Choosing a Maternity Care Provider

By Courtney Clark

February 18, 2012

Choosing a care provider for your pregnancy and birth is the first, and often the most daunting, task in pregnancy. Here in the Spokane/CDA region we are lucky to have many wonderful options. And yet, it’s surprising how often I meet women who pick the first OB or midwife recommended to them without an interview.

What do YOU want?

The care provider you choose will have a huge impact on your pregnancy and birth—unfortunately they don’t come “one size fits all”. As I recently heard Kim James, a certified birth doula in Seattle, WA, say, “You don’t go into a Chinese restaurant and order enchiladas. Those are going to be some weird enchiladas!” And just as you don’t expect every restaurant to serve the same kind of food, neither can you expect all care providers to provide the same kind of care.

So using the same analogy, if you were to choose a restaurant for dinner tonight you’d need to identify what kind of food you want, what restaurants are in your area, and what kind of food each restaurant serves. You might also want to look up a few customer reviews of those restaurants to be sure the food is good. When it comes to choosing a care provider you can do the same. Begin by learning what kind of birth YOU want. Follow that up by learning what care provider options are available to you locally and what kind of births they support.

Not every woman has the same ideal birth, just like not every woman is going to prefer the same kind of food. And it can be difficult, especially with your first baby, to even know what you want! But it is worth thinking over your preferences, personal values and needs. A few places to begin are:

Choosing a Birth Setting. Is there a particular birth setting you’d be most comfortable in? In our area you can choose to give birth at a hospital, birth center, or in your home. The place you choose to give birth will determine the type of care provider that can attend your birth—these two decisions go hand-in-hand.
Are you interested in an intervention-free or low-intervention birth? Do you think you might want or need an epidural?
How important to you is it that the same care provider that attends your prenatal appointments also attends your birth?
Do you have lots of questions, and would you prefer longer appointments in order to fully discuss them?

Which type of care provider fits your needs?

The good news in our area is that you have many options to choose from. The following list describes the main differences between care providers, but these are generalizations—practices will vary from provider to provider. That is one reason why scheduling an interview can be so important. I suggest using the Coalition for Improving Maternity Services “10 Questions” as a great place to get the information you’ll need to make the best decision for you and your family.

Obstetrician (OB)

Specialty: High-risk pregnancy and surgery
Setting: Hospital
Average prenatal visit: 6 minutes
During Labor: Consult periodically during labor to check progress, arrive shortly before birth to deliver the baby and monitor early recovery.

Obstetricians are doctors who have special training in prenatal care, labor, birth, high-risk pregnancy, and surgery. They have graduated from medical school and completed an additional 3 or 4 years of training in their specialty, focused on diagnosing and treating medical complications.

Obstetricians are well-suited to care for women with established serious medical problems or who are at high risk for developing such problems. They tend to view birth as a medical event best managed by highly trained specialists. Obstetricians most often have higher rates of interventions (such as cesareans and inductions) than other types of practitioners—even amongst healthy, low-risk patients.

Obstetricians tend to work in group practices which means you might not see the same doctor at every appointment and may not have your chosen doctor attend your birth. Find local obstetricians in our provider directory.

Certified Nurse Midwife (CNM)

Specialty: Uncomplicated pregnancy and birth
Setting: Hospital, Birth Center, or Home
Average prenatal visit: 20 minutes
During Labor: Remain with the mother through most of her labor, birth and recovery

Certified Nurse Midwives (CNMs) are educated in the two disciplines of nursing and midwifery. They are registered nurses who have graduated from a nurse-midwifery education program accredited by the American College of Nurse-Midwives (ACNM). Their educational focus is on normal health care during the childbearing year, parent education, prevention and screening for possible problems, and newborn care.

Nurse midwives are well-suited to care for healthy women who expect to have a normal birth. They provide prenatal care, care during labor and birth, and care after the birth. Midwives believe in the importance of women actively participating in and making informed decisions about their pregnancies. Many work to avoid unnecessary tests and treatments; and women under the care of midwives typically are less likely to have a cesarean, induction and other interventions than women receiving care from doctors. Some midwives provide continuous support throughout labor and birth. Find local midwives in our provider directory.

Direct Entry Midwife (CPM & LM)

Specialty: Normal, physiological pregnancy and birth
Setting: Birth Center or Home
Average prenatal visit: 30 minutes or longer
During Labor: Remain with the mother through labor, birth and recovery

Licensed Midwives (LM) and Certified Professional Midwives (CPM) in Washington State have completed 3 years of professional midwifery training, which includes all necessary education to care for women prenatally, during labor and birth and postpartum. This training also covers newborn care, newborn procedures and breastfeeding.

Direct entry midwives have the strongest belief in pregnancy as a normal, healthy life event rather than a medical condition and their intervention levels are the lowest. The amount of time spent with patients is typically greater than any other type of care provider and they most often have smaller case loads. Midwives provide the ultimate in personalized care that is tailored to each mother’s unique needs and preferences. Patients can choose to give birth in the way that feels most comfortable to them, including in a bath tub or birth pool—an option that is not available with any other type of care provider in our region. Direct entry midwives provide continuous physical, emotional, and informational support during labor and birth. Find local midwives in our provider directory.

Changing Care Providers

It is also worth noting that it is never too late to change care providers, or schedule an appointment with your own to make sure you are a good fit. Sometimes our preferences change as we gather more information, sometimes we discover a few months into the relationship that it isn’t as good a fit as we thought. Relationships do not improve during labor, though. If someone is making you uncomfortable, not fulfilling your needs, or not listening to your requests now it surely won’t get better when you are in labor. You didn’t sign a contract and you can explore more options at anytime, no matter how late you are in your pregnancy.