by Stephanie Greunke, R.D.
The information included in this post is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Always consult your healthcare provider to determine the appropriateness of the information for your own situation, or if you have any questions regarding conception, pregnancy, or your prenatal treatment plan.This post is intended for readers in the United States, as other countries have different policies when it comes to health care providers.
Choosing Your Birth Team
Choosing the members of your birth team is one of the most important decisions that you’ll make during your pregnancy. This person or group of providers will support you emotionally and physically throughout your pregnancy, advocate (and hopefully pursue) your wishes during labor, and check in on you during your postpartum period. This person is helping you start a new, exciting, and extremely vulnerable chapter in your life.
Trust and intuition are important factors in making this decision. You, your partner and potential providers will discuss the best option for your family, but ultimately this is your very personal decision.
A three part series
Since this is such an important topic, we will be doing a three-part blog series here on the Healthy Mama, Happy Baby blog. Today, I’ll provide information about various options for your provider/birth team. I’ll also provide benefits of each option. In part two, I’ll provide a list of questions to ask potential providers to ensure a proper fit. I’ll also provide a list of questions to ask yourself to confirm you’ve made the best choice. We will end this series with an article featuring a childbirth educator. She’ll discuss important considerations and tips for choosing a provider.
Think about big decisions you’ve made in your life, like choosing a college or a wedding venue. I’d like you to consider the idea that choosing a birth provider is an equally big decision. A big, very special decision that you’ll remember for the rest of your life. One that can significantly change the trajectory and outcome of your pregnancy.
When you’re overwhelmed during the first few days of pregnancy and want to see a practitioner ASAP, it’s tempting to choose the first provider you find or one based off a referral from a friend or your primary care physician. However, that quick decision may not lead you down the most ideal path for your specific situation. Please take some time to sit with this information, do your research, interview a few providers, and make an empowered decision instead of choosing the first provider you find. I promise you’ll thank me later.
Three Questions to Ask Before You Choose a Provider
While you’re considering potential providers, keep the following three factors in mind:
- What options do I have in my area?
- What do I want my birth to look like? This will determine the setting, types of interventions, people in attendance, and options for alternative treatments. Keep an open mind about this question.
- Does it matter to me who is in the delivery room? (For example, if your physician works in a group care setting, you may see multiple caregivers throughout your pregnancy. The one who attends you pregnancy may be the one who is on call.)
Understanding the Types of Providers
Your caregiver’s approach is going to depend on their training, experience, birth philosophy, and the policies of the hospital and state they practice in. If you’re looking to have a birth with minimal interventions, you’ll want to choose a provider and birth setting that welcomes a more physiological (natural) birth and is comfortable supporting a woman with alternative options. Otherwise, you could receive routine care, which may include interventions when the provider feels it is necessary or facility policy calls for it.
It’s important to understand that not all hospitals have the same policies and procedures when it comes to birth. You’ll want to tour multiple hospitals; work with a doula or childbirth educator in your area that is familiar with local hospital policies; and ask lots of questions. For example, some hospitals and physicians are comfortable with VBACs (vaginal birth after cesarean) while others are not. This could significantly impact your decision.
You’ll also want to take into consideration your state of health and how your pregnancy is progressing. If you’re healthy and the pregnancy is going well, you can safely choose any provider. If your pregnancy is complicated or if your caregiver anticipates any issues, you may want to work with an obstetrician alone or as a consultant along with your family physician or midwife.
Common Providers in the USA
- The most common choice for births in the USA, accounting for ~85% of the maternity care in the US
- Education: A minimum of medical school or a school of osteopathic medicine and three or more years of additional training in obstetrics and gynecology
- Their education focuses on detection and treatment of problems and they are trained to be surgical doctors
- They may work in a private practice or as part of a group
- Education: A minimum of medical school or a school of osteopathic medicine and two or more years of additional training in family medicine, including maternity and pediatric care
- Their education focuses on the health care needs of the entire family
- The typical maternity caregivers in most countries. They are becoming increasingly popular in the United States.
