Providers: You have options.
You find out you're pregnant, maybe for the first time, maybe for the second, third or more. What's the first thing you think of? Is it who your baby will be? All of the stuff you will need? Whatever your first thoughts, your mind will eventually turn to your care provider? Who will you entrust with the care of not only you, but your unborn child? There are several ways to go about this depending on your area and where you will decide to birth.
Providers can be broken down into three basic categories: OBGYNs, General practitioners and Midwives. We will talk about each of these a little bit, and the differences between them.
Most women have heard of the Obstetrician. Many have even seen one before for their well woman visits or for their birth control prescription. Obstetricians specialize in women's healthcare, including, but not limited to pregnancy and child birth. They are surgeons and are very good at recognizing and treating pathology. Depending on where you live you may or may not have an obstetrician in your community, though nearly all hospitals have one locally with hospital privileges. They may work in a group or solo practice.
Some things to note about the differences in these two types of practices: If your obstetrician is in a solo practice the doctor you hire is the only one you will see. They may have less availability and take on fewer clients than those in group practice, but you will most likely get your doctor when you deliver your baby. It is worth talking to this doctor about their availability around your due date.
If your obstetrician is in a group practice they will probably take more clients and availability will be less of an issue. The reason for this is that there is more than one doctor who can attend you. Our local OBGYN practice is a group practice and currently employs four doctors and one physicians assistant. This means that during your pregnancy you may see any of those five people at your prenatal appointments, often rotating through so that you see each of them at least once. When you deliver (assuming you do not schedule a c-section or induction with the doctor of your choice) you may get any of the four obstetricians attending you. Because of this you want to make sure that you like ALL of the doctors in the practice before deciding that they will be your attendants. You don't want to be playing Russian roulette on the day you have your baby. If you LOVE three of the practitioners and can't stand one of them, there is still a one in four chance that the one you can't stand will attend you when you give birth.
2. General Practitioners
General practitioners are much like obstetricians in that they have their MD and are trained to watch for and treat pathology. They are different in that they are not surgeons. If you are in need of a c-section an obstetrician will have to be called in to perform the surgery. They are typically (not always) a bit more laid back and many women choose them because they feel more comfortable with a doctor that they and their entire family can continue to see for their normal health issues well after pregnancy and birth. Many women who love their current family practitioner will continue to see them for prenatal care and choose them to attend their birth IF they have delivery privileges at their hospital of choice.
That brings us to a major point about general practitioners. Not all of them do prenatal care and not all of them have delivery privileges at a hospital. In my community we have over a dozen general practitioners, only two of which can/will attend births. Make sure that if you love a particular practitioner that they can attend you before you set your heart on them as your provider.
Up until now we have talked only about hospital based practitioners, but there is one other type of practitioner to take into consideration. Midwives (at least in Nebraska, I cannot speak for other states) practice outside of the hospital. Feel free to correct me if I am wrong, but at this time I know of no Nebraska midwives serving in a hospital setting. This can mean that they provide services through a birth center or in a home birth midwifery setting. This is the only practitioner that will attend you at home if that is where you prefer to give birth. Midwives are experts in normal birth. They are very good at recognizing potential issues before they become emergencies and refer women to a different medical provider if they do not feel comfortable with tending to her care.
Before we get too in depth with what a midwife is, let me first say that, contrary to popular belief, home birth IS NOT illegal for parents in Nebraska. Though, there are circumstances that make the legality for the midwife questionable. We will touch very lightly on that as we talk about the types of midwives that you have to choose from.
Midwives can be broken down into three groups: Certified Nurse Midwives (CNM), Certified Practical Midwives (CPM) and traditional midwives. At this time in Nebraska it is not legal for a CNM to practice in a home birth setting in Nebraska. CPMs and traditional midwives are not mentioned in the law at this time. CNMs can still be employed through birth centers and hospitals, though, as I mentioned, I know of no current hospitals in Nebraska that employ midwives. I do know of one birth center and one traditional midwife in Nebraska that is currently serving women.
There is yet one more type of birth to consider, and that is one where no attendant is present. The term used to describe this is 'Unassisted Birth' or "Free Birth'. For the purpose of this article, I am not talking about babies that come too quickly to get to the hospital. I am talking about women who make the conscious choice to birth with no medical attendant present. This is done sometimes because a woman cannot find an attendant she is comfortable with and sometimes is done because she wants to be completely unhindered or undisturbed during her birth process. Just because a woman does not want a medical attendant present does not mean she must be completely alone during her labor and birth. She may choose to have her partner, other children, family members or even a doula present and still be considered 'unassisted' because there is no MEDICAL personnel present.
*****Remember that a doula is NOT medical personnel. Even in an unassisted birth setting she cannot go outside of her scope of practice and perform medical duties such as vaginal exams, catching baby, cutting the cord, etc. These are the roles of a midwife. Her role as a doula does not change in an unassisted birth setting.******
Unassisted birth is currently legal in all fifty states.
**None of what is written here should be considered medical or legal advice**