Finding the right health care practitioner for your pregnancy can be daunting. For maternity care you will want someone who has the same approach to pregnancy as you do. You need someone who will provide you with safe and effective care. If this is your first baby or you looking to change practitioners the choice can be overwhelming. We’ve created this guide to help your decision making.
Guide to Pregnancy Specialists
You want a professional who can care for you during pregnancy, delivery and postpartum period. You will most likely choose a carer who provide a model of care you are comfortable with. Check out your options:
Best for: A medical model of care
This is a medical doctor who specializes in pregnancy, birth and postpartum. They may a specialist in gynecology (OB GYN). To become an obstetrician a doctor needs at least 4-5 years’ experience specializing in pregnancy care. In total they will have 11-14 years medical experience. To practice the must be board certified by the American Board of Obstetrics and Gynecology (ABOG).
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Maternal-Fetal Medicine Specialist
Best for: High risk pregnancies or baby complications
This is an obstetrician who specializes in high risk pregnancies. These doctors are also known as perinatologist or high risk obstetricians. To become a specialist they need 2-3 years training in this area. In total they will have 13-17 years medical training. Some specialist will only perform consultations and others will be present at the delivery.
Family Practice Physician
Best for: Combination of medical and midwifery care
These are doctors who specialize in general family medicine. They can treat men, women and children of all ages. Family physicians can provide low risk pregnancy care and same may attend births. They will usually refer you to an obstetrician if there are any complications in your pregnancy.
Best for: Low risk care with minimal medical input and option of water or home birth
Midwives provide care for low risk pregnancies. They can also assist or refer to obstetricians for high risk care. Midwives focus on birth being a natural process in a woman’s life. There are two types of midwives in the USA:
Nurse Midwives (CNM) – These are nurses who specialize in pregnancy and delivery. They are certified by the state board and can practice in all states. They usually are hospital based but may also attend home deliveries with physicians.
Direct Entry Midwives – Also known as independent midwives. They promote no unnecessary intervention and natural birth. They are not nurse trained but do specialize only in low risk maternity care.
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Direct midwifery care is legal and accessible in the following states:
Alaska, Washington, California, Florida, Texas, Oregon, Montana, Idaho, Wyoming, Utah, Arizona, Nevada, Colorado, New Mexico, Missouri, Arkansas, Louisiana, New York, Minnesota, Wisconsin, Tennessee, Indiana, South Carolina, Jersey, Vermont, New Hampshire.
It is illegal for direct entry midwives to practice in the following states:
Alabama, Connecticut, Georgia, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Mississippi, Nebraska, Nevada, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Dakota and West Virginia.
Although not illegal to practice Hawaii and Delaware make it difficult for midwives to obtain a license.
How to Choose an Obstetrician or Midwife
When choosing a maternity care provider you need to find the best fit for your needs. You want to get the best out of your pregnancy experience. Book an introductory visit with a potential care giver and consider the following.
You need determine how much of a risk pregnancy is to your health.
Low Risk Care
Most women are fit and healthy with no health complications. This would be classed as a low risk pregnancy and offer the choice of midwifery or medical care. Some women opt for a combination of obstetrician and midwife or family physician. This ensures that you can be referred should your care change to high risk. Low risk pregnancies are suitable for delivery in a hospital, birthing center or at home.
High Risk Care
Women are those who fall into the following categories are classed as higher risk
- Chronic health conditions
- Raised BMI
- Had more than 4 children
- Under 18 or over 35
- Multiples (twins/triplets)
- Pregnancy/delivery complications (current and previous)
- Previous C-section
- Abnormal shaped uterus or pelvis
High risk pregnancies are best cared for by obstetricians or perinatologist. Specialized maternity care is out of the scope of practice for family doctors or midwives. Hospital is the best place to deliver for high risk women. This enables high levels of observation for both mom and baby. The right staff and equipment will also be readily available should an emergency occur.
The Care Package
Find out what they offer women by as a care package. Do they offer postpartum care as well as pregnancy and delivery? Do prenatal visits take place in a hospital, clinic or at home?
Your care provider may work as part of a team. Will you be seen by the same person at each visit? Ask if it’s possible to meet the whole team before deciding. If you considering a midwife or family physician, who would they refer to if high risk care was needed? If you want to use other care providers such as doulas or osteopaths find out how they feel about this. Are they supportive or dismissive of them providing support for you?
Ask if they have a schedule of prenatal appointments. You may also want to know how often then want you to have an ultrasound scan. It’s important to find out how to communicate with your care giver outside of appointment times. Find out who to call or can you ask questions via email?
It’s important to ensure that your insurance policy covers the type of care you are being offered. Some policies may not cover midwifery or perinatology care.
Having the same approach to pregnancy is a must for a good relationship with your caregiver. Friends or family may be able to give you recommendations. There may be some reviews online or a check of how many times they have been sued. It’s important you feel comfortable around them or the whole team. Ask them what their philosophy of care is and does it match yours. When you leave your appointment consider if they
- Seemed interested
- Explained things easily
- Respected your wishes
- Were open to questions
- Had good manner and didn’t rush
If the answer to any of the above is no, or you have a bad feeling then keep searching. You need to be able to communicate open and freely with your healthcare provider for the best care.
There may be issues which are important to you e.g. induction or VBAC. Ask them their own policies on this and how flexible they are. If it’s an issue you feel strongly about you should find a care provider who agrees with you.
If you are not happy with the caregiver you are with first address your concerns with them. If they can’t be resolved then so not hesitate to change your care to a more suitable provider.
You probably already have a good idea of where you would like to deliver your baby. Options include hospital, birth centers or home. Most deliveries by doctors will take place in a hospital. Midwifery deliveries usually occur in birthing centers or at home. Ask you provider which hospital or birthing centers they are affiliated with. Do they have a good reputation in the area?
Midwifery care will focus on you having a natural birth with minimal intervention and pain relief. If a doctor is present you can have a greater choice of pain relief. Midwives are often skilled in water births, so ask if they have access to a pool. Find out what sort of transfer protocol they have in place should you need medical assistance. Find out what emergency medication they can use during transfers?
Medical care will usually focus on extensive fetal monitoring and intervention. This includes drugs to start your labor or speed it up. If you want an epidural ask if they have a 24 hr anesthetist on call at the hospital. If an emergency occurs during labor or after they can perform instrumental cesarean delivery or surgical treatment.
Ask what kind of care is provided for baby after delivery. What kind of equipment do they have should a problem occur after delivery or baby is born early? Ask if there is a neonatal unit available in the hospital, this is particularly important for high risk pregnancies. Birthing centers will have baby resuscitators for midwives to provide resuscitation until they can reach medical staff.