You’re about to spend a lot of time (and money!) with your maternity care provider. Not only should you feel comfortable meeting with her once a month, then biweekly, then weekly as you approach your due date, but you will also need to trust your provider with protecting your health and delivering your baby. It’s time to get to know the candidates and decide on the somebody who’s right for you!
OB or midwife?
Is your pregnancy considered high risk because you have an existing medical condition, are expecting multiples or have previously had complications during pregnancy or delivery? If so, you will need to team up with an OB/GYN or perinatologist to receive the proper monitoring and care. Otherwise, you’ll have your choice of seeing an OB/GYN or midwife. In the delivery room, OBs are classically associated with medical interventions—constant fetal monitoring, IVs, inductions, epidurals, possibly C-sections, sometimes episiotomies—whereas midwives typically take a more natural, holistic approach to childbirth. However, going with an OB does not rule out natural birth in the slightest, and choosing a midwife doesn’t have to mean that an epidural is off the table.
First, consider where you would like to deliver: at home, in a birth center or in a hospital. This decision can get you started down the yellow brick road toward your ideal caregiver.
Home births are statistically rare in the United States, but they have gained popularity in recent years. If you want to give birth naturally, within the cozy comfort of your own four walls, you will want to have a midwife in attendance. Midwives come in two forms: the certified nurse-midwife (CNM) or the direct-entry midwife. While CNMs are much more common, direct-entry midwives are often called upon for home births. A direct-entry midwife has learned through experience; she will not have the same accreditation held by a CNM. The requirements for direct-entry midwives vary by state.
Hospital birth is still far and away the most popular option in the U.S. Most hospital births are attended by doctors, but CNMs often have delivery rights in hospitals as well. If you’re planning on an induction, epidural or C-section—or if you want the peace of mind that comes with knowing these interventions are close at hand just in case, the hospital is the place for you.
You might have a certain hospital in mind where you would like to deliver, based on reputation, location or your insurance coverage. Make sure the doctor or midwife you’re considering has delivery privileges at this hospital.
A birth center is a sort of happy medium between a home birth and a hospital delivery. Birth centers can be freestanding, or they might be located inside or adjoining a hospital. The delivery room in a birth center will be homier than a typical hospital room, and the emphasis will be on natural birth—avoiding any unnecessary interventions. Here, you’re likely to find laboring ladies coping with pain through movement, massage, breathing techniques and tub births. Birth centers are staffed by CNMs, midwives who are medically trained and uniformly licensed to practice midwifery anywhere in the country.
Knowing what to look for
Once you’ve decided on a location for delivery and formed an idea of whether an OB or midwife would be your best fit, you might want to place a call to your health insurance before going any further. Ensure you have coverage in the setting you’ve selected, and then find out which doctors or practices are available to you.
OBs and CNMs are both commonly covered by insurance policies—and Medicaid, too—but you’ll need to get specific with names. Your insurance company can give you a list of approved doctors and midwives in your area, and you can go from there. However, it’s more common to come at it from the other direction—ask friends in your area for doctor recommendations, and then clear those names with your insurance.
To keep your options open, schedule first meetings (interviews) with a few top contenders. When you meet with them, get a feel for the vibe of the office and the office staff. Find out how many practitioners are in the group, and ask if it’s possible for you to see your doctor at each visit (if that’s important to you) or if you’ll meet with whomever is on staff that day.
Do we mesh?
As you’re quizzing your would-be doctor or midwife about the basics—How long have you been practicing? What can I expect at each appointment?—read between the lines to get a sense of her demeanor. Does she seem rushed or calm? Are her answers brief or detailed? Does she seem concerned only with physical health, or with mental and emotional health as well? Bedside manner does matter, especially when you’re in the throes of delivering a baby. Do your best to determine whether she’s a good match.
You’re allowed to discriminate on terms of personal preference. If you’re more comfortable with a doctor of a certain age or gender, then follow that inclination. The decision is yours to make, and you don’t have to explain your reasoning. Pick the person who makes you feel like you’re in capable hands, whether it’s the young OB fresh out of residency or the seasoned midwife with decades of deliveries under her belt. She should be someone you like and trust—you’ll be sharing a lot of personal stuff with her! Just as with any relationship, commit to the one who feels right, both on paper and in person.