What is an obstetric healthcare provider?
Choosing the healthcare provider who will help care for you during your pregnancy, labor, and delivery is an important decision. Different types of obstetric healthcare providers can fill these needs. Explore your options and think carefully about what is most important to you.
Healthcare providers to consider include:
Certified nurse midwives (CNMs): Specially trained, licensed professionals experienced in providing obstetric and newborn care. CNMs provide comprehensive, family-centered maternity care from the first prenatal visit through labor and delivery, and after the birth of your baby. Midwives are registered nurses who have earned their master's degrees in nursing, with a strong emphasis on clinical training in midwifery. Midwives work with obstetricians who are always available to assist if complications occur during pregnancy, labor, or delivery.
Obstetrician-gynecologist (OB-GYN): A medical doctor who is specially trained to provide medical and surgical care to women. OB/GYNs spend four years after medical school in a residency program studying pregnancy, reproduction, and female medical and surgical problems. To verify the credentials of an obstetrician, contact the American Board of Obstetrics and Gynecology. Specialists who provide mainly pregnancy care are obstetricians, while those who provide mainly female reproductive system care are gynecologists.
Perinatologist: Also called maternal-fetal medicine specialists, a perinatologist is an obstetrician who specializes in the care of women who might face special problems during pregnancy. These include young women under age 18 and women over age 35; women with certain medical conditions such as diabetes and hypertension; women with inherited (genetic) disorders; and women who have had problems with previous pregnancies. Perinatologists provide consultation as well as management of high-risk pregnancies, preconception counseling, and sophisticated prenatal diagnosis and treatment.
Doula: A woman who specializes in helping families during the childbearing year. A doula is a professionally trained labor and birth assistant who can provide education as well as continuous physical and emotional support during labor and birth. Some doulas provide both pre- and post-birth services. Doulas charge fees for their services. When you choose and meet with your doula, you can discuss how best she can help you during labor, birth, or postpartum.
Note: Most insurance providers will not cover the costs of a doula.
How do I choose an obstetric healthcare provider?
Many women continue with their current OB/GYN, family practice doctor, or midwife for pregnancy care. If your pregnancy appears to be high risk or complicated, you will need to also see a perinatologist. A high-risk pregnancy might include maternal medical conditions, such as high blood pressure, diabetes or a history of previous pregnancy complications, advanced maternal age (over 35 years of age), or younger women under the age of 18.
Questions to ask about a healthcare provider
Here are some questions to ask to help you determine the best prenatal healthcare provider for you:
- How long has the healthcare provider been in practice? When and where did the healthcare provider receive training? Does the healthcare provider have references?
- Is the healthcare provider board-certified? Has the healthcare provider had any problems with his or her medical practice? (To get this information, contact your state medical licensing board.)
- What are the healthcare provider's general philosophies about pregnancy, labor, and delivery? How do these fit in with my own beliefs?
- How many babies does the healthcare provider deliver per week?
- How many children does the healthcare provider have?
- Is the healthcare provider in a group practice? Will I see every provider with whom he or she rotates during my doctor visits? What are their qualifications?
- Do I have a choice about whom I see and who delivers my baby?
- If the provider is a doctor, will I see him or her at every visit, or will a nurse see me during my prenatal visits?
- At what hospital/facility does the healthcare provider have privileges? (This will determine where you can have your baby if you want this person to deliver him or her.)
- Will the healthcare provider I select be in town around my due date? (Note that there are no guarantees that a specific healthcare provider will deliver your baby since no provider is available 24 hours a day. Make sure you know the other providers in the practice or with whom the doctor shares delivery responsibility.)
- If I have a question, whom do I call? Who responds to the calls? Does my healthcare provider accept questions via e-mail?
- If I create a birth plan, will it be respected?
- What is the healthcare provider's policy on inducing labor if I go beyond my due date?
Try to schedule an introductory visit to meet with the healthcare provider and determine if you feel comfortable with him or her. During this visit, ask some of the questions listed above so you can create an opinion about the provider and make a final decision.
