Teamwork
One of the many decisions you need to make when you’re expecting a child is who will provide medical care during your pregnancy, the birth and postpartum. There are several options, including an obstetrician (OB), a family physician who includes obstetrics as part of the practice or a certified nurse-midwife (CNM).
You may wish to include a doula as well. You will choose where to deliver your baby, and you will have the option of creating a birth plan.
Choice of Providers
An OB is a physician who has been trained in maternity care and gynecology. This type of provider has completed a residency (additional training) after medical school that is specifically aimed at caring for women throughout their pregnancy, delivery and postpartum. Skills include routine prenatal care, high-risk maternity care and surgical interventions such as a Cesarean section (C-section). OBs often work in groups and share call with other physicians, and sometimes have nurse-midwives in their practices.
A family physician is trained to care for the entire family, and has completed a residency after medical school that concentrates on full-spectrum of care with long-term relationships with patients. Many have completed a fellowship after residency that provides additional skills in maternity care and delivery. Most obstetrics fellowship-trained family physicians are also able to intervene with a C-section, if needed, and can provide some high-risk care if they have been trained to do so. Some family physicians provide only prenatal and postpartum care, but do not deliver (in which case they will be associated with an OB group for the deliveries). They are also able to care for your baby after delivery.
A CNM has completed additional training after nursing education to provide prenatal care and labor and delivery. CNMs often allow for longer prenatal visits that include detailed education about what to expect during pregnancy, delivery and after the birth. Patients who choose a CNM are less likely to have a C-section.
A doula has training focused on continuous physical, emotional and informational support to an expectant mom before, during and after childbirth. Most doulas have completed a certificate program. They do not provide medical care.
Delivery Environment
Your preferences for birth, including the delivery environment, may be influenced by your pre-pregnancy beliefs, experiences and upbringing. Most women assume they will deliver in a hospital and do not discuss other options. In a hospital setting, women often have an intravenous (IV) line, continuous fetal monitoring, possible an epidural, and some restrictions regarding eating, drinking and movement during labor — whether they deliver vaginally or by C-section.
Some women may be interested in delivering at home, at a birthing center/home or at another nonhospital setting. Women who choose to have a home birth may do so because someone they knew had a positive experience or it has been how their family has traditionally delivered their children. Some women say they find delivering at home empowering and, even if they have to be transferred to the hospital, they would still prefer to start out at home with any future pregnancies.
What to Ask the Provider
Once you have decided what type of provider you prefer, you can get a list of providers from your insurance company. If you don’t have health insurance, be sure to ask about cost and payment plans. Next, compile a list of questions that are important to you. Sample questions follow.
• How many years have you been practicing? How many babies do you deliver each year?
• What is the likelihood that you will deliver my baby? What is your call arrangement?
• What happens if I have unexpected problem? Will there always be a provider available? Are high-risk physicians available?
• Are visitors allowed at my appointments and during the delivery?
• Are you open to birth plans and to my significant other’s involvement?
• With which hospital(s) are you associated?
• What are the policies and procedures for triage and labor and delivery units where you practice?
• What is your policy on a trial of labor after Cesarean (VBAC)?
• What is your policy on interventions if labor is slow or stalled?
• Will a lactation specialist be available after delivery?
Achieving a Smooth Birth Experience
Be sure to be bring up any personal beliefs or values that may guide your course of care, paying special attention to the reaction of the provider during the discussion. Childbirth classes will provide good information that may help you to become your own advocate. Ask your provider for information about various childbirth education classes that are available in your area. Examples include hospital-provided classes, Lamaze and the Bradley Method. Be sure to ask for information on options for pain relief during labor and accessibility to the Neonatal Intensive Care Unit (NICU).
Once you have made a plan with which you are comfortable, ensure that your provider supports your decisions and helps you feel confident throughout your pregnancy, which will make for a smoother, more enjoyable delivery experience. If you feel pressured at any time, be sure to address this issue with your provider. If you are unhappy with the response, consider changing your provider. Be sure to see several providers in the practice in case yours is unavailable during the time of delivery, and visit the location of planned delivery beforehand so you know what to expect.
Debra Danforth, MS, ARNP, FAANP, Associate Professor and Clinical Learning Center Direction, and Kayli Kapec, BS, Clinical Learning Center Coordinator, work with the Florida State University College of Medicine in Tallahassee.
