As soon as you decide to conceive, you’ll want to start looking for a practitioner to care for you during pregnancy and the birth of your baby. Whether you choose an obstetrician-gynecologist (ob-gyn), a family physician, a certified nurse-midwife (CNM), or a direct-entry midwife will depend on a number of factors, including what kind of experience you want, where you plan to give birth, whether your pregnancy is normal or high risk, and what your insurance will pay for.
Take a moment to write down your priorities, keeping in mind that you may have to make some concessions along the way. The list of priorities will help you formulate a more precise picture of who you are looking for.
Obstetrician-gynecologists are physicians who have completed four years of medical school and an additional four-year obstetric residency program. They take a written and oral exam to become board certified by the American College of Obstetricians and Gynecologists. Some OB-GYNs undergo additional years of training specializing in areas such as reproductive maternal-fetal medicine, endocrinology (infertility), and gynecologic-oncology (cancer of female reproductive organs).
Certified nurse midwives are registered nurses, the majority of whom have completed an additional two years master’s program in midwifery. As a part of their studies they are required to complete a program of clinical training. CNMs must pass a certification exam to be certified by the American College of Nurse Midwives (ACNM) and are licensed in the state where they practice.
Individual Vs. Routine Approach
If you’re looking for a practitioner who is more likely to take a holistic approach to your care – and someone who sees birth as a normal process, intervening only when necessary and not routinely – you may prefer a midwife.
Births attended by CNMs usually have fewer interventions – such as continuous electronic fetal monitoring, epidurals, and episiotomies – without any difference in outcomes for women or their babies. Women who opt for midwifery care tend to have a lower rate of cesarean section, too. In general, midwives tend to have more time to answer all your questions and help you learn about the physical and emotional changes you experience throughout pregnancy. A midwife can also help you think about what kind of birth experience you want – and she’ll support you in your decision. The focus is on prevention, on emotional support, and on health and wellness of the mother and baby. For example, a midwife will guide you through an unmedicated labor if that’s what you choose, but an epidural will still be an option if you’re giving birth in a hospital.
When would a midwife not be an option?
If you have a medical condition such as high blood pressure, epilepsy, heart disease, or diabetes, or had certain serious complications in a previous pregnancy, your pregnancy will probably be considered high risk. In this case, you’ll need to see an obstetrician or possibly a perinatologist (a physician who specializes in high-risk pregnancies).
Be aware that if you start out with a midwife and develop a problem down the road – such as premature labor or preeclampsia, your care will be transferred to an obstetrician or perinatologist. (Depending on your condition and the practitioners’ arrangements, you may be able to have a midwife as well as a physician handle your care together, if you like.)
Some women choose practices that have both ob-gyns and midwives. And others opt for a family physician. The most important thing is to choose someone you feel completely comfortable with, who’s appropriate for your individual needs, who’ll respect your wishes, and who practices in the right setting for you.