place
of practice, and arrangement with the consulting physician, but they generally
won't accept women with significant health problems such as heart disease or
insulin-dependent diabetes, and they don't normally handle multiple births
beyond twins. They also cannot administer anesthesia or perform surgeries, but
they do monitor patients carefully throughout pregnancy and childbirth, and
will consult with or refer patients to a physician if they need an epidural,
C-section, or other special medical care. A recent study of birth-certificate
data showed that infant mortality and low birth weights were about one-third
less common with nurse-midwives after adjusting for risk.
Family Physicians: Beyond the Pregnancy
They say the best way to find out about a doctor who delivers
babies is to talk to the delivery-room nurses, so when Laurette Platt, 38, a
labor, delivery, and emergency nurse in Fillmore, Utah, got pregnant, you could
say she was the horse's mouth. In fact, that's how she chose Brent Jackson, MD,
her own family physician, to deliver her fourth child, even though she had used
an obstetrician for her other children before moving to the small town. She
chose Jackson despite warnings from her last doctor to stick with an
obstetrician because she had hemorrhaged during her last delivery. The closest
obstetrician was 90 miles away.
"I'd sort of been brainwashed in nursing school and from my
previous pregnancy experience that I had to use an ob-gyn. But I had worked
with Jackson. I knew his skill. He's as skilled as any ob-gyn I've ever worked
with. And I saw how he good he was with his patients. He was willing to try
anything I wanted as long as it was safe for mother and baby. I requested not
to have an episiotomy (which is a cut made below the vagina to widen the
opening during delivery), and he didn't give me one."