My whole life, I looked forward to becoming a mom! But when that first pregnancy test came up positive, I quickly became overwhelmed with all the things I'd have to figure out-the first of those being finding a doctor. I had grown up hearing horror stories about pregnancy and childbirth, so finding a provider that would help me feel calm and comfortable along the way was so important to me. And now that I'm pregnant with baby number three, I can tell you with absolute assurance--this may be one of the most important decisions you make during your pregnancy! Not only will they care for you and baby every step of the way, but your provider will be the one to support you and help to ensure you get the delivery you're hoping for!
So today, let's take a look at all of your options for prenatal care and how to pick the PERFECT provider for you!
Types of Pregnancy Healthcare Providers
Knowing you have options when it comes to your care is vital! When I was pregnant with my first, I honestly thought that everyone goes to an OBGYN for pregnancy. So I didn't even consider the alternatives.
Although OBGYNs are a popular choice in the US for pregnancy care, you can also see a family doctor, a midwife, or a perinatologist.
Although probably not your first choice when it comes to pregnancy care, many family doctors will be more than happy to care for you during the entirety of your pregnancy. And in fact, this can be an excellent choice even though it's not as common.
Family doctors are trained to care for patients of all ages with a wide range of conditions. This means that not only can they care for your pregnancy needs, but any other medical needs that come up as well. And once your baby is born, they can care for your baby too! It truly is an all-in-one stop for all your needs!
So if you have a family doc that you've seen for years that you feel incredibly comfortable with, this may be a good fit for you! Just know, some family docs will not be able to actually deliver your baby. So make sure to ask your doctor if they can deliver. If not, you can still see them for your prenatal care, but you may want to consider one of the other options if you want the same person to deliver that cared for you during pregnancy.
Midwife (CNM, CM, or CPM)
Midwives are truly amazing! And they have been helping women deliver babies for thousands of years--long before medical schools existed. Midwives specialize in pregnancy, delivery and postpartum care, but they may also provide standard gynecological services as well. They are a great option for very low-risk pregnancies, and can deliver in a variety of settings--from home births and birthing centers to hospitals.
Midwifes often work side by side with physicians, and you can often find them working in some of the same clinics as OBGYN's and perinatologists. And although they don't have a medical degree, they are still highly trained.
Certified nurse midwives (CNM) often have the most training, having gone through nursing school and then going on to receive a graduate degree as well. To practice, they have to pass an exam by the American Midwifery Certification Board. After they do so, they can work in hospitals, clinics, homes and birth centers to provide gynecological AND obstetric services anywhere in the US. They can also prescribe medications just like a physician.
Certified midwives (CM) are similar. They have a graduate degree in midwifery and are required to pass the same exam as CNM's. The biggest difference is that their undergrad work is not in nursing. Unfortunately, only a few states within the US allow them to practice.
Certified professional midwives (CPM) deliver in homes and birth centers. In order to work, they have to pass the requirements set forth by the North American Registry of Midwives. Once they pass those requirements, they can practice in some states but they cannot do as much as a CM or CNM, such as prescribe medications.
In the US, midwives are becoming increasingly popular as moms are striving for lower intervention births.
OBGYNs are still extremely common in the US for prenatal care. Not only can they provide care for low-risk pregnancies, but since they are trained medical and surgical professionals, they can offer services for higher-risk pregnancies and deliveries that midwives just cannot. For example, if you have an emergency or complication during your delivery, an OBGYN can provide a life-saving caesarean that a midwife or other provider could not. This can be a huge advantage, as you never know what can happen during childbirth.
Some worry that OBGYNs may intervene too much unnecessarily. While this may be true in some instances, there are a lot of OBGYN's out there that want to provide as little intervention as possible, especially when they know that's what the mother wants. It's important to remember that every medical professional will differ in their beliefs and approaches on situations. However, just know that because they are medically and surgically trained, if they worry even for an instant that the health of the baby or mother is at risk, they are going to respond with what they've been trained to do in that situation (which may mean a C-section or other intervention.)
Perinatologist/Maternal-Fetal Medicine Specialist
If this is your first pregnancy, you will likely start with one of the previous options. However, if your provider finds that you are extremely high risk, they may refer you to a perinatologist (or maternal-fetal medicine (MFM) specialist). This is often the case if they find that either you or your baby has a condition that may put either one of you at risk. This may include a birth defect or genetic disorder within your baby, a chronic or serious health condition within yourself, if you've had several miscarriages or pregnancy complications in the past, or if you're over 40.
Perinatologists specialize in being able to diagnose problems, care for existing conditions, and intervene as needed. If you are referred to a perinatologist, you will likely be seen much more frequently during your pregnancy and have more testing and monitoring done.
Picking Your Provider
It's great to have options! And when it comes to your pregnancy, this is especially true! Every person and pregnancy will be different. And we will ALL have different preferences and health conditions that need to be considered. Remember, it's okay to be picky! Whomever you choose will be watching over the health of both you and your baby over the next 9 months! So choose someone you will be comfortable with and who has similar opinions and beliefs about childbirth as you do.
When picking your provider, here are some tips to find the perfect fit for you!
Decide what kind of delivery you'd like to have
The first step is to really figure out what you want your delivery to look like. What are your birth preferences? Although delivery is still a long time away, start putting together your birth plan now. Some questions you may want to ask yourself include:
- Do I want to give birth at home, in a birth center, or a hospital?
- Do I want to have a vaginal delivery, VBAC, or C-section?
- Do I want to avoid a C-section?
- Do I want to give birth unmedicated (no epidural/pain meds), or do I want some pain relief during labor?
