Choosing a Prenatal Practitioner
One of the most important and often delayed decisions associated with pregnancy is the choice of a prenatal practitioner. With the option of choosing a gynaecologist, a family physician or a midwife, the earlier you find out who is best suited to your needs, the better is the journey of pregnancy and delivery.
Kinds of Practitioners
The difference in the prenatal practitioners lies not only in the way they treat you as a patient, but also the kind of delivery they prefer and the knowledge base they have in terms of pregnancy.
What might have suited your friend or relative might not be what you would have preferred for your birth experience. So proper thought and a basic knowledge of the how various practitioners work, as well as their work philosophy, is a good way to start and finalise your particular choice.
These doctors have studied obstetrics and gynaecology and specialise in pregnancy and birth. They undergo four years of training to know the minute details of labour, birth, child and mother care, surgery and also high-risk pregnancy. They receive a certification or a degree after the course completion and can even pursue to specialise in fields like infertility, where the doctors are called endocrinologists, or high-risk pregnancy, called maternal-foetal specialists or perinatologists.
An OB/GYN is therefore a trained doctor from a medical school. They are the ones who generally resort more to drugs, surgery, and the latest techniques than other practitioners and those who have the most theoretical knowledge about Obstetrics Gynecology. However, in practice, the many choices involved in child brith (caesarean or vaginal delivery? Epidural or natural birth?) is very individualistic and different obstetricians may have different views on the matter.
Many women prefer an OB/GYN to other practitioners because of the skill they posses, pertaining to their academic background, to handle emergency cases. Expectant mothers who fear complications find it most comfortable to ask and get advise from a doctor who knows the latest techniques and can offer a wider range of gynaecological medical treatment.
The disadvantage many feel with obstetricians is that the whole process of childbirth may become very professional and you have to deliver in a hospital environment. Also, sometimes, you may feel that slightly less personal attention is given to you than by a family doctor or a nurse midwife. Again, all these are based on an individual doctor’s way of handling his or her patients.
Certified nurse-midwives are practitioners who have had training in gynaecology at midwife schools and offer special attention to mothers either in a hospital, birth clinic or home. Many midwives also work in conjugation with obstetricians to give more personalised attention and care to a pregnant woman.
Lay midwives do not have a certificate to validate their knowledge but they too may posses the same training, course work and practical experience as a certified nurse midwife. These individuals mostly practice in homes or private birth clinics.
In England, almost 80% to 90% of low threat, normal deliveries are performed by midwives. The high preference is probably due to the more informal background of the practitioners. Many women feel that they can open up and speak to a midwife more freely than a professional doctor. In addition, as childbirth is considered by many, as not a sickness, but a normal, natural procedure, the decision to opt for a homebirth midwife can be preferred over having a doctor insist on a hospital for the delivery. Furthermore, many women recognize that midwives have been helping women give birth for centuries while it is only within the last few hundred years that medical doctors have begun delivering babies.
The approach of midwives towards prenatal care is more friendly and personal and focused on the woman as a whole. Midwives use less technical methods than an obstetrician does, though they may regularly consult one for special treatments. These practitioners also provide more practical knowledge about childcare, care during labour, and birth plans to parents. Midwives look to encourage parents and family members to work on an individual basis and to be proactive in their pregnancy and birth.
However, opting for a midwife does have its downside. Midwives are not trained to look after pregnancies classified as "high-risk" or deal with any complexities that might arise during birth. Treatment procedures, like giving anaesthesia or performing a surgery, do not fall under their line of work. Midwives can monitor a pregnancy but may refer a mother to a doctor for special medical attention. They may also not work with a mother who has a systemic disease, like diabetes.
The experience, familiarity, place of practice and knowledge of a midwife are important considerations to be made by future parents before choosing one for their pregnancy journey.
As the name suggests, these doctors don’t just specialise in pregnancy cases but are general practitioners who provide medical attention to the whole family. Many parents believe that referring to a family physician is better than an obstetrician or a midwife because they can provide the professional information and also take care of the child’s and mother’s health after birth.
Many family physicians have operated independently and successfully delivered babies though some may refer you to an obstetrician if they feel you need more specialised prenatal care. Expectant mothers may also prefer going to a family doctor because of the familiarity with the doctor and his approach, due to their continuous interaction with them in the past. A background of family practice medicine also helps these doctors to look into the patient’s overall health rather than concentrating just on the prenatal care.
Family doctors mostly prefer natural births and avoid taking high-risk cases or refer these mothers to other specialised doctors. Their approach is friendly and they too encourage a woman’s partner to understand the importance of prenatal care and participate throughout the pregnancy and delivery.
A doula is a professional individual who does not help in childbirth but acts as a support for the mother. There are usually two kinds of doulas, those who take care of the prenatal health of the mother and others who give postnatal support. Some doulas may offer both while others work on one type of care only.
In the UK, there are a number of doulas who have received professional doula training in labour support and are members of an organisation. They are mostly women who have themselves experienced childbirth and are rearing a child. Because of their personal experience and professional training, they can many times give timely and much needed support, especially to first time mothers. Though a doula cannot offer any medical advice, she can offer tips, such as breathing techniques, exercises, diet, movements, that can help make labour easier for mothers. Many studies have found that doula-assisted births are generally quicker, have fewer complications associated with them and result in caesarean sections less often compared to births without a doula.
A doula can work with a midwife or an obstetrician and while these individuals help the actual process of childbirth, a doula is there to help the mother. You can hire a doula full time or part time and they can work with you at home or at a hospital.
Making the Right Choice
Once you understand the role and expertise each kind of prenatal practitioner has, it is important to ask yourself the following questions:
- how much information will you want your practitioner to provide you with?
- do you want your prenatal health care provider to make all the decisions?
- do you want to be proactive in your pregnancy and labour?
- is it important to you to have a natural birth?
When the answers to such questions are clear in your mind, you can look for practitioners in your area who closely suit your needs. If you have a number of people who could be your practitioner, do not hesitate to analyse each one’s experience and approach, as this will do you good in the end.
Some women may also have a gender preference. Though both male and female practitioners are equally trained, it is not unusual for a woman to have preference towards a particular gender. Do not hesitate to word your thoughts before selection though it won’t hurt to check out all the doctors and midwives in your area, regardless of gender.
Once you have short-listed a few of the caregivers, the next step is to interview them. This simply means making an appointment with them and asking a few questions about their practice philosophies. During this "interview," you will also want to ask questions regarding their consultation times, whether they offer late or early appointments, how to contact them during an emergency, whether they work alone or with a group of other practitioners, and whether anyone else may look after you during your time there.
Though it may sound too early, you should also try to find out what kind of facilities you are provided with when in labour. If you are delivering in a hospital, are the specialists around and can you keep the baby in the same room as yourself? Another important question is whether your insurance will cover the cost of your choice of practitioner.
Finally, you should choose a practitioner with whom you are most comfortable with and you can trust completely. Only then will you get maximum satisfaction with the treatment you receive and bring home pleasant memories along with the baby.