Choosing Your Care
Giving birth is a group effort. Although you'll be the star of the labor and delivery show, it's essential to chose the right supporting cast. This includes your primary caregiver, labor coach or coaches, and any specialists you might need.
Many factors will affect the type of care you choose, including your level of risk (low-risk pregnancies require the least intervention), insurance coverage, and preferred caregiver style. Whomever you choose, you deserve someone who listens to your concerns and provides helpful answers to your questions.
The following pages contain capsule descriptions of the major types of pregnancy and labor professionals. After you identify the ones you need, you'll want to schedule interviews to determine which individuals, or practices, are best for you.
The list of questions at the end of this article can help you find a caregiver who shares your pregnancy and childbirth philosophy. If you're not comfortable with the first person you interview, keep looking. Don't settle for a caregiver you dislike or distrust. You will be seeing a lot of this person in the next nine months. And they will be participating in one of the most important events of your lifetime -- the delivery of your baby.
The Reproductive Endocrinologist (RE)
Many couples don't need to see an RE, or fertility specialist. But for those who are unable to conceive after a year of trying (six months if you're over 35, or sooner if you or your husband have a history of reproductive problems), it can be a necessity.
According to RESOLVE, the National Infertility Association, when fertility is at issue, it's best to look for a board-certified or board-eligible RE -- that is, an obstetrician/gynecologist who has completed five or more years of specialized training in this area -- rather than continuing to work with your primary caregiver. After your pregnancy is established, most REs will refer you back to your regular doctor or midwife.
RESOLVE has a referral list of more than 700 REs worldwide. Call 617-623-0744 for more information.
The Obstetrician/Gynecologist (Ob-Gyn)
Ob-gyns are physicians who specialize in the care of women during pregnancy as well as diseases that affect the female reproductive organs. In addition to a four-year residency that includes experience in obstetrics, infertility, and surgery, they may complete additional training in an area such as infertility or high-risk pregnancy.
Ob-gyns generally deliver in hospitals or birthing centers, and are the most widely used pregnancy professionals in the United States today. Look for the FACOG credential next to your ob-gyn's name -- it means that she or he is a Fellow of the American College of Obstetrics and Gynecology. For more information, or to find an ob-gyn in your area, visit the Web site of the American College of Obstetricians and Gynecologists at www.acog.org.
The Maternal-Fetal Specialist
Also called a perinatologist, a maternal-fetal specialist is an obstetrician who has received training and certification in the care of high-risk pregnancies. This training often extends into pediatrics, since the perinatologist may need to manage problems that occur in babies before they are born.
Women who have had complications during prior pregnancies, those who are carrying multiples, and those who have other medical problems may use a maternal-fetal specialist in addition to, or instead of, an ob-gyn. Typically, you will be referred to this specialist if complications arise in your pregnancy.
The Family Physician
At the other end of the spectrum from the maternal-fetal specialist is the family practitioner, a general physician who has gained experience after medical school in areas such as pediatrics, obstetrics, internal medicine, and surgery.
He or she works with your entire family, from infancy through old age, and can provide a welcome sense of continuity to the pregnant patient. A family doctor may be a good choice in the case of a low-risk pregnancy, and will generally refer you to specialists as needed in the event of complications.
In many parts of the world, the majority of prenatal care is provided by midwives. The use of midwives is growing more common in the United States, as well.
There are several types of midwives, including lay or traditional midwives, who are usually informally trained; certified midwives, who have undergone training and certification in programs that vary according to state; and certified nurse-midwives, who have degrees in nursing and are qualified to provide complete obstetric care for women in low-risk pregnancies. All midwives are legally required to be associated with a physician or group of physicians who can deal with pregnancy or birthing complications.
Most states now permit nurse-midwives to prescribe medication, but they will not perform cesarean births or administer anesthetics. Some nurse-midwives have solo practices and will assist you if you decide to have your baby at home, although most are affiliated with hospitals or birthing centers.
For more information about the American College of Nurse-Midwives, go to www.midwife.org.
While not technically a medical professional, a doula can provide much-needed support before, during, and after your labor. From the Greek term meaning "most trusted female servant," doulas are trained to assist the woman and her partner in any way needed.
