When you’re searching for a healthcare provider to help you navigate pregnancy and delivery, you might find that the world of prenatal health care can be complex. In this “How To” post, we’ll discuss the different types of healthcare providers that can guide you through your pregnancy and delivery.

What type of provider will care for you during your pregnancy and deliver your baby?

You have several options, including:

• An obstetrician: A physician trained in prenatal care, labor, and delivery. An OB can usually work with high-risk pregnancies and is trained to perform cesareans. This is the type of provider chosen most often by women in the United States.
• A certified nurse-midwife: A registered nurse who receives special training in women’s health and is certified to care for women from puberty through menopause. Midwives provide prenatal care and deliver babies, but usually do not work with high-risk pregnancies and cannot perform surgeries. CNMs delivered 8 percent of babies born in the US in 2009, according to the American College of Nurse-Midwives.
• A direct-entry midwife: An independent midwife whose training can come from a variety of sources. While CNMs are registered nurses, DEMs are not.
• A doula: A person who accompanies you during labor and delivery to help with emotional support and serve as a labor coach. A doula is not a healthcare provider.

So which option is right for you? Closely consider your ideal birthing situation, and examine your preferences on the following issues.

With an obstetrician….

You’ll probably deliver in a hospital. That means that you’ll have access to fetal monitoring and other technology should a complication arise. Additionally, OBs are trained to perform a Cesarean section, if it is medically necessary or if you prefer to give birth this way. Some OBs perform C-Sections regularly, but this isn’t always the case.

If you decide an OB is right for you, ask….

• Which hospitals the physician is associated with. This will determine where you deliver your baby, so if you have a specific hospital in mind, be sure that the doctor you choose has delivery privileges there.
• The physician’s stance on different birthing methods. Physicians have differing opinions on vaginal births, water births, the use of doulas, and pain medication. Discuss your goals and expectations with all possible physicians in order to confirm that they are on board with your birth plan.
• The physician’s policy on C-Sections. What is the physician’s C-Section rate? How often are episiotomies (intentional incision in the vaginal wall) performed, and under what circumstances?
• Whether the physician is part of a group or solo practice. A group practice ensures that you will always be able to see a doctor, but also means that the physician on call when you deliver your baby might not be your usual ob-gyn. A solo practice guarantees that you will see the same doctor at each visit, but scheduling an appointment may be a bit more challenging. If you decide to use a physician at a group practice, it may be a good idea to meet all of the ob-gyns in the group.

With a Certified Nurse Midwife…

You may be able to deliver in either a birthing center or at home. However, most certified nurse midwives deliver primarily in a hospital setting. If you choose to deliver at home, there may not be immediate access to the technology and emergency equipment provided in hospitals. Certified nurse midwives often place an emphasis on following the mother’s birth plan whenever possible.

If you decide a Certified Nurse Midwife is right for you, ask about…

• Your entire healthcare team. CNMs are associated with certain physicians that they partner with in the case of complications or emergency. Make sure that you meet your entire healthcare team so that you feel comfortable with everyone you might encounter during your prenatal care, labor and delivery.
• Their opinions on pain medication during labor. Which medications can they provide? Do they encourage you to make your own decisions regarding pain management?
• Their rate of transfer to OB care. Under what conditions would your baby be delivered by the physician? Be sure to ask about their C-section rate as well.
• Whether they perform episiotomies. Under what circumstances?

Direct entry midwives usually deliver in home or in birth-center settings. They don’t usually use a fetal-monitoring system, and serve more as a consultant and partner in the pregnancy process, heavily relying on the mother’s wishes.

If you are interested in having a doula assist you, be sure to ask your OB or midwife if they allow doulas in the delivery room. Some providers find that having an extra person in the room is a hindrance and don’t allow it.

Where should you deliver?

There are three options.

1) A hospital. If there are certain amenities that you are looking for in a hospital, be sure to check out which ones in your area offer them, and let that help narrow down your physician or midwife options. These amenities might include:

• Tubs for water-births, where the mother is able to deliver in a tub of water. Some women find this soothing and believe it is better for the baby.
• Rooming-in, where the infant stays in the room with the mother after delivery instead of in the nursery.

2) A birthing center. CNMs are usually the providers that deliver at a birthing center. This space provides more privacy and flexibility, as the atmosphere is meant to be relaxing, comfortable, and natural. Options at a birthing center might include:

• Birthing tubs or showers
• Large beds and areas where the family can be present for the delivery.

3) In-home. In-home deliveries are rare, but some CNMs, as well as DEMs, will deliver in your home. If this option is appealing, be sure to talk to your provider about emergency plans in case of complications.

What happens after you deliver?

Your baby will need several check-ups in the first few months after birth. Find a pediatrician. If you use an OB or CNM associated with a large practice, deciding on a pediatrician through the same group might be easier, but is not necessary. Check out our post on how to find a pediatrician.

You might also consider a lactation consultant. If you plan on breastfeeding your baby, a lactation consultant can be helpful. Deciding on one before delivery can relieve some stress after the baby is born.

Image provided by Meagan

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