Choosing a Prenatal Care Provider
From midwives to OBs and beyond
- Midwives and OBs are the most common prenatal care providers.
- There are benefits to each. Midwives spend a lot of time getting to know you. OBs have more ability to handle high-risk and emergency situations.
- Where you want to give birth will also influence your care provider options.
A hundred years ago, asking what kind of prenatal care provider you wanted was not a question. Obstetricians (OBs) are doctors who specialize in pregnancy and birth. They were the only common, accessible option for most people in the United States.
Today, things are different. There are many more options for prenatal care providers! This is a good thing, because it means each pregnant person can choose what makes them comfortable. Ideally, everyone should be able to access a care provider that they trust and feel comfortable with.
But having options can create a lot of confusion, too. Different care providers practice in different healthcare settings. They also offer a variety of types of care models and have different value systems and approaches to birth. Though these vary by person and practice, this information will help guide you as you choose what type of provider you want for your birth.
What are my options?
There are two broad categories of pregnancy providers: physicians and midwives.
Most people think of obstetricians (OBs) as “the people who deliver babies.” This is true for the vast majority of births in the U.S. OBs both go through four years of medical school followed by a residency. Residency is time spent in a hospital or clinical setting under the guidance of another doctor. Residency is often four years, but occasionally longer for those with very specific training. OBs are trained in “obstetrics,” which includes prenatal through postpartum care.
OBs are trained in normal birth, but they are experts in high-risk or complicated cases. They’re trained to perform surgeries, including cesarean sections. OBs are often trained in gynecological care as well. We call these doctors OB/GYNs. Gynecological care extends beyond pregnancy, birth, and postpartum. It covers reproductive care and disease.
Family medicine and naturopathic doctors are also options for prenatal care providers. They are less commonly used for prenatal care than OBs. Some family medicine doctors also include obstetrics care in their practice. They may be trained to perform simple cesarean births so they don’t have to transfer their patient to an OB/GYN. Naturopathic doctors may also be trained in midwifery and can attend deliveries.
The other major category of providers is midwives. Midwifery developed before medical care was standardized and regulated. It has been practiced for thousands of years. Throughout that time, midwifery has evolved significantly. In its current form, it is guided by the idea that pregnancy and birth are normal parts of human life, and pregnancy is not an illness or disease.
Both midwives and OBs work to ensure the health and safety of the pregnant person and their baby.
Midwives are reproductive healthcare professionals. They are the experts in low-risk pregnancy and are the most qualified to help those who are seeking a birth experience with minimal medical interventions. Depending on state laws, midwives may be certified to work outside of pregnancy and postpartum to provide gynecological care. This may include prescribing birth control, medical abortions, and fertility assistance.
In the U.S. there are many types of midwives. The two most common are certified nurse-midwives (CNMs) and certified professional midwives (CPMs). CPMs may be known in different states as licensed midwives or direct-entry midwives. The main difference between them is in their schooling: CNMs attend nursing school and have an RN before attending midwifery training. Training for CPMs varies, often by state. Often CPMs train through a midwifery school. They then have hands-on experience through an apprenticeship model, where they may work with one or more midwives to gain clinical experience.
Other less common types of midwives include CMs, who attend graduate school for midwifery, and DMs, who have doctorate degrees in midwifery.
About 90% of CNMs work in a hospital setting. Most CPMs either offer home births or work at birth centers. While CNMs/CMs and CPMs usually work in different settings and have different training paths, they share some core values. All midwives focus on the pregnant person and their autonomy in decision-making. They also have a holistic view of birth. To a midwife, birth isn’t just a “medical episode.” It is a transformative period in that family’s story. Midwives hold space for emotions and spend extra time getting to know the pregnant person. Like an OB, they also ensure the health and safety of the pregnant person and their baby.
How do I choose?
With all of the options, how do you choose a provider? Here are some very general tips for which might be the best fit.
Deciding where you want to give birth is a helpful place to start. At a hospital, you will have the choice between a nurse-midwife (CNM) or an OB. A hospital birth may feel safer for some people. Anyone with a history of health complications may decide a hospital birth with a CNM and OB backup feels best. Others may feel more comfortable having an OB attend their birth. Hospitals are well-equipped to deal with severe pregnancy complications. They have pain relief medication such as epidurals on hand, as well as other medical services for various situations.
Professional midwives (CPMs) cannot work in hospitals, but they can work in birth centers. Birth centers usually offer more homey, less distracting environments. If you want a birth center birth but are worried about potential risks, ask the birth center what their transfer of care policy is. Many birth centers partner with nearby hospitals in case an emergency arises. If you want a home birth, a CPM is your best choice.
There is evidence that shows midwifery reduces the risk of cesareans and other complications. People who choose midwives are overall statistically happier with their birth experiences.
Type of care
If you’re looking for a care provider who can offer longer appointments and more personalized care, midwife-based care is a good option. There is evidence that shows midwifery reduces the risk of cesareans and other complications. People who choose midwives are overall statistically happier with their birth experiences.
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The benefits of ongoing relationships may be a good reason to choose an OB or family doctor as your prenatal provider. If you go with your family medicine doctor, ask about their experience, how many deliveries they do, and when they might transfer care in case of complications.
Making a decision
Making the choice of who to work with during your pregnancy can feel like a really big choice. Each provider type has unique benefits. You get to decide which of those benefits is most important to you. When looking for prenatal providers, it may help to think about your medical history to help you decide which setting and type of provider would be best for you. Your personality is also important to consider when thinking about what style of care you’d like to receive. Remember, you can always transfer care, even as late as your third trimester.
While there are lots of technical details to consider, the most important thing is finding a provider that you feel you can talk openly with and that you trust. That trusting relationship is the foundation of all your care.
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