A doula can help you develop and implement a birth plan, provide comfort and support during the birth, facilitate communication with medical staff, and stay with you throughout your labor. A second type of doula, known as a postpartum doula, can help you with newborn care, breastfeeding support and advice, and even cooking and light cleaning.
For more information about Doulas of North America, go to www.dona.com.
Questions for Prospective Doctors and Midwives
Print out this page and bring it along to your interviews with prospective doctors or midwives.
Background and Philosophy
____ How long have you been in practice?
____ When and where did you receive training?
____ What is your general philosophy concerning pregnancy and birth?
____ How many babies do you deliver per week/month/year?
____ Who do you share on-call duties with? What is the rotation schedule?
____ How long have the others been in practice?
____ Will I be seen by every practitioner?
____ Do I have a choice about who I see?
____ What is your definition of a high-risk pregnancy?
____ Do you return calls personally, or ask a nurse or receptionist to call back?
____ What is your policy on induction? How long beyond term, for what reasons and what percentage of women do you induce?
____ What is your cesarean rate? When do you perform cesareans?
____ Do you encourage VBAC (vaginal birth after cesarean)?
____ What is your episiotomy rate? When do you perform episiotomies?
____ What tests do you require for a woman with my background (age, history of miscarriage, etc.)?
____ Please explain fully each test that will be performed.
The Birth Experience
____ Do you do home births?
____ Where do you deliver (name of hospital or birth center)? Why?
____ Do you support the presence of a doula?
____ Do you encourage and respect written birth plans?
____ When a mother arrives in labor, what is the standard procedure?
____ May I labor, give birth, and recover in one room?
____ What is the nurse-to-patient ratio? (According to ACOG, it should be one nurse for two women in early labor, then one-to-one in the pushing stage.)
____ Does the hospital have a policy on the use of electronic fetal monitoring during labor?
____ Do you have a squat bar or birthing chair?
____ Do you do water births?
____ Is there access to a whirlpool/tub for those in labor?
____ What is your policy on epidurals?
____ Can my partner and/or doula be with me at all times, including in the operating room if I have a cesarean?
____ How many other people can I have with me at all times?
____ Will my baby be with me at all times after birth?
____ Can my partner spend the night in my room if he or she wishes after the birth?
____ Is there a lactation consultant on staff? Is she on call 24-7?
____ How soon after birth can/must I leave the facility?
____ What is the average cost of a vaginal birth? A cesarean birth?
Labor and Delivery
____ At what point in labor do you recommend coming to the birth center?
____ How long will you allow me to labor before starting intervention?
____ How much time will you spend with me when I'm in labor?
____ Do you do vaginal breech births?
____ Will you attempt external version (turning a breech before birth)?
____ Do you require IVs during labor?
____ Do you recommend epidurals?
____ What is your policy on using Pitocin in labor? After birth?
____ How do you handle a long labor? Are there time limits?
____ Do you use vacuum extraction or forceps? Under what conditions?
____ Do you have a set position you would want me to birth my baby in? What laboring positions do you recommend?
____ Is my partner allowed to catch the baby? Cut the cord?
____ Can I breastfeed immediately after birth?
____ Do you encourage women to breastfeed?
____ What is your policy for postnatal care?
Questions for Prospective Doulas
Print out this page and bring it along to your interviews with prospective doulas.
____ What training have you had? Are you certified? (You may want to verify this with the appropriate organization.)
____ Tell us about your experience with birth, both personally and as a doula.
____ What specific services do you provide?
____ May we call you with questions or concerns before and after the birth?
____ Which care providers have you worked with? Where have you attended births?
____ When do you join women in labor? Do you come to our home or meet us at the hospital?
____ Will you meet with us after the birth to review the labor and answer questions?
____ Do you work with one or more backup doulas (for times when you are not available)? May we meet them?
____ What is your fee? Is any part of your fee refundable if you do not attend the birth?
__Please provide us with a list of previous client references.
After the interview, discuss the following questions with your partner:
____ Did you find the doula to be kind, warm, and enthusiastic?
____ Is she knowledgeable?
____ Does she communicate well?
____ Is she a good listener?
____ Do you feel comfortable with her?
Sources: The Mayo Clinic Complete Book of Pregnancy and Baby's First Year (Morrow); RESOLVE: The National Infertility Association, www.resolve.org; The American College of Obstetricians and Gynecologists, www.acog.org and www.medem.com
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.