You might be planning a pregnancy and are in search of the perfect care provider, or you might already be pregnant and feel the pressure of prenatal care breathing down your neck. Either way, relax! Choosing a medical professional to oversee your care while pregnant doesn’t have to be daunting. In fact, it can be quite fun, because you get to map out what kind of pregnancy and birth you plan to have along the way — something you will have to prepare for regardless.
What Is an Obstetrician?
Obstetricians are licensed physicians who train at accredited medical schools in the United States. The Bureau of Labor Statistics accounts for 20,090 physicians being employed in this field in May of 2015. These doctors are required to complete a combined 12 to 15 years of college education and clinical work prior to being able to practice. There are pros and cons with every care provider, but obstetricians may be judged in the harshest light. Notorious for having a less-than-desirable bedside manner, many doctors have gotten a bad rap for their attitude toward patients, which is often a symptom of their desensitization to pregnancy. It’s important to note that this is a normal consequence for any human being and can happen to both doctors and midwives.
Obstetricians are covered by all insurance policies that offer coverage for pregnancy and childbirth. That may be one of the biggest considerations many expectant parents need to take into account when making this decision. Women who are apprehensive about birth may feel more secure in opting for an obstetrician-attended hospital birth. This removes the potential for needing to be transferred to a hospital should something go wrong during a home birth or birth center delivery.
What Is a Midwife?
Midwives have been around since colonial days and perhaps even before that. There are two kinds of midwives: those who attend hospital births and those who attend home births. The latter are often referred to as lay or direct-entry midwives. Both types can attend deliveries at birthing centers, but only hospital midwives can attend those at birth centers affiliated with hospitals. Hospital midwives tend to be employed in group practices where obstetricians also practice. For that reason, they tend to treat patients much the same as obstetricians would and recommend more medical interventions than a lay midwife would.
In the event that there is an emergency which requires a Cesarean delivery, an obstetrician must step in and take over, but both kinds of midwives typically accompany Mom throughout the delivery — they just don’t tend to her medically. There are male midwives, but they aren’t common — at least not yet. A lot of women prefer female care providers when it comes to birth simply because they feel they can relate to them better and a female is more likely to have personal experience with birth that goes beyond the workplace and a textbook.
A midwife’s philosophy is deeply entrenched in the woman’s ability to trust her own body. Biologically, women were created to give birth and their bodies are entirely capable of carrying out the process without medical interventions in the majority of cases. Unfortunately, medical pressures from doctors and pharmaceutical organizations often push interventions onto uninformed parents. The Clinical Advisor reports labor induction can lead to complications and advises against it when not medically necessary — a practice that hospitals follow less and less each year.
The best thing you can do to safeguard against this is to educate yourself and sign yourself up for the most natural birth experience that you’re comfortable with. The fewer invitations you extend to medical intervention when it comes to childbirth, the fewer you will generally incur.
For women who desire natural childbirths without pain medication, a direct-entry midwife is a great possibility for them. Women who desire pain medication won’t have this option and can rule it out from the start. If you’re hoping to deliver at a birth center, make sure to check out their policies regarding birth. Some cater specifically to natural childbirth, which means epidurals and IV meds aren’t available.
How Are They Different?
Much of the care you receive while pregnant will depend on the type of provider you gravitate toward. While not all doctors are created equally, midwives tend to have a stronger reputation for allowing women to have more control over their births and having a better bedside manner overall. As a disclaimer though, high risk or complicated pregnancies are usually not eligible for midwifery care. These include:
- Problems with the placenta
- Babies presenting with chromosomal abnormalities
- Gestational diabetes
- The need for a cesarean
Generally, a midwife is more lenient when it comes to testing. Most will opt for recommending low-tech births, too. This means they see the advantages of using as little technologic intervention as possible, which research supports. A typical patient of a midwife will only receive one — if any — ultrasound at or around 20 weeks to screen the baby’s anatomy for any problems.
Complications do arise during childbirth and sometimes cannot be predicted. Between 2008 and 2009, the Huffington Post reports 129 serious complications occurred per 10,000 hospital births. It’s important to note that such issues arise far less often in low risk pregnancies — the only kind midwives can oversee. Both obstetricians and some midwives are capable of managing such complications. However, lay midwives cannot administer many medications or assist in surgical procedures. They can apply sutures if tearing occurs. The Midwives Alliance of North America states only 1 percent of infants born in home births later require hospital care.
How to Choose
It is a completely normal process to be nervous over which provider to choose. Researching both types thoroughly can get you started, but you can read a great deal about midwives and obstetricians and still, neither side may be reflected in the care provider you call and make your first prenatal appointment with.
Instead of jumping to make an appointment with the first provider you see in the yellow pages or who friends have recommended, schedule consultations with both obstetricians and midwives. These appointments are like an interviewing process where the expectant parents can discuss their hopes for the pregnancy and delivery while the providers can make it clear what their policies and views are, too.
This meeting is typically when you’ll figure out who you mesh well with and whether you are more interested in a hospital birth with an obstetrician or a home birth or birth center delivery with a midwife. Deliveries attended by lay midwives are often not covered by insurance, though some policies will provide partial reimbursement. Careful attention should be paid if planning a birth with a lay midwife since the average cost of these births ranges from $1,500 to $3,000, Money Crashers reports.
This is an important choice and one that shouldn’t be made lightly. Take time to make your needs known to potential providers and veer toward those who have more respect for your ideas and want to encourage you to birth your way, rather than theirs. If you sort through all the options and go with your gut, you can’t go wrong.