How can I decide what kind of practitioner to see for prenatal care and childbirth?
As soon as you decide to try to conceive, you'll want to start looking for a practitioner to care for you during pregnancy and the birth of your baby. Whether you choose an obstetrician-gynecologist (ob-gyn), a family physician, a certified nurse-midwife (CNM), or a direct-entry midwife will depend on a number of factors, including what kind of experience you want, where you plan to give birth, whether your pregnancy is normal or high risk, and what your insurance will pay for.
Here are the primary considerations:
Do you have a serious chronic medical condition?
If you have a medical condition such as high blood pressure, epilepsy, heart disease, or diabetes, or had certain serious complications in a previous pregnancy, your pregnancy will probably be considered high risk. In this case, you'll need to see an obstetrician or possibly a maternal-fetal medicine specialist (a physician who specializes in high-risk pregnancies).
Be aware that if you start out with a midwife and develop a problem down the road – such as premature labor or preeclampsia – or find out that you're having twins, your care will be transferred to an obstetrician or perinatologist. (Depending on your condition and the practitioners' arrangements, you may be able to have a midwife and a physician handle your care together, if you like.)
Do you already see a practitioner you trust and feel comfortable with?
If you already have a good relationship with a certified nurse midwife, an ob-gyn, or family practitioner who provides prenatal care and delivers babies, you may want to stay right where you are.
But if you're unsure whether your current practitioner will respect your birth preferences, you have any other doubts about her or about giving birth at the hospital where the practitioner has privileges, or you're curious about other options, this is the time to look around for another doctor or midwife.
How important to you is a more individual, less routine approach?
If you're looking for a practitioner who is more likely to take a holistic approach to your care – and to see birth as a normal process, intervening only when necessary and not routinely – you may prefer a midwife.
Births attended by CNMs usually have fewer interventions – such as continuous electronic fetal monitoring, epidurals, and episiotomies – without any difference in outcomes for women or their babies. Women who opt for midwifery care tend to have a lower rate of cesarean section, too.
In general, midwives tend to have more time to answer all your questions and help you learn about the physical and emotional changes you experience throughout pregnancy. A midwife can also help you think about what kind of birth experience you want – and she'll support you in your decision. For example, a midwife will guide you through an unmedicated labor if that's what you choose, but an epidural will still be an option if you're giving birth in a hospital.
That said, there are some physicians who provide this kind of personalized care, too, and some midwives who may not, so find out as much as you can about the practices in your community. You may want to consider interviewing midwives as well as doctors before making your final decision.
What kind of setting do you want for your delivery?
If you have no health problems or pregnancy complications and you have your heart set on giving birth in a birth center or at home, you'll want to find a midwife who practices in these settings.
Birthing centers are usually staffed by CNMs. Birth centers are known for being supportive environments for having a natural birth without routine interventions and for welcoming anyone you'd like to have there with you, including family, friends, and siblings.
If you want to give birth at home, you can choose either a certified nurse-midwife or a direct-entry midwife to attend you.
On the other hand, if you want the option of getting an epidural, or you're very anxious about something going wrong during labor and delivery and don't want to chance having to transfer to a hospital, you'll want to be in a hospital from the get-go. For a hospital birth, you can choose an ob-gyn, a family physician, or a certified nurse-midwife as your primary caregiver.
What do most women choose?
Obstetricians are by far the most common choice in the United States, although certified nurse-midwives are becoming more popular: In 2006, CNMs attended almost 8 percent of deliveries in the United States and over 11 percent of vaginal births.
Some women choose practices that have both ob-gyns and midwives. And others opt for a family physician. (Not all family physicians continue to do obstetrics after their training, though, so you'll have to ask.) The most important thing is to choose someone you feel completely comfortable with, who's appropriate for your individual needs, who'll respect your wishes, and who practices in the right setting for you.