Choosing Your Care Provider
Note: the purpose of this article is to help inform only. This is not to prescribe, diagnose, persuade, or otherwise give any medical advice. I am a doula, and doulas are non-medical professionals. If you have any questions about anything regarding your medical care, please reach out to your medical provider.
No doubt, bringing a child into the world is an intimate experience full of twists and turns. From the very beginning of pregnancy, we are confronted with myriad decision making points: which prenatal vitamin do I take? What kind of classes should I attend? Should I co-sleep with my baby or sleep train them? Do I want to give birth at home, a birth center, or in a hospital? The list goes on and on.
One of the first and most important decisions we are faced with is choosing a medical care provider. This role is unique to your pregnancy and birth, unless you are working with a family care doctor who also specializes in obstetrics (more on this later). While you and your family are the directors of your own experiences, who you have as your provider can impact your journey greatly. They will be the one you see most regularly, who is responsible for guiding the health and wellbeing of both you and your baby. If you’re starting out at the beginning, here is a brief overview of each kind of provider
Certified Professional Midwife/Out-of-Hospital Midwife
Catches babies at home and at free-standing birth centers
CPMs are clinical professionals specializing in caring for people in their childbearing years. They attend births at homes and birth centers, and see their clients regularly throughout their pregnancy. Often, visits with CPMs are 30-60 minutes, wherein you are able to really get to know them and have your questions answered. They do all of the same standard care procedures like listening to fetal heart tones, measuring fundal height, checking blood pressure, and running important labs. Out-of-hospital midwives tend to be more knowledgeable in supporting physiologic birth, and can provide more in depth discussion and education. Midwives will also usually visit their clients 24-48 hours after the birth, again at 1 week, and again at 6 weeks. This is much more comprehensive than the “standard” 1 6 week visit. Midwives cannot perform c-sections, administer epidurals or IV narcotics, and usually choose not to repair tears that require advanced surgical attention. Midwives are equipped to handle standard birth emergencies, including active management of the third stage, neonatal resuscitation, episiotomy, and perineal repair . They also usually have access to IV fluids and nitrous oxide. Talk with midwives you are interviewing with to see what their standards of care are, what kinds of emergencies they are comfortable handling outside of the hospital, and what their transfer to hospital rate is.
PROS: More time and attention spent on clients; more focus on family-centered and physiologic birth; more receptive to individualized care; can attend births in out-of-hospital settings like homes and free-standing birth centers.
CONS: Cannot perform c-sections, administer epidurals or IV narcotics; does not have direct access to a NICU.
In Washington State, we are lucky to have midwives who have access to licensure. Because our state accepts CPMs as medical professionals, many of them take insurance, including Medicaid/Apple Health.
Certified Nurse Midwife/In-Hospital Midwife
Catches babies at a hospital, sometimes (rarely) at free-standing birth centers
CNMs are registered nurses (RN) who have additional schooling and certification in midwifery. They attend births most commonly in hospitals in tandem or separate from an OB practice, although occasionally some CNMs attend births out of the hospital. Some people find CNMs to be the “best of both worlds” approach, where they have the benefits of midwifery care (“less is more” approach, longer appointment times, more individualized care) and being in a hospital setting (access to OR, epidural anesthesia, and NICU). While they cannot perform c-sections, they can prescribe a full range of medications, including birth control. CNMs often work in a large practice, where the midwives share a call schedule or work in shifts. That being said, their practices are usually much smaller than a typical OB practice.
PROS: Midwifery model of care while still being in a hospital setting; authority to prescribe medications (including medicines to start/augment labor); almost exclusively females working in the practice; benefit of having a midwife who also has the experience of an RN.
CONS: Still in a hospital setting, so clients wanting a more “natural” feeling midwife may not get it; sometimes if the practice is full they will send clients to the OBs; work in shifts, so usually a patient can’t guarantee which midwife will attend their birth; cannot perform c-sections.
Family Care Doctor
Catches babies in a hospital
Family Care Doctors do not exclusively catch babies, but some do have additional training and credentials as an OB/GYN. They attend births in hospitals, but are separate from the hospital OB practice. Often, clients have been seeing their Family Care Doctor for years before they got pregnant, and can stay in their practice throughout their pregnancy and birth. This means they do not need to find an additional provider. They can do everything that another OB can do. The only difference is that families can see them beyond pregnancy and initial postpartum. Many are also the father’s doctor as well as the baby’s pediatrician.
PROS: Care for the whole family, sometimes including pediatrics; same privileges and scope of practice as an OB; can perform c-sections and prescribe medication; can see a patient from pre-pregnancy and beyond; may be more likely to give individualized care.
CONS: Often Family Practice Doctors are hard to get in to see, as they book up quickly and stay with their patients for longer.
Obstetrician
Catches babies in a hospital
OBs are medical doctors who specialize in pregnancy and birth, and usually also are gynecologists. They attend births in hospitals in usually a very large practice. OBs specialize in high-risk pregnancies, and have the capacity to perform c-sections, prescribe medicines, and handle birth emergencies. An OB is a good choice if you know you will need care for a high-risk pregnancy that needs more monitoring during pregnancy and birth, if you know you will likely need/want a planned c-section, or if you feel more comfortable working with a medical doctor. OBs tend to be most well-versed in births that require more medical intervention, so most do not favor or fully support physiologic, unmedicated birth. That is not a hard and fast rule by any means, but tends to be a common observation. OBs see patients throughout their pregnancies, often for visits as short as 15 minutes to check vitals and fetal heart tones. Since they work in larger practices, patients will often have 1 primary OB, but will typically see many (if not all) in the practice. They work on a shift schedule, so there is no way of guaranteeing you will have your primary OB when you come to the hospital to have your baby. They will typically only see a patient at 6 weeks postpartum. OBs sometimes work in tandem with Maternal Fetal Medicine specialists (MFM) for particularly complex high-risk pregnancies.
PROS: Can perform c-sections; prescribe medicines; perform surgical procedures like cerclage, 4th degree tear repair, hysterectomies, and external cephalic versions (ECV); are skilled at handling most high-risk pregnancies and birth emergencies; are medical doctors; work in a team of skilled medical professionals.
CONS: Tend to favor medicalized, intervention-based birth rather than physiologic birth; sometimes see birth as an illness or something that needs to be treated; can perform medically unnecessary c-sections or inductions; tends to favor a large amount of cervical exams and consistent fetal monitoring; short prenatal visits with emphasis on fetal health; only 1 6-week postpartum visit.
Asking the Good Questions
No matter if you plan on birthing in the hospital with an OB, or at a birth center with a midwife, or have plans change halfway through, your choice is vital to your wellbeing. Be sure to ask providers you are interviewing with questions specific to you and your ideal care, and be sure to note how they respond when you ask them. If you find yourself in a place of needing care from one type of provider but wanting another, but sure to let your provider know and see what options you have. You deserve to have a birth experience most like the one you desire, no matter who your provider is. Above all, be sure you feel heard, respected, and have ample opportunities to ask questions, have discussions, and make informed choices. Your providers are there to care for you! And with any decision made for your pregnancy and birth, it is better to know all your options and make a choice that best suits you and your unique story.
