While expectant mothers are faced with a myriad of decisions while pregnant, one of the most essential decisions to make is who to choose as a health care provider for your pregnancy, labor, delivery and postpartum care. This choice depends largely on what type of experience you want. The choice can also be influenced by where you plan to give birth, whether or not your pregnancy is considered high-risk, and what insurance coverage you may have.
The majority of babies born in the US are delivered by an OBGYN (obstetrician-gynecologist) in a hospital setting. OBGYNs are doctors with medical degrees that have completed a four-year residency and possibly additional study to further specialize in their field. As doctors, OBGYNs are able to manage and treat medical conditions such as diabetes and other pregnancy complications. OBGYNs are also able to perform surgeries, such as cesarean sections, if necessary.
Prenatal care usually follows a set schedule and is conducted in the OBGYN’s office or clinic. The majority of labor and delivery is done in a hospital setting or birthing center. Some OBGYNs, especially in a hospital setting, may follow strict protocols for laboring women. This may include IV insertion upon admission, bed confinement during much of labor, and continuous use of electronic fetal monitoring. Some OBGYNs will work in tandem with midwives. Many times, in this situation, medical circumstances at the time of birth will determine who delivers the child.
Midwives are also trained health care providers. A Certified Nurse Midwife have RN nursing degrees as well as training in midwifery. A Certified Professional Midwife may have a bachelor’s degree as well as specific training in midwifery. A Lay Midwife usually has “hands on” training with a more experienced midwife. The majority of midwives work with expectant moms who deliver in the hospital. But, nearly 4% of midwives attend labor and births in birthing centers or in family homes.
In general, midwives are more involved with an expectant mother prenatally than OBGYNs. Midwives do more counseling regarding nutrition and exercise. They also are more supportive of the emotional changes that happen within a family when facing the arrival of a new addition. Prenatal care often occurs in the family home, and family members become very familiar with the midwife.
So, how does an expectant mother choose between an OBGYN and a midwife? She may want to consider the following:
Is a vaginal birth a priority? Midwives are strong supporters of vaginal births. With OBGYNs, it is important to ask about their general philosophies and practices regarding vaginal births and C-section rates.
Is having a caregiver present throughout labor and delivery important? Midwives are more involved during this time than OBGYNs.
What kind of pain management will be used? Midwives often support natural methods such as warm showers, massage and acupressure. OBGYNs may utilize more pharmaceuticals for pain.
Is birth location important? In general, most midwives will support home birth, whereas most OBGYNs prefer hospital or birthing centers for delivery.
Which general care policies mesh best with expectations? As mentioned before, OBGYNs may follow strict protocol once in the hospital setting. A midwife is usually less strict and will tailor a labor plan to the needs of the expectant mother. This may mean things like more freedom to move around during labor and to use intermittent fetal monitoring devices.
Is more one-on-one prenatal attention desired? Midwives offer this at a greater level than most OBGYNs.
Is the pregnancy considered high-risk due to things such as advanced maternal age, carrying multiples, or a previous C-section? If so, there may be a higher chance that surgical or other medical intervention may be needed at the time of birth. These types of circumstances are out of the realm of a midwife.
The surest way to determine your best possible care provider, is to research your available choices and then “trust your instincts.” Picture your pregnancy, labor and delivery in your mind. What will make you feel most supported, safest and most secure? What you envision is likely the best for you and for your baby and should be the basis of your birth plan.
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