Pregnancy

OB or midwife? Hospital or birthing center? You just found out that you’re expecting. It’s only natural to feel overwhelmed. The multitude of decisions that both you and your spouse or partner need to make during your pregnancy can be staggering. Choosing the right type of health care provider that will suit your needs, gain your trust and that you’re comfortable with will take plenty of research and consideration. It is vital that an expectant mom find a caregiver that will make her feel comfortable and will listen to her concerns during pregnancy.

“The importance of getting involved in your own pregnancy cannot be stressed enough,” says Dr. Marguerite Lisa Bartholomew, maternal-fetal medicine specialist at Cedars Sinai Medical Center in Los Angeles, Calif.

The OB/GYN

The OB/GYN plays an important role during a woman’s lifetime. They are the ones that women will usually turn to for consultation and care for some of our most intimate, physical and emotionally reproductive life-changing events such as conception, birth and menopause.

It is vital that an expectant mom find a caregiver that will make her feel comfortable.

An obstetrician specializes in the care and treatment of women during the entire time of their pregnancy, birth and recovery, with their guidelines set by the American Board of Obstetrics and Gynecology. The March of Dimes estimates that about eight in 10 women will choose an obstetrician to manage their care during pregnancy. Most OB/GYNs found in the United States work in private practices, either by themselves or within a group.

The Nurse-Midwife

The history of the nurse-midwife in the United States dates back to 1925. According to MedlinePlus (a service provided by the U.S. National Library of Medicine and the National Institutes of Health), during that year, Mary Breckenridge, a nurse in Kentucky, founded the Frontier Nursing Service. It used public health nurses, who received additional nurse-midwifery education in England, to staff nursing centers throughout the Appalachian mountain region. These centers not only tended to the routine health care needs of families, but they also provided women with childbearing and delivery care.

Fast forward to 2006, where an estimated 70 percent of nurse-midwifes graduate at a master’s degree level from college with their programs accredited by the American College of Nurse-Midwives (ACNM). Nurse-midwifes work in a collaborative role, providing a wide variety of health care services to expectant women and their newborns. Licensing requirements for nurse-midwives vary on a state-by-state basis, so it is best to contact an organization like the ACNM to find out about the specific requirements in your area. Certified nurse-midwives practice in a wide variety of settings, including private practice and birth centers.

The Birth Center

Birth centers can provide Mom-to-be with a return to a traditional, non-invasive way of giving birth and at the same time offer an alternative that may best suit her needs and desires. The National Center for Health Statistics estimates that 29 percent of live births in 2000 took place in a freestanding birthing center. While most of the birth centers in the United States are independently run facilities, some centers can be found in specific hospitals.

The atmosphere that usually awaits couples in birth centers is home-like, a comfortable environment where you and your partner can find benefits not commonly offered in a hospital setting. Birthing centers aim for a “maxi-home” rather than “mini-hospital” type of environment.

Birth centers extend the best combination of home and hospital, providing “the comforts of home but have the systems and equipment in place to initiate emergency care,” says Kate E. Bauer, executive director of the American Association of Birth Centers based in Perkiomenville, Pa.

Unlike most hospitals, birth centers may offer you the freedom to move around during labor and less pressure to use other forms of intervention, such as enemas, episiotomies and narcotics that offer pain relief. “The benefits may include freedom of movement, freedom to make decisions regarding the birth of your baby, ability to eat and drink freely during labor,” says Sue Turner, a licensed midwife at Ventura Birth Center in Ventura, Calif. “The women seeking to deliver at a birth center are usually very educated regarding the tools that are used during labor and are motivated to experience a natural birth.”

Dorinda Dove, a certified nurse-midwife at The Birth Center in Wilmington, Del., says moms-to-be and their partners should research everything they can get their hands on about birth centers. However, she believes that a certain amount of soul-searching should be completed, too. “It is most important to decide from within if this is something that you feel you believe in,” says Dove. “Having your baby outside of the hospital requires a person to take a large amount of responsibility for the decisions that they are making in regards to themselves and their baby.”

Doing the Research

Consider the advice of those around you during your decision-making process. Look toward your family, friends and coworkers for possible recommendations. Take the time to research the professional medical backgrounds during your search for the right health care provider. Get on the Internet, as national organizations such as the American Medical Association, the American College of Obstetricians and Gynecologists and La Leche League provide informative Web sites that offer advice and a wealth of knowledge that will give you a good start.

It’s a good idea for the mom-to-be to interview either the OB/GYN or certified nurse-midwife that she has selected as possible candidates for her care, as it is highly important that a woman finds a physician that she feels comfortable with, trusts and agrees with her views with regards to her health care during pregnancy and childbirth.

Write a list of significant questions to take with you on your interview: What are the provider’s fees? Are they covered by your particular insurance plan? Does the provider have an emergency, after-hours number to call if need be? Is the provider’s practice close to home or your place of work? If the OB/GYN is affiliated within a group practice, it is a good point to ask the potential provider if you will get familiar with the other specialists, as there is a chance that your baby will not be delivered by the specific provider that you choose, but by a fellow group partner. This is also the case if you choose an OB/GYN who has their own private practice. If they happen to be unavailable when you go into labor, another doctor that you are unfamiliar with will have to step in to deliver your baby. These are all specific points that need to be addressed during your decision-making process.

Dr. Bartholomew says every mom-to-be owes it to herself to be her own health care advocate. “Be honest about your history, and ask questions if you don’t understand something,” she says.

Maternal specialists will agree that they want to make sure each woman is an informed and satisfied patient during her precious nine months of pregnancy. “I appreciate a patient with an interest in her health and who kindly tells me what is on her mind, even if she is unhappy with what is going on,” Dr. Bartholomew says. “Doctors are people, too, and we want you to be informed. You must have a sense of trust in your physician and be comfortable with the care plan.”