When I entered the world of pregnancy and birth back in 2017, I thought that there was one option for prenatal care: OBGYN.
Now, this is a great option, but that's just it, it is an option. As I have entered the birth professional world, in addition to having now 2 more pregnancies since then, a whole new world has been opened to me with regards to selecting a provider and how important it is to truly feel taken care of during these nine precious months.
Much of this information has been taken from the great book, Pregnancy, Childbirth, and the Newborn: The Complete Guide. (Stay tuned for my insight on this massive book next week on the blog, you can subscribe to my email list to get notified plus receive a free postpartum plan template when you sign up)!.
Why is Choosing a Provider Important?
Just as with any care that we are paying to receive, we want to make sure that we not only feel taken care of but also feel heard and respected. If you have one, two, or even forty questions that you want to ask, but never have the time or even feel like you have the time to ask them, that provider may not be the best one for you. If anytime you ask a question and it is just shrugged off with a reply such as "Don't worry about that honey, we'll take care of you," again they may not be the right provider for you.
Some of us may choose a provider based on reviews and opinions from our trusted family members and friends. For most of us we may just google OBGYNs or midwives and go with the closest person or the first one that pops up into the search results. While this may be okay, you still have the right to decide who you like and who is a good fit for you. That is why it is important to not only look at the different options that their are, but also what models of care are out there as well as what to questions to ask the provider when you first meet them to gauge whether you will feel taken care of and respected during your time seeing them.
Types of Providers
There are a few different types of providers that you can choose from for prenatal care. Some areas have all these options readily available, while others do not. Always do your research and ask other moms in the area by word of mouth or even in moms groups about what options are available.
Physicians-OBGYNs
-graduated medical school
-have training in obstetrics (surgical with a specialty focused on pregnancy, birth, and the postpartum period) and gynecology (medical and surgical treatment of diseases of women)
-most of their education focuses on the detection and treatment of problems
-must pass board certification administered by the American College of Obstetricians and Gynecologists (ACOG)
-delivery babies in hospitals
Perinataolgoists-OBGYN
-have further training and certification in managing very high-risk pregnancies and births
-referred to by other OBGYNs and midwives
-usually in major cities and medical regions
Midwives
Certified Nurse-Midwife (CNM)
-graduated from nursing school, is a registered nurse, then had additional training in midwifery
-practice is based on the midwifery model of care
-tend to spend more time in prenatal visits with their clients
-more individualized care
-will refer to OBGYN for any serious medical problems
-must pass the exam by the American College of Nurse-Midwives
-delivery babies in hospitals, birth centers, and at home
Licensed Midwives (LM)
-completed up to 3 years of formal training to their state's requirements
-practice is based on the midwifery model of care
-similar to CNM without a nursing background (not required)
-provide care for women planning births at home or in a birth center
Certified Professional Midwife (CPM)
-training is comprised of school, apprenticeship, and self-study
-practice is based on the midwifery model of care
-similar to LM (no nursing background required)
-must pass an exam administered by the North American Registry of Midwives
-delivery babies in birth centers and at home
Models of Care
There are two models of prenatal care: the medical model and the midwifery model. *
Medical Model: designed to replace or alter the body's own resources with medical and technological interventions.
It is based on these premises:
-natural childbirth is unpredictable, unreliable, and potentially unsafe.
-routine care protocols for all women give the caregiver a sense of control over the birth process
-medical interventions improve labor and birth
-c-sections are no less safe for the mother or baby than natural labor and vaginal birth: in fact, they may be safer
-caregivers use routine interventions before problems arise. If problems arise they intervene quickly with the tool most likely to have the quickest effect.
Midwifery Model: designed to maintain and enhance a women's physiological and psychological resources for giving birth.
It's based on these premises:
-birth is a normal physiological process and an emotionally transformative experience
-a women's state of mind influences the labor process, so individualized care is necessary
-a women's participation contributes to a healthy pregnancy, labor, and birth. Therefore childbirth preparation is necessary
-low intervention and c-section rates are desirable
-caregivers monitor the mother's and baby's well-being and provide education and support. If problems arise, they start with tools that cause the least intervention to regain a healthy physiological process.
*(Pregnancy, Childbirth, and the Newborn: The Complete Guide - 4th Edition - Simkin, Whalley, Keppler, Durham, and Bolding p. 18)
Questions to Ask a Potential Caregiver
Just because you have scheduled an appointment with a provider does not mean you need or must keep them for the duration of your pregnancy. You have the right to pick, choose, and keep your provider dependent on how you feel.
Here are some great questions to ask during your first meeting with the provider to see if you would like to stay with them or move on to a different practice or person:*
-Will I see you or another caregiver at each appointment?
-Does a nurse sometimes handle prenatal visits?
-Do the caregivers in your group share a similar philosophy of care?
-What are the chances you'll be at my birth?
-Will your colleagues respect the birth plan I've made with you? Will the hospital staff?
-Do you recommend childbirth preparation classes? Doula? Birth Plan?
-What do you think of trying for natural childbirth and how do you support this approach?
Do you use non-drug ways to relieve labor pain and avoid routine interventions if possible?
-How many of your clients attempt natural birth? How many succeed?
-How often do you use interventions (IV fluids, induction, episiotomy, forceps, etc)?
-How often do you find it necessary to perform an unplanned c-section birth with a first-time mother having a low-risk pregnancy?
How many of your clients have a c-section? (low risk vs high risk)
-What can I do to help reduce the likelihood of needing a c-section?
-If I develop complications during pregnancy or labor, will you manage my care or will you refer me to another caregiver? Who is that person?
-When and how often will I see you for checkups after birth?
(Pregnancy, Childbirth, and the Newborn: The Complete Guide - 4th Edition - Simkin, Whalley, Keppler, Durham, and Bolding p. 19)
Hopefully, this information will help you not only to decide on what type of care and provider you would like but also serve as an important reminder to feel listened to and respected by your provider.