Doctor or Midwife?
- Obstetrician/gynecologists (ob/gyns). These MDs specialize in women's reproductive care. In addition to medical school, they complete specialized training in obstetrics and gynecology. To become board-certified, they must pass written and oral exams. Certified ob/gyns can become fellows of the American College of Obstetricians and Gynecologists. Ob/gyns usually deliver babies in hospitals. They vary widely in their views about managing childbirth, from conservative to very open-minded about what goes on in the delivery room.
- Certified nurse-midwives (CNMs). Often simply called midwives, CNMs are registered nurses with special training in the care of women with normal, low-risk pregnancies. They have also completed a program in nurse-midwifery (or a Master's program) accredited by or with pre-accreditation status from the Division of Accreditation of the American College of Nurse-Midwives. For certification, they must pass a national exam and maintain an active nursing license. Midwives tend to take a low-tech, personalized approach to childbirth, often with an emphasis on childbirth preparation and education. They may deliver babies in a hospital, a birthing center, or in the parents' home, and they should have collaborative arrangements with a medical doctor in case of complications. You should inquire to find out what those arrangements are.
- Family practitioners (FPs). These medical doctors are a bit like the old-fashioned family doctor, providing basic medical care for a variety of conditions. After medical school, FPs receive specialized training in family medicine, including obstetrics, and must pass an exam to become certified. They are trained to provide care for normal, low-risk pregnancies and deliveries.
Where can I find possible candidates?
- Friends, family, neighbors -- anyone who has recently given birth.
- Your family doctor.
- The hospital or birthing center where you'd like to give birth.
- The American Medical Association's Online Doctor Finder, http://www.ama-assn.org (for MDs).
- The American College of Nurse-Midwives, http://www.acnm.org (for CNMs).
What should you keep in mind when considering possible candidates?
- Convenience. When you're pregnant, it's important to make things easy for yourself. How close is the practice to your home or work? How close is the hospital or birthing center where the practitioner would deliver your baby?
- Insurance coverage. Find out which professionals are covered by your insurance plan. Your candidate should come from this list to ensure coverage. Some companies may have restrictions regarding certified nurse-midwives -- be sure to check first.
- References. It's a good idea to collect at least three recommendations for a practitioner. These can come from your current doctor, previous patients, city and county medical societies, hospital referral programs, or staffers at birthing centers.
- Credentials. Check out the educational background of each midwife or doctor. If you'll be using a group practice, check the credentials of all members of the group. But don't focus exclusively on a doctor's diplomas: even the best academic qualifications don't guarantee a kind bedside manner.
- Disciplinary records. Find out whether the doctor or midwife has been disciplined for medical malpractice. Contact your state medical licensing agency and ask whether any actions have been taken against the practitioner.
What should you ask during an interview with a potential healthcare provider?
- How often will I be seen during pregnancy?
- Who normally responds to phoned-in questions and concerns -- and is he or she available around the clock?
- Which tests are standard? Which specialized tests might you advise for me?
- Will you definitely deliver my baby, or could it be another doctor in your practice? Will I get a chance to meet each doctor who might deliver my baby?
- What sort of maternity or special-care facilities are available at the hospital where I would deliver -- birthing rooms? rooming-in for the baby? a neo-natal intensive care unit?
- How do you feel about medication-free childbirth?
- At what stage of labor would you use an epidural?
- When do you feel it is necessary to induce deliveries?
- What is your rate of cesarean deliveries?
- What else can you tell me about your preferences and standard practices for labor and birth?
- How do you feel about breast-feeding?
- What is your fee? Does that include lab fees? How and when do you want payment?
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