- Do I want to avoid an episiotomy?
- Do I want to be able to move around fully during my labor, without constant monitoring?
- Will I want or need an induction for any reason? OR do I want to avoid an induction at all costs?
Not only will the answers to many of these questions help you narrow down where you will deliver if you don't already know, but it can help narrow down your provider options as well.
If you're wanting a very low intervention home birth for example, you will most likely want a midwife. If you prefer a hospital birth and having someone that can intervene if something goes wrong during delivery, an OBGYN will likely be a good choice. But remember, this is just a general guide. You can have a low to no-intervention birth at a hospital with an OBGYN. And just because you hire a midwife doesn't mean they will have the same perspectives on things as you. Every provider is different, so it's important to ask your potential provider LOTS of questions before going with them! (More on that later!)
Not all providers will be covered by your insurance, so it's important to check with your insurance before making any decisions or scheduling any appointments. It's also important to check to see if you will be covered at the location that the doctor is contracted to deliver at, as a lot of providers only have certain hospitals they can deliver at. If you are wanting to deliver in a birth center or at home, many insurances won't cover the delivery. So make sure that your insurance will cover both the provider you want as well as the delivery at the location you desire.
When choosing my most recent provider, the doctor I selected unfortunately wasn't contracted to deliver at the specific hospital I was wanting. I ultimately decided to go with the provider anyway and will be delivering in a different location than I originally planned. For me, this wasn't a huge deal because I really prioritize finding a provider that supports my birth preferences over the location, but some may be the opposite.
Ask around for recommendations
One of the best things you can do is ask for recommendations! If you have close friends or family that have given birth, see who their provider was and ask them about their experience! If you live far away from family and friends, try joining a FB mom's group and ask in there! You will likely get a lot of responses on doctors that are loved as well as those that you should probably avoid! In my experience, my favorite doctors have always come from word of mouth! Hearing real-life experiences from others and how the prenatal care and delivery went can give you a great idea on how your birth will go.
Another option is to read online reviews. Just keep in mind that just because a provider's office has a lower review on google doesn't mean that the doctor is horrible. I've noticed that a lot of reviews are about either longer wait times or even just a bad experience with insurance or the front staff. Honestly, if I see reviews about long wait times, it's often because the doctor is great at giving each patient adequate time instead of rushing them out the door. Which, to me, is a positive.
Ask your potential provider lots of questions!
Once you've found someone that you think will be a good fit, go ahead and schedule that first appointment or see if they'd be willing to meet with you for an initial consultation! Some offices are more than happy to accommodate, and meeting them will help you decide both if you feel comfortable and if their beliefs align with your own.
When looking for a new OB for my most recent pregnancy, finding a doctor that does NOT do episiotomies was very important for me. Both of my previous doctors rushed into performing them during my deliveries, and my pelvic floor suffered DRAMATICALLY from it. So it goes without saying that the first question I asked my new doctor was about that. I was so grateful when he told me that he has actually only performed one episiotomy since he started practicing, as recent research has shown that episiotomies often do more harm than good. This gave me immense comfort knowing his beliefs aligned with my own.Here are some questions you may want to ask your provider at your initial visit:
- What are your C-section rates? In what situations will you decide to do an emergency C-section?
- What is your opinion on episiotomy vs. tearing? Are your episiotomy rates high?
- Do you push for inductions at a certain point? Do you allow your patients to go past 40 weeks gestation?
- What lab testing/scans do you perform during pregnancy? Will I get more than one ultrasound?
- Do you do ultrasounds in office, or will I have to go to another location for that?
- Do you do routine cervical checks in the final weeks of pregnancy? (Remember, though--whatever the answer to this question is, you can always opt out if you don't want them done).
- Do you have experience helping moms deliver in different pushing positions, or do you only deliver with moms on their back? Have you ever helped a mom deliver not on her back even if she had an epidural?
- What hospitals are you contracted/associated with? Do I have options on where I can deliver?
- Will I get to see you for every appointment? Or will I be seeing different providers during my pregnancy based on who is available? (Some offices have a handful of providers, and they may just rotate through. If seeing the same provider every appointment is important for you, find an office that will allow you to be seen by the same provider every appointment.)
- Will you be the one to deliver (even on weekends or after hours?) (For offices with several providers, they will often switch off who is on call--this may result in you having a different doctor deliver than who took care of you during your pregnancy if you go into labor on a weekend or in the middle of the night.)
If you feel comfortable with the provider and feel like they will support your preferences during pregnancy and birth, then book those prenatal appointments!
Other Things to Consider/Keep in Mind
It's Okay to Switch Providers
Some people feel like they can't switch to a new provider if at any point they change their mind about what they want. Remember, you can switch to a new provider at ANY point, even in your third trimester, if you feel uncomfortable or unsupported. What's most important is that you get the care that you need. Giving birth can be scary and hard and you will be at your most vulnerable, so you need to feel 100% confident with who you've selected to care for you at this time.
Consider Hiring a Doula
Although some providers will claim to be on your side and support your preferences, when it comes down to it, they may default to what their standard procedure is during your delivery instead of focusing fully on what it is that you wanted. Having a doula with you that can stand up for you and vouch for you in your most vulnerable time can be a lifesaver. Just remember to interview several doulas and find someone you feel tremendously comfortable with just like you did with your healthcare provider.
Pregnancy and the thought of delivery can be terrifying! But finding a provider that will support and care for you every step of the way can help remove that fear for you! And before you know it, that sweet little baby will be here and it'll all be worth it!