Midwife or OB: Finding the one that's right for you

When you choose your doctor or midwife, you are entrusting her with your baby’s health and well-being along with your own. With baby on the way, this is one decision you can’t put off. We’ve laid out a practical menu to get you started on the right course (for you!).

Who’s who?

OB/GYN or Perinatologist: These highly trained specialists are the most common choices for prenatal care. If your pregnancy is considered high risk in any way, you will probably need to see an OB/ GYN or perinatologist; a personal history of epilepsy, heart disease, high blood pressure, diabetes, or complications in previous pregnancies will place you in this category. Likewise, if you’re expecting multiples, you should see an OB/GYN or perinatal specialist.

Family practitioner: If your current gynecologist or family practitioner also practices obstetrics, she may be the most comfortable choice. Her familiarity with your history and family will be reassuring and, like any practitioner, she can refer you to a specialist should you encounter serious complications.

Certified nurse-midwife (CNM): If you’re interested in birthing naturally or pursuing an alternative birth plan such as a water birth, a midwife will come in handy. Midwives work to create the best mind and body birth experiences without relying on unnecessary medical interventions. CNMs work closely with OBs, so (for peace of mind, if nothing else) an MD is never far away.

Direct-entry midwife: These midwives often attend home births. They are not trained nurses, but they may be Certified Professional Midwives (CPMs) or Certified Midwives (CMs). A “traditional midwife” is not certified but has learned through experience. Depending on your home state, certain midwifery certifications will or will not qualify these midwives as legal medical practitioners.

Where to?

Hospital: Hospitals are the most common places to give birth in the United States. The typical routine includes medical interventions such as constant fetal monitoring and an IV feed with the optional use of oxytocin (Pitocin) to encourage labor and an epidural for pain management. However, hospitals are evolving, and some now encourage a more natural process: cutting back on interventions, encouraging mother-baby bonding, and even providing birthing tubs. If you favor a certain hospital because of its location or reputation, make sure the doctor you pick has privileges there. If you employ a CNM, she may help you deliver at the hospital with a doctor on hand if needed.

Birthing center: These locales provide many prenatal and postpartum services along with delivery care. They are usually cozier, more soothing environments than hospitals. You choose how many people can be in the delivery room, and kids are welcome. Breastfeeding, rooming in, and natural birth practices are strongly supported. The midwives on staff can help with normal birth processes; for quick access in an emergency, choose a birthing center near a hospital.
 
Home: Giving birth amongst the sights and smells of home is a comforting thought for some moms. If you choose a home birth, a midwife (CNM or direct-entry) will be your best option. (Verify that yours is OK with home birthing and has a relatively short commute from her office and home to yours.) Home births do not include access to the medical interventions that are available in hospitals; so, if you change your mind and want an epidural in the heat of labor, you’ll be out of luck!

Pop quiz

You want your practitioner to have your best interest at heart when it’s your day to pop. Before you commit, ask a few key questions to make sure you’re on the same page:

• How long—and in what setting—have you been practicing? What certification do you hold?
• For a doctor: Where do you have delivery privileges?
• For a midwife: Where do you deliver? Do you work with a doctor? What happens if I have severe complications during delivery?
• How can I reach you with questions or in an emergency?
• Do your patients usually choose natural birth or epidurals with routine interventions? What do you recommend?
• Will you help me develop a birth plan?
• How many doctors (or midwives) are in your practice? Will I see you personally at every appointment?
• Do you deliver most of your own patients?
• Do you induce many of your patients? Do you encourage induction for convenience?
• How many of your patients have C-sections? Under what circumstances would you advise
  a patient to have a C-section?
• How much will I see you throughout my labor and delivery, and what will you do to help me
  during this time?
• Do you regularly perform episiotomies?
• After birth, do you encourage skin-to-skin contact, rooming in, and breastfeeding? 

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