Once you have decided to conceive, then you will want to make a decision as to what kind of practitioner will care for you throughout your pregnancy, labor, and delivery. Depending upon several different factors, such as where you plan to give birth, whether your pregnancy is high risk, and what kind of insurance you have, your decision may be for a primary care physician or a midwife, or both.
Primary Care Definition
Primary care can be defined in a couple of contexts. It may refer to the doctor who provides healthcare for the majority of health services, generally a general practitioner, to a group of established patients. This is the way most insurance companies understand the definition in the context of primary care networking (doctor-insurance company interfacing for coverage). The term can also be applied to a certain level of care, usually the first care people receive unless they need more serious intervention. Different practitioners deliver primary care. The doctors may be pediatricians, obstetricians, internists, and general practitioners, as well as nurse practitioners.
When A Pregnancy is High Risk
Should there be complications from a previous pregnancy, or medical conditions that put the pregnancy in the high-risk category, it is natural that an obstetrician or a perinatologist (a doctor who specializes in high risk pregnancies) is the right choice for primary health care.
If you already have a good relationship with your ob-gyn or a GP who delivers babies, then it may not be necessary to look elsewhere for care from another source. However, if you're not convinced your primary care doctor will honor your birthing decisions, you may want to find another primary care practitioner for the pregnancy and delivery. This is where a certified midwife comes in. She will work together with you and with a secondary care doctor, such as an obstetrician throughout the pregnancy, labor, and delivery.
The Services of a Midwife
The beauty of having a midwife working together with you and a secondary care doctor, is that the midwife has the authority to address any unnecessary medical interventions during labor and delivery, where a nurse in the delivery room has no such authority. Women who have a CNM with them during labor and delivery have fewer interventions, such as continuous electronic fetal monitoring, epidurals, and episiotomies, without any difference in the outcomes for women or their babies. They also have fewer cesarean deliveries.
If the doctor is not predisposed to working with your midwife, then you may prefer to have the midwife use a doctor she has worked with in the past as an alternative. Most midwives have established excellent rapport with physicians and the doctors are happy to work with the midwives to ensure a good outcome to the delivery, especially one in a hospital or birth center. These doctors may be referred to as acute care doctors because they are not associated with the client directly and are only involved for a short period of time - during the actual birth if necessary. The term acute care is most often associated with emergency room treatments, however, the definition includes the services of an obstetrician for a birth.
Obstetricians continue to be the most common choice in the US, although certified nurse midwives are certainly closing the gap. More than 11 percent of vaginal births in the US in 2006 were attended by CNMs.
Whether a primary care physician or a midwife or both are chosen to attend the birth, the important factor is to feel safe, secure, and comfortable with the person - knowing they will respect your desires and take proper care of both your needs and those of your baby.