Choosing a Prenatal Care Provider
I am five weeks pregnant. Can I choose whether I will see an obstetrician or a midwife? What are some advantages of midwifery care?Question:
In the U.S. today, in most communities, it is possible to choose the type of services you and your partner desire for care during preconception, pregnancy, labor and birth.
Even within most HMOs and insurance plans, there is some latitude for selecting between care by a physician or by a midwife.
Whether or not you decide to receive care from an obstetrician, a perinatologist, a midwife or family practice physician can depend on life circumstances -- some under your control and some not. For example, the office you visit may not offer a choice of care providers, or you may be "high risk" and midwifery care may not be appropriate.
Health care providers, regardless of areas of specialty, are committed to offering the best care to women, mothers and babies. The system works well when women are able to make informed choices about type of care and the type of practitioner.
More information on choosing a prenatal care provider:
In a study in the Journal of Nurse Midwives (Kennedy, 2000), some of the qualities that set midwifery care apart from obstetric care were belief in the normalcy of birth, exceptional clinical skills, judgment, and commitment to the health of women and families.
Women characterized the midwives who cared for them as calm, patient, confident, decisive, intelligent, mature, persistent, honest, compassionate, trustworthy, flexible, understanding and supportive, warm, nonjudgmental, gentle, nurturing, not focused on self, realistic, reassuring, soothing and possessing a generous and loving spirit.
Numerous studies have shown midwifery care to be safe, effective, and satisfying for women.
Obstetricians "direct" labor and birth. This is important for the significant number of women who require the care of an expert to manage abnormal conditions related to pregnancy. Women with preexisting medical diseases such as diabetes, or heart, liver or kidney disease need specialized care.
Even though the physician may collaborate with an internist or endocrinologist, the obstetrician is an expert at managing the pregnancy complicated by such conditions. If complications develop during the pregnancy, such as severe hypertension, pregnancy induced hypertension, multifetal gestation, uncontrolled gestational diabetes or fetal compromise, the care of an obstetrician is sought.
This medical specialist is an obstetrician who has additional board certification in the care of the high risk mother and fetus.
Frequently, perinatologists see women once or twice during a high-risk pregnancy and then consult with the obstetrician with a plan of care. If a woman has a fetus with a genetic or structural defect or if there is a problem with utero-placental insufficiency, care would be directed by the perinatologist. Specialized testing and even fetal surgery may be performed by such providers.
These sites contain valuable information about the array of choices in care:
-- American College of Nurse Midwives
-- The Maternity Center Association
-- The Midwives Alliance of North America
-- Citizens for Midwifery
-- Coalition for Improving Maternity Services