Who Cares In The US? Choosing A Maternity Care Provider

Who Cares In The US? Choosing A Maternity Care Provider

One of the first decisions you make as a new parent is choosing your healthcare provider.

It might not seem like a big decision, but the care provider you choose will have a big impact on your birth experience.

You might begin by asking your friends, calling your insurance company or just looking on Google maps to find a conveniently located healthcare provider.

Does your doctor or midwife choice really matter that much? Do you need to spend time learning about all of your options?

When it comes to deciding what care provider to choose for your pregnancy, most women in the US have many choices – though they may not be aware of all of them. Insurance, your state laws and your location might dictate part of your decision. Learning about all of your options and thinking about your birth preferences will help you make a choice you can be truly confident in.

Why Does Your Healthcare Provider Choice Matter?

The healthcare provider you choose will directly impact how your birth experience unfolds and how you feel about it. The location you choose for your birth can impact how you labor, your immediate bonding experience and even your breastfeeding relationship.

If you desire to have an unmedicated birth – even if you take every class, hire a doula and faithfully practice your positive affirmations – your birth experience might be one hampered with memories of difficult decision making during contractions, if you didn’t take time to research your healthcare provider options. Rather than having a positive memory of your birth, you might be left feeling unsupported.

Even if you are planning for a scheduled c-section, induction or other medical interventions, the doctor you choose can greatly influence whether it is a positive or a negative experience. Often, regardless of how labor unfolds, if a mother feels fully supported and respected she is likely to view her birth experience as a positive one.

What Maternity Healthcare Options Are There?

Your available options might vary based on your insurance, state laws, location and other factors. For most women though, there are several options including: family physicians, obstetricians (OB), certified nurse midwives (CNM), certified midwives (CM), and certified professional midwives (CPM). Each of these healthcare professionals receive training to support a mother during her pregnancy, birth and the postnatal period. However, the type of training they receive, their approach of birth, and the birth philosophies they are exposed to can vary greatly.

It is important to remember that regardless of training each professional is an individual. Meet with your prospective healthcare provider to be sure they are able to support your birth preferences, attend at a birth location you are comfortable with and uses a care model (private, large hospital/clinic based practice, etc) you are okay with.

If you are a high-risk mother, you will be best cared for by an obstetrician or maternal fetal health specialist depending on the type of complications you are experiencing.

Knowing the training and typical care philosophies of each of these professionals can help you make an informed choice. There isn’t a right place or way to give birth, but women do labor best and report a more positive experience when they feel safe and supported.

Here is an explanation of each type of maternity care provider and possible locations to give birth:

A Hospital Birth With An Obstetrician (OB)

Obstetricians are medical doctors that have graduated from an OB residency program. They are trained to provide medical care for women during pregnancy, birth and the immediate postnatal period. Obstetrical training also includes surgical practice such as learning to perform c-sections and episiotomies. They are typically trained to use modern obstetrical practices (ultrasound, induction methods, etc), and to manage labor and birth. These skills are excellent for mothers experiencing a high-risk pregnancy.

For low-risk mothers, while they can opt to use an OB, choosing an OB can increase the risk of interventions as that is how they are trained to support birthing mothers. If you are low-risk and desire an unmedicated birth it is important to find an OB experienced with supporting low-risk birth.

Many women choose their OB based on recommendations. Your friend might have had a wonderful experience with her OB but her birth preferences might vary from yours. If she had a positive experience, but not the type of birth you hope for, you might find another OB is a better match for you. Be sure to take time to ask these important questions that you can find here.

Another important part of choosing an OB is finding one that delivers at a hospital you feel comfortable at. Your doctor isn’t the only person you will be working with during labor. In many cases, you will be cared for only by the hospital nursing staff until shortly before or even after you begin pushing. Find out the hospital policies regarding mobility during labor, routine IVs, mother/baby separation, and any time limitations for laboring. Even if your doctor is comfortable with your preferences, the hospital he delivers at might not be. Choosing a hospital that easily facilitates your preferences can help avoid frustrations during birth.

Your Family Physician

Family physicians complete a residency program after medical school and pass an exam given by the American Board of Family Practice. Family physicians used to provide all of the medical care for the majority of families – from pregnancy and birth all the way to geriatric care. The increase of specialists and growing liability concerns has reduced the number of family physicians that provide maternity care. Around 25% of family physicians still provide maternity care in the US.

