Choosing an Obstetric Health Care Provider
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Choosing the health care provider who will help care for you during your pregnancy, labor, and delivery is very important. There are several types of health care providers who can care for your needs during your pregnancy, labor, and delivery. Be sure to explore your options and evaluate what is most important to you.
Some health care providers to consider include:
Certified nurse midwives (CNMs) — These are 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) — This is 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 — This is a woman who specializes in helping families through the childbearing year. Doulas do not provide any clinical care, so they do not replace your obstetric health care provider. Generally, your relationship with your doula will begin during pregnancy. A doula can help you find the appropriate childbirth class, learn techniques, write a birth plan, and more. Most doulas will provide early labor support at home, coming to your home and helping you while you are in labor before you are ready to go to the hospital or birth center. When you are ready to leave for your hospital/birthing center, she will go with you or follow in her car.
Note: Most insurance providers will not cover the costs of a doula.
How do I choose a health care provider?
The first question to ask is whether your pregnancy is likely to be normal and uncomplicated, or complicated and high-risk. A high-risk pregnancy might include maternal medical conditions such as high blood pressure, diabetes, or a history of previous pregnancy complications. The mother’s age is also an important consideration. Young women under age 18 and women over age 35 have special needs during pregnancy. If any of these conditions apply to you, you should seek care from a health care provider experienced in treating women with your type of medical condition, such as a perinatologist or an OB/GYN. If you are at low-risk for complications, your family doctor or a midwife might be right for you.
Questions to ask
Once you decide the type of provider that best suits your needs, you will need to select one person in particular. Here are some questions to ask that might help you determine the best prenatal health care provider for you:
- How long has the health care provider been in practice?
- When and where did the health care provider receive training?
- Is the health care provider board-certified?
- Does the health care provider have references?
- Has the health care provider had any problems with his or her medical practice? (To get this information, contact your state medical licensing board.)
- What are the health care provider’s general philosophies about pregnancy, labor, and delivery? How do these fit in with my own beliefs?
- How many babies does the health care provider deliver per week?
- How many children does the health care provider have?
- Is the health care 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 who 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 health care provider have privileges? (This will determine where you can have your baby if you want this person to deliver him or her.)
- Will the health care provider I select be in town around my due date? (Note that there are no guarantees that a specific health care 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 health care provider accept questions via e-mail?
- Am I allowed to write a personal birth plan? Will it be respected?
- What is the health care provider’s policy on inducing labor if I go beyond my due date?
You might want to schedule an introductory visit to meet with the health care provider and determine if you feel comfortable with him or her. During this visit, you might want to 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.
Choosing where baby will be born
When selecting a health care provider, consider what options are available for delivery. Like providers, there are many options to consider when deciding where to have your baby. These include:
If you have already selected a health care provider, consult with him or her to find out where he or she delivers babies. Then consider the following:
- Is the hospital a reasonable driving distance?
- When can I take a tour of the hospital? (Taking a tour might help answer some of these questions for you).
- 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? According to the American College of Obstetricians and Gynecologists (ACOG), one nurse per two women during early labor, and one nurse per woman in the pushing stage of labor is 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 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, squat bars, or birthing chairs available?
- Are water births done at the facility? Is there access to a whirlpool/tub for women in labor?
- 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?
- Is video taping allowed during delivery?
- What resources are available in the hospital? Is there a "new family" class to teach me how to care for my newborn?
- Can my partner spend the night in my room after delivery? What type of sleeping arrangements are available for my partner?
- Is there a lactation consultant on staff? Will I automatically be scheduled to meet the lactation consultant?
- When can family and friends visit? Can children visit?
- Is 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. 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 health care providers you are considering for your pregnancy care. They might help clear up any concerns you might have.
American Pregnancy Association. www.americanpregnancy.org Accessed 8/3/2011.
National Institutes of Health. Pregnancy: Eunice Kennedy Shriver National Institute of Child Health and Human Development health.nih.gov. Accessed 8/3/2011.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/3/2011...#9698