Choosing a Midwife or Other Pregnancy Care Provider
Freedom to choose. Is it a right? A privilege? A duty? It really depends a lot on what it is that one is making a choice about. In the case of a woman who needs health care during her pregnancy and birth, there are a number of different options available to her.
Obviously, choices in care providers will vary depending on where she lives in the world, the health care system there, and the specific locale and standards of care there. In some areas of the United States, it’s impossible to find a midwife with proper training, due to the legalities of practicing midwifery there. In other areas, a doctor who will attend the birth of a woman who once had a cesarean birth and would now like to have a vaginal birth is impossible to find. Some women have an HMO for their health care provider, and this will limit their choices. Those with dynamic health insurance will often have a wider range of different types of care providers to choose from.
Who are the different practitioners who typically attend births? A woman’s doctor, usually called an Obgyn, or Obstetrician-Gynecologist, is a doctor who specializes in providing reproductive medical care to women. Issues related to well-woman care, pregnancy, birth, menopause, reproductive health, etc., are addressed by an Obgyn. A family doctor may also attend births. Many smaller towns still have a family doctor who makes house calls and comes to the home of the birthing woman to assist her during a birth. A doctor may work in home, hospital, or birthing center.
A midwife also provides health care to women during their pregnancies, births, and afterward. There are two main licenses for midwives. A CNM, or Certified Nurse Midwife, and a non-nurse Midwife, often licensed as an LM, CPM, or Licensed Direct Entry Midwife. The third classification of midwife is a non-licensed midwife. These midwives usually have many years of experience, may or may not have been formally trained, and have not undergone a licensing process. Being unlicensed, they are mostly unregulated, and therefore it can present a problem if a potential client would like to verify that they have all the appropriate skills.
A midwife can work in a hospital, birth center, or at home. A Certified Nurse Midwife has a national certification in the U.S., whereas a non-nurse midwife will be regulated by the individual state in which she practices. Some states license and regulate non-nurse midwives, some have made it illegal, and some states consider the practice of midwifery alegal. No licenses are given, no regulation is provided, and the women who attend births as midwives are not breaking the law. The consumers in the places where midwifery is illegal and alegal may have a more difficult time locating a practitioner who is skilled, experienced, and practices within safe and appropriate guidelines, but not always. In the final assessment, a valid license doesn’t ensure a quality practitioner, and a lack of license doesn’t indicate a dangerous one. A couple must check the references, ask questions about the training and track record of any midwife or doctor they plan to hire. Speaking with others who have used that same provider can be the single most useful tool when choosing who is to care for the woman and her unborn baby.
What qualities are considered valuable in a maternity care provider? In my experience, each woman has a slightly different list. Some want a physician with a very clinical style. Someone who will run lots of tests and be extremely cautious about everything. They may feel comforted by his or her willingness to use interventions. In the case of women who have had major challenges becoming pregnant, a doctor like this can make her feel more protected, and she may interpret his conservative manner as more ideal for protecting her baby from harm. Another woman may prefer a more laid back provider. Someone who is relaxed yet thorough. The personalities and practice styles of doctors and midwives can differ, but most women value kindness, patience, expertise, honesty, and good communication skills in their provider.
What’s the best way to go about choosing the care provider who is right for you? I recommend composing a list of a few doctors and midwives in your area who are covered by your insurance. If giving birth at home may be a reasonable choice for you, and paying out of pocket is an option, you may want to add a homebirth midwife or two to your list. Try to speak to a number of trusted friends or acquaintances and ask them about their experiences with their provider. Take notes. Make a list of qualities that are important to you. It helps to have some prior knowledge about pregnancy and birth, so reading a bit about birthing options before selecting a doctor or midwife is a wise decision.
Set up interviews, if possible, with a few doctors or midwives who scored high on your list. If this proves difficult, maybe see if you can speak to them over the phone. Be cautious hiring a practitioner who has no time for his or her patients and is hard to reach, impatient, and rushed. A skilled doctor or midwife who has time for the women and families she serves is a huge plus.
The setting where the birth will take place should also be considered before a provider is chosen. Depending on the kind of care a woman wants and what is important to her during the process of childbirth, the birth venue can be a big deciding factor. Some hospitals are happy to work with birth doulas (birth coaches) and some forbid you to bring a support person who isn’t related to you. Some have very high C-section or epidural anesthesia rates. Some hospitals lack an intensive care unit for babies who are ill at birth. Some locations provide hot water tubs for labor, and birthing balls, birthing chairs, and open minded professionals who encourage upright positioning and natural birthing techniques as a matter of course. My advice is to find out where the doctor or midwife has privileges before making your choice. Many times, I’ve seen a woman choose a wonderful doctor, only to find he works in an unpleasant hospital. In these cases, she is often only visited by her wonderful doctor at the end of the birth, and she spends the majority of her labor at the mercy of not so wonderful hospital staff and oppressive hospital policies. So, do your research.
Another situation which is becoming more and more common these days is a practice of doctors. An obstetrical group is composed of a number of practitioners who work together. You may receive care from a few doctors or midwives throughout your pregnancy, and when it comes time to give birth, one of the members of the group practice will attend your labor. Find out as much as you can about the doctors in the group, as well as how much say the patient has in requesting one doctor over another.
Choosing a pregnancy care provider is a very personal decision. Often it comes down to a strong feeling you are choosing the right person. They are human, and should act that way. They should listen to you and take your needs and individual situation in to consideration when caring for you. Each woman has a right to create a pregnancy and birth care experience that is respectful of her wishes and honors her dignity.