Choosing who will help care for you during your pregnancy, labor, and delivery is very important. There are several types of health care providers who can care for your needs during pregnancy and childbirth. Be sure to explore your options and evaluate what is most important to you before making a decision.
Some obstetric health care providers to consider include:
- Certified Nurse Midwives (CNMs): Specially trained, licensed professionals experienced in providing obstetric and newborn care, CNMs provide comprehensive, family-centered maternity care from the first prenatal visit through labor, delivery, and after the birth of your baby. Midwives are registered nurses who have earned their master's degree in nursing, with a strong emphasis on clinical training in midwifery. Midwives work with obstetricians who are always available to assist if complications occur during pregnancy, labor, or delivery.
- Obstetrician-Gynecologist (OB/GYN): A medical doctor who is specially trained to provide medical and surgical care to women, OB/GYNs spend four years after medical school in a residency program studying pregnancy, reproduction, and female medical and surgical problems. To verify the credentials of an obstetrician, contact the American Board of Obstetrics and Gynecology. Specialists who mainly provide pregnancy care are obstetricians, while gynecologists primarily provide female reproductive system care.
- Perinatologist: Also called maternal-fetal medicine specialists, a perinatologist is an obstetrician who specializes in the care of women who may face special problems during pregnancy. These include women over age 35; women with certain medical conditions, such as diabetes, hypertension, and sexually transmitted diseases; women with inherited (genetic) disorders; and women who have had problems with previous pregnancies. Perinatologists manage high-risk pregnancies, preconception counseling, and sophisticated prenatal diagnosis and treatment.
- Family practitioner (FP): a medical doctor who specializes in the health care of all family members. Some FPs provide normal OB/GYN care, but will refer high-risk pregnancies and other problems to an OB/GYN.
- Doula: a person who specializes in helping families through the childbearing year. Doulas do not provide any clinical care, so they do not replace your obstetric health care provider. Generally, your relationship with your doula will begin during pregnancy. A doula can help you find the appropriate childbirth class, learn birthing techniques, write a birth plan, and more. Most doulas will provide early labor support at home, coming to your home and helping you while you are in labor before you are ready to go to the hospital or birth center. When you are ready to leave for your place of birth she will go with you, or follow in her car. Note: Most insurance providers will not cover the costs of a doula.
How Do I Choose a Health Care Provider for Pregnancy?
Choosing a health care provider for pregnancy depends on your level of risk for pregnancy complications. If you have high blood pressure, diabetes, or a history of previous pregnancy complications, are younger than 18 or 35 and older, you should seek care from a health care provider experienced in treating women with your type of medical condition, such as an OB/GYN or perinatologist. If you are at low risk for complications, your family practitioner or a nurse midwife may be right for you.
Once you decide the type of provider that best suits your needs, you will need to select one person in particular. You may want to schedule an introductory visit to meet with the health care provider you are considering and determine if you feel comfortable with him or her. Here are some questions to ask during your meeting:
- How long have you been in practice?
- When and where did you receive training?
- Are you board-certified?
- Do you have professional or patient references?
- Have you had any problems with your medical practice? To get this information, contact your state medical licensing board.
- What are your general philosophies about pregnancy, labor, and delivery? Think about how they fit in with your own beliefs.
- How many babies do you deliver per week?
- What is your cesarean delivery rate?
- How many children do you have?
- Are you in a group practice? If so, will I see every provider with whom you rotate during my doctor visits? Do I have a choice about whom I see and who delivers my baby? Note: If you choose a health care provider who belongs to a group practice, usually all the members of the group will see you during your pregnancy and one of them will be there for the delivery.
- Who will I see at each appointment?
- Will you be in town around my due date? Note that there are no guarantees that a specific health care provider will deliver your baby since no provider is available 24 hours a day; make sure you know the other providers in the practice or the providers with whom the doctor shares delivery responsibility.
- If I have a question, who do I call? Who responds to the calls? Do you accept questions via e-mail?
