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Choosing a Pregnancy Practitioner

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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."

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