Studies comparing family physician practice to that of midwives and OBs have found that family physicians are more likely than midwives but less likely than OBs, to perform interventions. In many cases, if a mother becomes high-risk she would be transferred to an OB. However, some family physicians are also trained surgeons so they can perform c-sections and provide other high-risk care.

The advantage to using a family physician is a complete continuity of care. You might already have a relationship with your doctor and they will provide simultaneous care for you and your baby during the postnatal period and beyond.

If you family physician does offer maternity care, they most likely deliver in a hospital. There are a few physicians that offer home birth care but state laws, large physician practices, and liability concerns mean it isn’t a common service.

Certified Nurse Midwives – Home Birth, Freestanding Birth Centers or Hospital Birth

When you hear midwife you might picture a free spirited woman with little medical training. However, a certified nurse midwife (CNM) is a registered nurse that has graduated from an accredited nurse-midwifery program with an advanced nursing degree, certificate or masters degree and passed an exam by the American Midwifery Certification Board (AMCB). Just like any other professional, her (or his, yes there are male midwives) appearance, lifestyle and personality varies greatly.

They also support women in a variety of births, not just home birth. A CNMs training focuses on wellness, prevention and holistic maternity care. Their nursing background means they have skills to support women at home, in a freestanding birth center or in a hospital setting.

For low-risk women, this low-risk provider often means an intervention free birth, or a birth with only necessary interventions if complications arise. They are more likely than an OB to discuss your emotional health, your diet and your birth preferences. The average midwifery appointment is closer to sixty minutes while the average OB appointment is fifteen. Even if you are not planning a completely intervention free birth, some private CNM provide personalized holistic care in a hospital setting.

The safety of planned home birth or freestanding birth center for a low-risk mama with a CNM in attendance has been supported by many studies. Birth is a normal physiological process, though complications can arise, it often unfolds best without interventions. In fact, some routine interventions done in hospitals can increase the need for more interventions, this is known as the cascade of interventions.

Should unexpected complications arise, CNMs are trained to handle them. They carry oxygen, Pitocin for postpartum bleeding and know neonatal resuscitation. CNMs have safety guidelines to define low-risk and will recommend anyone not falling within those guidelines deliver at a hospital so they have access to obstetrical care. Some states require a CNM have an OB they refer to, or one that provides back up care or oversight.

Midwives are also trained to help women establish breastfeeding. While they aren’t certified lactation professionals, they are able to help most women with routine breastfeeding initiation. The low risk birth support and lack of mother baby separation that occurs in out-of-hospital settings also helps with initiating breastfeeding.

Certified Midwives (CM) graduate from the same accredited programs as CNM and pass the same exam, but their undergraduate degree is a non-nursing degree – though it is often healthcare related. Their care is very similar to that of a CNM, they often work in similar settings but they are not legal in every state.

Home Birth or Freestanding Birth Center Birth With A Certified Professional Midwife (CPM)

A certified professional midwife (CPM) is an independent individual that has met the qualifications set by the North American Registry of Midwives (NARM). They do not typically hold a nursing degree, and don’t necessarily need a degree to meet the NARM qualifications. They are legal in some states, illegal in others and in some they aren’t legal or illegal – they are in a bit of a gray area.

These midwives receive their training under an apprentice style learning, but also with academic and clinical components, and they must pass an exam. Unfortunately, the confusing legality can make choosing a CPM confusing. You can learn more about CPMs by visiting NARM.

Most CPMs provide home birth care. If CPMs are legal in your state, there might be a freestanding birth center run by CPMs. These midwives are also trained to handle complications and are equipped to support low-risk mamas in out-of-hospital settings.

Some families choose CPM care due to the personal nature of it. The traditional midwifery approach often equals a close relationship between mother and midwife and a holistic approach that includes the whole family.

As you can see, you have several options when it comes to choosing a maternity care provider. Take time to think about your ideal birth.

Is it likely to happen with the care provider you’ve chosen?

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Maria Silver Pyanov is a mama of four energetic boys and one unique little girl. She is also a doula and childbirth educator. She's an advocate for birth options, and adequate prenatal care and support. She believes in the importance of rebuilding the village so no parent feels unsupported.

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