You’re pregnant. Congratulations! Before you begin all the fun stuff such as decorating the nursery and picking out baby clothes, you’ll need to make an important decision: Who will help care for you and your baby during pregnancy and childbirth? Learn about your options so that you can put together a prenatal care team that will best meet your needs and goals.
More than 90% of women choose an OB-GYN—a physician that specializes in women’s reproductive and general health—as their prenatal care practitioner. OB-GYNs oversee prenatal checkups, ultrasounds and tests. They also take care of nonpregnancy-related female needs, such as Pap smears, breast exams and contraception.
OB-GYNs almost always deliver babies in hospitals. They are the best choice for women with high-risk pregnancies—those who are older than 35, are underweight or overweight, are carrying multiple children, have had a problem with a previous pregnancy, or a health problem such as diabetes or high blood pressure.
OB-GYNs are also trained to perform cesarean sections (C-sections), which account for more than 31% of U.S. births, according to the Centers for Disease Control and Prevention.
Keep in mind that OB-GYNs are more likely than midwives to use surgical and technological interventions, such as episiotomy (an incision made in the perineum to make more room for the baby) and a vacuum or forceps during delivery. And if you’re hoping to give birth without drugs or an epidural, an OB-GYN may not be right for you.
A family physician can serve as your primary care provider, your OB-GYN and the baby’s pediatrician, thereby meeting all of your family’s medical needs. But family physicians typically don’t perform C-sections. If complications occur, you’ll need to switch to an OB-GYN.
A midwife is not a doctor but a trained health care professional who cares for women during pregnancy, labor, delivery and post birth.
“Midwives are trained to support the natural process of birth in a way that is holistic and family-centered … while providing the least amount of intervention necessary,” says Paige Barocca, a midwife with Moonstone Midwifery in Baltimore.
That makes midwives a great choice for women who want to avoid an epidural or labor-inducing drugs. Midwives can prescribe these drugs if the woman changes her mind, and they are more likely than doctors to offer breastfeeding and lactation support.
While midwives often perform hospital births, many also deliver babies at birthing centers or, like Barocca, in women’s homes. Many health insurance plans cover midwife deliveries at a hospital, but not at a birthing center or home. However, birthing centers and midwives are typically less expensive than hospitals and physicians.
Karissa Harris used midwives to deliver her third baby at a hospital via water birth.
“Even though she was my biggest baby by almost a pound, her birth did not result in any tearing like my first two did,” Harris says. “I attribute that in part to the midwives and their willingness to let me listen to my body.”
Three main types of midwives
Midwives cannot perform C-sections. You may be transferred to an OB-GYN if an emergency arises. Learn about the three main types below:
• A Certified Nurse-Midwife (CNM) is a registered nurse with a graduate degree in midwifery. CNMs are certified by the American Midwifery Certification Board (AMCB) to perform births in all 50 states and Puerto Rico.
• A Certified Midwife (CM) has a graduate degree in midwifery and is certified by the AMCB.
• A Certified Professional Midwife (CPM) is educated via a midwifery school, apprenticeship or other professional courses before being certified by the North American Registry of Midwives. CPMs typically perform home or birthing center births and cannot prescribe many types of medications.
A doula is a trained pregnancy and labor companion who provides emotional and physical support to the mother and her family and helps to ensure that a woman has the birth experience she wants.
A doula will generally meet with family members at least once during the pregnancy to get to know them and to discuss their birth plan (see sidebar at right). The doula can help the woman find a physician or midwife, educate her on childbirth options and help ease her anxieties and concerns. “Once a family hires me, I am theirs,” says Elizabeth Oldham, owner and CEO of Doulas of Northern Virginia. “We’re walking through this together, and they know that they have somebody they can lean on through the pregnancy.”
During the birth, the doula will employ various techniques to help the mother and her partner (if she has one) relax. These techniques can include massage, aromatherapy, music and more. The doula will also serve as an advocate to help ensure the family’s preferences are followed.
Stacey Trost, a mother of two, hired a doula for the birth of her first daughter. The doula helped Trost move into various positions to ease her pain, guided her through meditations and spoke with the medical team to ensure her wishes were met.
“She was firm on my behalf, and I really appreciated that,” recalls Trost. “I felt so very looked after. I don’t know what I would have done without her.”
Like midwives, doulas are an excellent choice for women who want a natural childbirth with few interventions. Studies have shown that women who use doulas are less likely to have C-sections, epidurals, pain medications and labor-inducing drugs. Doulas can also help reduce the length of labor, improve mother-baby bonding and increase the chance of breastfeeding success.
You may wonder what all of these prenatal care providers have in common? They want women to have a healthy pregnancy and baby.
“We are not just growing babies,” says Barocca, “but growing resilient parents who are taking an active role in their children’s lives from the very beginning.”
Creating a Birth Plan
A birth plan will help you communicate your birth preferences to your medical team. Discover some of the main areas to include:
Location: Where do you want to give birth? Many women give birth at a hospital, but hospitals differ in the types of birthing rooms they offer and the protocols they follow. Home births offer women with low-risk pregnancies much more comfort, but you won’t have the amenities of a hospital if something goes wrong. Birthing centers feel more relaxed than hospitals but offer some of the same medical amenities.
Pain management: Do you want to try to give birth without an epidural or pain medications?
Induction: Do you want to be induced if your labor is going slowly, or would you rather have more time to let the process progress naturally?
Atmosphere: Do you want to play music? Would you like a certain type of lighting? Do you want to use a birthing ball or have the freedom to move around during labor?
Type of delivery: Would you like to try for a water birth? If you’ve had a C-section before, do you want to try for a vaginal birth after cesarean (VBAC), or would you rather schedule another C-section? If you opt for a C-section, do you want to see the baby coming out?
A doula can help you come up with any other items to include in your birth plan. Remember that these details are simply guidelines, not requirements. They may need to change based on how your labor goes and whether any complications arise.
This article was originally published in the June 2021 issue of Baltimore’s Child, a sister publication of Frederick’s Child.