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- Location and insurance can limit your choices. Not all types of care providers are within a comfortable distance, and many insurance plans only cover certain types of caregivers. Home birth and care by someone other than a licensed doctor or midwife may not be covered. Find out about your plan. You can also ask your regular doctor for a referral to an out-of-network midwife if your HMO does not cover midwifery care.
- Where can this doctor or midwife practice? Practitioners typically have "privileges," or the right to admit patients and treat patients, at one or more hospitals or birthing centers. You'll want to match a care provider and a birthing location that you're comfortable with. When deciding where to have your baby, it's a good idea to ask about family-centered care: Does the facility offer water birth? Do they encourage immediate contact between mom and baby? Do they require a certain length of stay for the newborn in the nursery after birth? Do they have lactation services and support breastfeeding?
- What are the rates of episiotomy, cesarean, vaginal birth after cesarean and induction associated with this practitioner or birthing location? Cesarean rates above 15 percent or episiotomy rates above 20 percent are high, unless this doctor or hospital specializes in high-risk pregnancy. These rates could be a sign that care providers would rather go into surgery than manage your labor, are trying to rush your delivery along or may not be informed of the risk and benefits of these procedures.
- Besides the answers to these questions, you also need to know yourself. If you have preexisting medical conditions such as diabetes or kidney, liver or heart disease, you should seek care from an obstetrician or a perinatologist.
Any mom-to-be beginning prenatal care under a family-practice physician or certified nurse-midwife whose pregnancy turns high-risk should be comanaged by the original health care provider and an obstetrician through the remainder of pregnancy and delivery. This is sometimes necessary due to twins, breech presentation, severe pregnancy-induced hypertension or gestational diabetes not controlled by diet.