Note: If you choose a doctor who belongs to a group practice, usually all the members of the group will see you during your pregnancy, and one of them will be there for the delivery.
How do I choose where to have the baby?
As with providers, options are available when you are deciding where to have your baby. These include:
If you have already selected a healthcare provider, ask where he or she delivers babies. If it is a hospital, your questions might include the following:
- Is the hospital a reasonable driving distance?
- When should I sign up to take childbirth education classes and take a tour of the hospital?
- What standard procedures are done when a woman arrives in labor?
- Is there an anesthesiologist on duty in the Birthing/Obstetrics Unit, or is the anesthesiologist on call? This might be important if there is an emergency or if you want pain relief. It will take longer to get relief if the anesthesiologist must drive from home to get you the medicine rather than being on duty at the hospital.
- What is the nurse-to-patient ratio? One nurse per two women during early labor and one nurse per woman in the pushing stage of labor are ideal.
- Is the hospital a teaching hospital? Will medical students or residents attend my birth? Can I limit this if I want to?
- What is the hospital's policy on the use of electronic fetal monitoring? If fetal monitoring is required, what is the required length of time?
- Does the hospital have perinatologists or neonatologists on staff? Some hospitals do not have doctors who specialize in high-risk pregnancies (perinatologists) or pre-term babies (neonatologists).
- Does the hospital have a Newborn Intensive Care Unit? (NICU)
- Does the hospital allow "rooming-in" (rooming in means the baby can stay with you in your room), or does my baby have to stay in the nursery? Can I have my baby stay in my room most of the time, but go to the nursery if I need help?
- Does the hospital have a one-room option in which I can be in labor, deliver my baby, and recover all in the same room (called a birthing room or suite)? Do I have to be transferred to another hospital room after I deliver my baby?
- What are the features of the birthing or hospital rooms? Are birth balls, peanut balls, squat bars, or birthing chairs available?
- Are water births done at the facility? Is there access to a whirlpool/tub or shower for women in labor?
- Does the hospital support skin-to-skin care after the birth?
- What is the hospital's cesarean rate? Epidural rate?
- Can my partner be with me at all times, including in the operating room, if I have a cesarean delivery? How many other people can I have with me? Can my other children attend the birth?
- Can I have videos taken by my family during delivery?
- What resources are available in the hospital after birth?
- Can my partner spend the night in my room after delivery? What type of sleeping arrangements is available for my partner?
- Are there lactation consultants on staff? Can the postpartum nurses assist me with breastfeeding? Will I automatically be scheduled to meet the lactation consultant? Does Lactation Services offer breastfeeding support groups or private consults?
- When can family and friends visit and are children welcome? Is visitor parking free?
Hospital birthing rooms
Some hospitals offer birthing rooms in addition to their standard hospital rooms. These rooms are meant to provide a "home-like" experience as much as possible. They are private and decorated to resemble home.
When your labor turns into delivery, the room is converted into a delivery unit so you don't have to move to have your baby.
Often, hospitals have a limited number of birthing rooms and other policies governing these rooms, so check with your particular facility for this information.
Birthing centers and home births
Although most births take place in hospitals, more women are choosing to have their babies in other locations, such as at birthing centers or home.
Birthing centers, usually located near a hospital, allow women with uncomplicated pregnancies to deliver there. Most are run by certified nurse-midwives or doctors. Be sure to research the staff's credentials when selecting a birthing center. Although rare, problems during labor and delivery can arise, so you'll want the best opportunity to get the best care.
Although common in most of the world, these are relatively rare in the United States. Approximately 0.9% births per year occur in the home. Most doctors will not agree to do a home delivery, nor will most nurse-midwives. The reason is simple: life-threatening complications can happen fast during labor and delivery, and most homes are too far away from a hospital where emergency care can be provided.
If you have any questions about your birthing options, talk to some of the healthcare providers you are considering for your pregnancy care.