Health Pregnancy

Choosing A Doctor Or A Midwife

One of the first decisions you will need to make in your pregnancy is who will provide your medical care? The two main choices are a midwife or an obstetrician. Most women give birth with an obstetrician, but midwives are gaining in popularity.

by Patricia Hughes 

One of the first decisions you will need to make in your pregnancy is who will provide your medical care? The two main choices are a midwife or an obstetrician. Most women give birth with an obstetrician, but midwives are gaining in popularity. Your philosophy of birth and the type of experience you want for your birth will help guide your decision.  

Birth with a Midwife
A midwife is qualified to deliver babies. She may be a nurse or may have received training strictly as a midwife. Midwives offer more choice in where you will deliver your baby. They work in hospitals, birthing centers and even in your own home for a home birth. You will find more personal, one on one care with a midwife, since she will see you for all your prenatal appointments and attend your birth. Women who want a natural birth often choose midwives. 
Midwives offer continuous support during labor. Doctors often aren’t in the room until just before it’s time to push. The [tag-tec]midwife[/tag-tec] is with you throughout labor and delivery. During the birth, you are likely to have fewer interventions with a midwife. In addition, you will have more options for birth positions than most doctors will allow, such as squatting, a [tag-ice]birth[/tag-ice] chair or being on all fours. If a problem or complication should arise, most midwives work with a doctor for back up.  

Types of Midwives
A Certified Nurse Midwife (CNM) is a registered nurse as well as a graduate of midwifery school. This type of midwife is certified through the American College of Nurse Midwives. They are usually licensed by the state as well. Some work in private practice and others in practice with obstetricians. Most CNMs deliver in either hospitals or birth centers. 
A Certified Professional Midwife (CPM) has graduated from a midwifery school, but is not a registered nurse. She has had schooling and clinical experience. A CPM is certified through the North American Registry of Midwives. Some states have licensing programs for this type of midwife and others do not. Most work in birthing centers or offer home births. 
A Direct Entry Midwife (DEM) may have a variety of education and training experiences. Generally this type of midwife has done an extensive apprenticeship with an experienced midwife. Ask about her education, training and experience, as they vary widely. Some states do not allow the licensing or certification of DEMs. Most of these midwives attend home births.  

Birth with a Doctor
Most women see an obstetrician for [tag-self]prenatal care[/tag-self]. An OB GYN will generally only deliver in a hospital. In many cases, there are several doctors in practice together. Throughout the pregnancy, you will see all the doctors in the practice. When you go into labor, you will get the doctor on call to deliver your baby. This results in less personal care than with a midwife, since you are seeing several different providers. During labor, nurses will provide most of your care. The doctor will come in just before it’s time to push.  
There are pros and cons to having a doctor attend your birth. Your [tag-cat]pregnancy[/tag-cat] and birth will be more medically managed with a doctor. You are likely to receive more interventions, such as IVs, Pitocin, continuous fetal monitoring and c sections with a doctor. The biggest benefit of a doctor is the expertise in the event you should experience a complication during pregnancy or delivery. If you are high risk, you will probably need to see an obstetrician. Women who want pain relief or an epidural often choose an OB GYN for care. 

Questions to Ask a Doctor or Midwife
  • Where did you receive your education or training?
  • Where do you deliver babies?
  • What prenatal test do you routinely offer?
  • Will you include me in decisions regarding my care?
  • Is the person willing to review, discuss and honor your birth plan?
  • What percentage of patients ends up with c sections?
  • How do you feel about breastfeeding?
  • Will the baby be taken away for evaluation or kept in the room with me?
  • What interventions are commonly used during labor and delivery?
  • How do you feel about patients refusing some prenatal testing?
  • Do you routinely perform episiotomies?
  • What type of birthing classes do you recommend?
  • Can dad cut the cord after the birth?
  • What is the protocol for inducing labor?
  • What is your philosophy of child birth?  

Patricia Hughes is a freelance writer and mother of four. Patricia has a Bachelor’s Degree in Elementary Education from Florida Atlantic University. She has written extensively on pregnancy, childbirth, parenting and breastfeeding. In addition, she has written about home décor and travel.

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