- Am I allowed to write a personal birth plan? Will it be respected? A personal birth plan is a written agreement between you and your doctor as to how your baby will be delivered. It gives the parents more of a role in the decision-making process; however, the plan is no guarantee that your birthing process will go as planned, because complications can arise. If there are problems, your doctor will make decisions based on what is safest for you and your baby.
- What is your policy on inducing labor if I go beyond my due date?
Another important thing to consider when selecting a health care provider is where you want to deliver. If you have a certain place in mind, you need to make sure that person has the appropriate privileges at that facility so he or she can deliver your baby there.
Choosing Where Baby Will Be Born
Like providers, there are many options to consider when choosing where your baby will be born. These include:
Hospitals: If you have already selected a health care provider, consult with him or her to find out where he or she delivers babies. Then consider the following:
- Is the hospital a reasonable driving distance from your home or place of work?
- Are hospital tours available?
- What standard procedures are done when a woman arrives in labor?
- Is there an anesthesiologist on duty in the Birthing/Obstetrics Unit, or is the anesthesiologist on call? This may be important if there is an emergency or if you want pain relief. It will take longer to get relief if the anesthesiologist must drive from home to get you the medicine versus if he or she is on duty at the hospital.
- Is there 24-hour staffing of Labor and Delivery by an OB/GYN?
- What is the nurse to patient ratio? According to the American College of Obstetricians and Gynecologists (ACOG), one nurse per two women during early labor, and one nurse per woman in the pushing stage of labor, is ideal.
- Is the hospital a teaching hospital? Will medical students or residents attend my birth? Can I limit this if I want to?
- Does the hospital have perinatologists or neonatologists on staff? Some hospitals do not have doctors who specialize in high-risk pregnancies (perinatologists) or pre-term babies (neonatologists).
- Does the hospital have a NICU? (Neonatal Intensive Care Unit, a place for babies born with complications and require critical care).
- Does the hospital allow "rooming-in"? Rooming in means the baby can stay with you in your room. Or, does my baby have to stay in the nursery? Can I have my baby stay in my room most of the time, but go to the nursery if I need help?
- Does the hospital have a one-room option in which I can be in labor, deliver my baby, and recover all in the same room? (Called a birthing room or suite).
- What are the features of the birthing or hospital rooms? Are birth balls, squat bars, or birthing chairs available?
- Are water births done at the facility?
- Is there access to a whirlpool/tub for women in labor?
- What is the hospital's cesarean rate? Epidural rate?
- Can my partner be with me at all times, including in the operating room, if I have a cesarean delivery?
- How many other people can I have with me?
- Can my other children attend the birth?
- Is videotaping allowed during delivery?
- What resources are available in the hospital? Is there a "new family" class to teach me how to care for my newborn?
- Will I be given a private room for my stay?
- Can my partner spend the night in my room after delivery? What type of sleeping arrangement is available for my partner?
- Is there a lactation consultant on staff? Will I automatically be scheduled to meet the lactation consultant?
- When can family and friends visit? Can children visit?
- Is parking free?
You should consider taking a tour of the hospital where your baby will be born well in advance of your due date. Taking a tour will help answer some of these questions.
Birthing Centers: Although most births take place in hospitals, more women are choosing to have their babies in other locations, such as a birthing center. Birthing centers, usually located near a hospital, allow women with uncomplicated pregnancies to deliver there. Most centers are run by certified nurse midwives or doctors. Be sure to research the staff's credentials when selecting a birthing center. Although rare, problems during labor and delivery can arise, so you'll want the best opportunity to get the best care. Be sure to ask what the procedure is for complications and emergencies, not only for your baby, but for yourself.
Home Births: Home deliveries, although common in most of the world, are relatively rare in the U.S. Most doctors will not agree to do a home delivery, nor will most nurse midwives. The reason is simple: Life threatening complications can happen fast during labor and delivery, and most homes are too far away from a hospital where emergency care can be provided.
If you have any questions about your birthing options, talk to the providers you are considering for your pregnancy care. They should help clear up any concerns you are having.