Big Decisions: Types of Providers

Hey future mamas!

As many of my friends in my community contemplate pregnancy or actually get pregnant, I'm thrilled to see that I've become a small but mighty source of information about making decisions in this process.  I love talking about it and I love helping people make educated choices about their health consumerism and their consumerism in general.  This week's posts are lovingly dedicated to multiple friends who shall remain nameless who asked me about this topic recently.  Best of luck to them and their partners in crime as they navigate these waters.

The decision of where to give birth wouldn't have even occurred to me as a decision until a couple years ago.  But as I began researching information about how to get pregnant, I realized that there were choices on where to be pregnant that I didn't even know existed.  I hope this week's posts will serve as a launching point for several of you who are doing your own research.

Types of Providers

A Doctor - This would typically be an OB/GYN but also could be a family practitioner, dependent on where you live.  They are typically affiliated with one hospital where they have "admitting rights" and that will dictate where you deliver.  OB/GYNs are surgeons by trade.  They are surgeons who have specialized in surgery required to deliver babies.  They are not typically well trained in natural child birth techniques, and are much more likely to recommend labor augmentation drugs, pain reducing medications like an epidural, and c-sections.  This is all, of course, statistically speaking, and should not be taken as a blanket comment about EVERY ob/gyn in the world.  They can provide both your prenatal care and your labor/delivery/recovery care.  Your insurance probably covers everything this provider provides.

A Midwife - There are two types of midwives... nurse midwives (CNMs) are trained first as nurses, then additionally as midwives.  In the state of MA where I live, they must practice in a medical facility (as opposed to in a home).  direct entry midwives are not nurses first.  They are more likely (in my limited experience) to work in people's homes.  Midwives are trained in vaginal childbirth.  They do not perform surgery, though they might perform small procedures like stitches necessary if you tear while giving birth.  They 'replace' the doctor in our typical view of pregnancy and childbirth... However, they are typically are affiliated with a doctor or facility who knows them well and will serve as a "back up" if your pregnancy or labor/delivery becomes high risk and you need more medical help than they are trained to provide.  They can provide both your prenatal care and your labor/delivery/recovery care.   Your insurance probably covers everything this provider provides.

A Doula - A doula is a completely separate type of provider.  I think it means "mothering the mother" in some language like Greek or Latin or something.  This person's job is not to deliver your baby, but instead is to help you through the process.  Think of them as a paid support provider similar to the role your husband or mother might serve.  They can be REALLY helpful, even if you have an active, involved husband and mother.  First, they have a wealth of knowledge that your husband and mother don't have because those people haven't attended hundreds of births.  Secondly, they probably know the venue and providers you're working with... so they can help you navigate the system while you're figuring all of this out for the first time.  And third, they are an objective 3rd party who can really help with decisions if you're in a rough spot.  Statistically speaking, women who hire doulas have FAR less c-sections than those who don't.  Your insurance probably won't cover this person, but the small amount they charge is totally worth it.  If I get pregnant again, I'm going to save up for a doula.  For sure.

Labor and Delivery Nurse - this provider is an 'assistant' to your midwife or doctor while you're in labor and delivery.  I didn't think they mattered too much when I was making decisions about where to give birth.  The thing is... on a busy night in the L/D unit, you might see more of this person than you do of your midwife.  And you CERTAINLY will see more of her than you'll see of your OB/GYN.  You don't get to pick this person.  You are picking a type of labor and delivery nurse by picking a facility.  So be sure to ask lots of questions about how L/D nurses act, provide care, etc while you're touring facilities to give birth in.  Ask how long their shifts are.  Ask how many patients they care for at one time.  Ask how they feel about drugs, lack of drugs, atypical positioning, intermittent fetal monitoring, etc... This person will become your/your husband's best friend or worst nightmare if you have a long labor/delivery.  Her services are covered by your inpatient hospital bill which is covered by your insurance.

Recovery Nurse - this provider is an 'assistant' to your midwife or doctor before you go home.  It might be the same as your L/D nurse if you're in a small facility.  Or you might not have one at all if you labor at home or in a small center and go home immediately.  I didn't think they mattered too much when I was making decisions about where to give birth.  The thing is... if you labor and deliver in a hospital and stay on the recovery unit for the average current stay of 2-3 days (4-6 for a c-section), you'll see a LOT of this provider... they give you your meds, they take your vitals, they check your bleeding, they make sure you do everything you're supposed to do before discharge... and they share a LOT of opinions while they do these things.  You don't get to pick this person (though you might be able to request the same nurse for several days in a row if you're lucky).  You are picking a type of recovery nurse by picking a facility.  So be sure to ask lots of questions about how nurses act, provide care, etc while you're touring facilities to give birth in.  Ask how long their shifts are.  Ask how many patients they care for at one time.  Ask how they feel about waking you in the night, caring for your child, co-sleeping while in the hospital, formula/breast feeding, etc, etc, etc.  Her services are covered by your inpatient hospital bill which is covered by your insurance.