Prenatal care optionsWho provides your care
The options for prenatal
care vary across the US. It's best to investigate several different
options before deciding upon the type of care that suits your needs.
Often, however, the choice is made for you according to the HMO or type
of insurance you carry. Usually, there is an option to choose care with a
physician (family practitioner or obstetrician) or midwife. Certified
nurse-midwives (CNM) and certified midwives (CM) are graduates of a
formal program in midwifery who take a national board exam. Direct-entry
midwives (lay midwives) serve an apprenticeship and may or may not have
formalized education.
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What is collaborative care?
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| A: |
Sometimes, women develop complications in pregnancy where
specialist care is needed to assure the health of the baby or mother but
the midwife or family practice physician may still see the mother
following the plan of care outlined by the obstetrician or
perinatologist. Alternating visits may be made with the midwife.
Occasionally, a midwife may request that an obstetrician be present at
the time of birth. Collaborative care may also include other specialists
for varied conditions. Midwifery care is primarily intended for healthy
women. However, the certified nurse-midwife and certified midwife can
continue to be instrumental in many cases.
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| Q: |
How does midwifery care work?
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| A: |
Midwives are dedicated to supporting women and families, serving
as advocates for them, and providing safe, expert care. Certified
nurse-midwives (CNMS) and certified midwives (CMS), if licensed by the
state, can legally provide care to women during their reproductive
years. The certified nurse-midwife (CNM) and certified midwife (CM)
practice within a health-care system provides for consultation,
collaborative management, or referral as indicated by the health status
of the client.
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| Q: |
When might I be referred to an obstetrician or specialist?
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| A: |
Some conditions or events in pregnancy are considered too high
risk for management by midwives or family practice doctors. Referral to a
specialist would be the best plan for the mother and baby in these
cases. The scope of a midwife's practice does not allow for the care of
such clients and she would complete the visit and refer the patient to
an obstetrician for the remainder of the pregnancy. If later in the
pregnancy, an ultrasound reveals that a baby has a congenital defect
that requires intervention or a cesarean birth, the midwife would also
refer such a client to a perinatologist and the remainder of the visits
and the birth would take place at a perinatal high risk center.
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| Q: |
Does my care change if I'm having a home birth?
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| A: |
Currently, care for home birth is limited in many areas of the
US. Licensed CNMS and CMS may and do practice within the home with an
appropriately selected client population. If home birth looks like an
option for you, it is best to discuss this with your doctor or midwife.
You may not receive a ready referral, but at least you can discuss the
pros and cons from their perspective. Typically, a midwife, local doula
organization, or childbirth educator is the best source for finding a
home birth practice in your community. Once you tell your doctor or
midwife that you are planning to deliver your baby at home, they may
decline to see you for prenatal care. Some home birth providers offer
prenatal visits while others prefer you to attend regular visits with
your own doctor at his or her office. Be sure to check your insurance
plan to confirm benefits.
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| Q: |
How will I choose my prenatal care?
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| A: |
Begin your search for a care provider as soon as your pregnancy
test is positive. Look for one who suits your philosophy on care. Ask
questions about his or her experience, credentials, philosophy, birthing
practices, and support of breast-feeding. Check your insurance to see
if midwifery care is covered. By law, such care must be covered so
insist on your rights if there is reticence. Midwives who practice in a
hospital or birthing center have all pharmaceutical interventions at
their disposal but they prefer to support the natural processes whenever
possible. When necessary, midwives may discuss the use of external and
internal monitoring, oxytocin augmentation, or induction of labor,
intrathecal and epidural anesthesia, and narcotic analgesia. Midwives
manage emergencies such as fetal distress, shoulder dystocia (difficult
shoulders), hemorrhage, and other obstetric emergencies until their
consultant arrives. In some settings, midwives use vacuum extraction to
deliver babies who are in need of rapid delivery. They do not perform
cesarean births but may assist at such procedures.
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Hospital scan:
Part of your prenatal care may take place at the hospital if your doctor's practice doesn't have ultrasound equipment.
At the Doctor's office:
If you have shared care, some of your prenatal appointments will be with your doctor at her office.
Obstetrician:
An obstetrician will be involved in the care of women with complications or a multiple pregnancy.
Midwife home visit
If your care is midwife-based, a midwife may visit you at home for some of your prenatal appointments.