- Certified Nurse-Midwife (CNM): A minimum of nursing school and one or more years of additional training in midwifery. Most work in a hospital under an OB’s supervision
- Licensed Midwife (LM): A minimum of three years of formal training according to their state’s requirement. Most work in birth centers or attend home births
- Certified Professional Midwife (CPM): The only midwife credential that requires knowledge and experience in out-of-hospital settings.
- Education and practices are based on the Midwifery Model of Care
Support Team (Doula, Acupuncturist, Chiropractor, Homeopath, etc.):
- While they aren’t acting as your primary provider, they can provide additional care to improve your pregnancy, labor, and postpartum. You may even be able to have an acupuncturist, chiropractor, or homeopath at your side throughout your labor.
Understanding Provider Benefits
- They are able to perform cesarean sections and any other necessary surgical procedures during your pregnancy and delivery
- Are able to work with “high-risk” pregnancies
- More often covered by health insurance
- In addition to providing you with care during your pregnancy, they can serve as the doctor for your whole family and the pediatrician for your new baby.
- You may have a strong relationship with this provider due to history.
- They are less likely to use technological interventions during labor.
- They often spend more time with you during labor and during your prenatal/postnatal visits (usually 30 min – 1 hour).
- You have the option of delivering in a hospital, at home, or at a birth center
- Provide individualized, hands-on and/or emotional support during labor.
- Will often attend your birth, regardless of location.
- May help reduce the need for technological interventions.
- Can enhance the relationship with your primary provider.
- Will support you and your partner throughout pregnancy, labor, and postpartum
Provider options for setting (This will depend based on your state and facility):
- Hospital (your options: OB-GYN and CNM as primary providers with LM and CPM as attendants)*
- Birth center within a hospital (your options: CNMs and optional OB, if transferred)
- Freestanding birth center (your options: midwives, required credentials varies by state)
- Home (your options: midwives, required credentials varies by state)
*If you choose to labor at a hospital, see if the hospital is part of the Mother-Friendly hospital initiative which promotes evidenced-based, Mother-and-Baby-Friendly maternity care.
Understanding Patient Rights
Are you still not sure if an OB-GYN or a midwife is the right option for you? You can do both! Some mamas find it helpful to use both a midwife and an OB-GYN during their pregnancy. Of course, you’ll have to pick one of them to be the main provider, but you can use a midwife in a hospital where you have the option of using an OB if things don’t go as planned, or you can use a midwife for your prenatal/postnatal care and an OB during delivery.
You have the option to switch providers at any time during your pregnancy. If you have any hesitations, aren’t feeling completely supported, or aren’t getting the answers you need, know that you can (and probably should) change providers. Remember, this person is working for you, so you have the ability to walk away from the relationship if it isn’t serving your needs.
No matter who you decide to work with, remember that it’s your legal right to participate in decision making with your provider. As a patient, you are required to be given information about the pros, cons, and alternatives of any health care option or medical treatment. If you do not agree to a certain procedure, you have given informed consent and by law your caregiver must honor your decision.
Resources for further research
One of my favorite books on pregnancy, Pregnancy, Childbirth, and the Newborn, has a fantastic list of online resources to help moms make informed decisions when choosing their provider. Here are a few that I personally use:
- Maternity care choices
- Mother-friendly hospitals
- Midwifery laws by state
- Locate a birth center
- Research obstetricians
- Find a nurse-midwife, licensed midwife or certified professional midwife
- Find a birth or postpartum doula
After you’ve considered the above information and have an idea of what kind of providers will make up your birth team, it’s time to meet with potential providers and take a tour of the facility where you’ll be giving birth (unless it’s your own home!). In the next blog, I’ll give you a list of questions to ask potential providers and factors to consider when you tour facilities. Have your own thoughts to add? Find the conversation on Instagram and Facebook.