Choosing a Provider

Whether you've been trying to conceive for months or you've just found out you're expecting a surprise, one of the first decisions to be made is who to go to for prenatal care. 

In many areas, the main options for maternity care providers are Obstetricians and Midwives. Sometimes Family Practitioners attend births as well. In our local area of Columbia, SC, the choice is mainly between OBs, Certified Nurse Midwives, and Licensed Midwives.

So what's the difference between them all?

Obstetricians are Medical Doctors who have specialized in pregnancy and birth. They deliver in the hospital setting and can care for anyone from low to high risk. Obstetricians also have surgical training and are able to perform Cesarean Deliveries and Circumcisions. 

Certified Nurse Midwives are Advanced Practice Nurses who have had additional specialized training specifically for prenatal care and birth. CNMs practice primarily in hospitals and birth centers and can care for low to moderate risk patients. CNMs work under the supervision of a physician (often an OB) and can transfer care to the OB if the patient becomes high risk or needs more intervention, like a Cesarean Delivery. 

Licensed Midwives are most often women who complete schooling and a clinical apprenticeship specifically focused around prenatal care and birth. Some LMs have additional medical training of some sort, although this is not required. The didactic school portion can take place in person or online, and the student finds an active LM to study and learn clinical skills. LMs only care for low risk women and deliver in home or birth centers. If a client becomes too high risk, the LM refers the client to an OB. 

Each type of providers has extensive training and experience caring for pregnant families and newborn babies. So who is best for you? Your decision will often depend on a few factors. 

1. Your medical needs
As you can see, not every type of care provider can care for every patient. Risk factors such as high blood pressure, diabetes, and any pregnancy complications may be beyond the scope a midwife can treat. If you do have a higher risk pregnancy, you're more likely to need the more advanced labor monitoring that is offered in hospitals by OBs. 

2. Where are you most comfortable?
Stress can inhibit labor in multiple ways. One of the best ways to remove some of that stress is to labor in a comfortable environment. For some people that means delivering in a hospital where baby can be constantly monitored and advanced procedures can be done nearly immediately if needed. For others they prefer to stay in their home where they are in control and can do what they want- take a bath, chill on the couch, or walk around the neighborhood. Neither of these options sound preferable to you? Birth centers can be a happy medium between the two. Birth centers provide a more home-like feel without having all of the birth equipment and messiness in your personal space. 

3. Payment/Insurance
Sometimes insurance plans only cover specific doctors delivering at specific hospitals. For many people, this can limit available options. Even if your OB is covered by insurance at your chosen hospital, sometimes the Anesthesiologist who comes for an Epidural or the Pediatrician who sees baby are not in your network, leading to more bills. At least locally, homebirth with a licensed midwife is not covered by insurance, so that would become an out of pocket expense for anyone choosing to deliver that way. Checking into who and what is covered by your insurance and thinking about covering finances if you choose to deliver out of network can be important things to look at well before you go into labor. 

4. Referrals and Recommendations
Especially if you are new to the area or are expecting your first baby, you might still have a hard time choosing who to go to for care. Asking friends, coworkers, or local social media groups who they recommend can be a good place to start.

5. OB/CNM Groups
You might find a provider that you absolutely love. Yay! But they work in a group, and you're not a fan of anyone else in the practice. Many of the local OBs and CNMs work in groups that use a rotating schedule to determine who will be on call when a patient goes into labor. Ultimately, there may only be a 1 in 5 (or however many other doctors are in the practice) of your doctor to actually be the one with you in labor! Many people are fine with this, but some are not as comfortable with that uncertainty; it's something else to consider when choosing. 

Everyone's experiences are different, and you can always change providers if you don't feel comfortable with the first (or second, third....) you choose. Many factors may lead you to seek care from any particular provider, and it is so very important that you feel comfortable with your chosen attendant. This person will be seeing you at your potentially most vulnerable time welcoming your child; that needs to be someone you are confident is up to the task.