Choosing a Prenatal Caregiver: Doctor or Midwife?

I have read countless books about pregnancy and childbirth. Each one I've read that has a section about choosing a caregiver has stressed the importance of choosing the right one for what you want. Most often, the caregiver you choose will also determine the location where you will birth your baby, and vice versa. Your caregiver also has a large impact on how your pregnancy and childbirth are handled and any interventions that are likely to be made. I have a list of excellent books on the right side of this page that you can refer to for suggestions on interviewing and choosing a caregiver that is right for you, so I won't go into great detail here about it here, unless I get feedback asking for more information.

Here's a brief description of the types of pregnancy caregivers:

• Obstetrician - Surgeon by trade, trained specifically to handle high-risk pregnancies. Only delivers in hospitals. Services are almost always covered by insurance. Is accountable to the hospitals at which they work, and must follow all birth procedures outlined by the AMA and hospitals.
  
• Certified Nurse Midwife - Trained specifically for pregnancy and childbirth. Handles low-risk pregnancies . Must transfer high-risk cases to an OB. Can deliver in hospitals or birthing centers. Services are generally covered by insurance, depending on your plan and limitations within it. Is accountable to the hospitals and birthing centers at which they work, and must follow all birth procedures outlined by the AMA and hospitals.
• Certified Professional Midwife - Trained specifically for pregnancy and childbirth. Handles low-risk pregnancies. Must transfer high-risk cases to an OB. Only delivers at home or in a specific setting provided for birth without the equipment provided at a birthing center. Services are almost never covered by insurance, but many CPM's are willing to negotiate costs and possibly trade for their services because they understand the financial burden on families. Licensed and certified with the state, and must follow state laws and guidelines regarding birth procedures.
• Direct Entry Midwife (sometimes referred to as a "lay midwife") - Trained specifically for pregnancy and childbirth. Handles low-risk pregnancies. Must transfer high-risk cases to an OB. Only delivers at home or in a specific setting provided for birth without the equipment provided at a birthing center. Services are almost never covered by insurance, but many DEM's are willing to negotiate costs and possibly trade for their services because they understand the financial burden on families. Unlicensed, which allows more flexibility in birth procedures because they are not constrained by state guidelines.

You should definitely consider where you want to birth your baby when choosing a caregiver. It's a good idea to have a list of questions prepared before meeting with your caregiver for the first time. Suggestions for questions are listed in many books, such as "Pregnancy, Childbirth and the Newborn" and "The Thinking Woman's Guide to a Better Birth". Do your research and have a good idea of your birth preferences so that you can discuss these with your caregiver and get a feel for how willing he or she is in working with you to achieve the birth you desire. It's OK to discuss your birth preferences with a caregiver you've already been working with, but if your caregiver seems resistance to your wishes or unwilling to work with you, you may want to consider finding one that is more open to your wishes. This is YOUR choice!

My Decision:
I tend to go by feeling rather than facts or statistics. I find it tedious to interview several caregivers, but that's just my personal standpoint. I have chosen a Direct Entry Midwife because I know I want to birth at home. I am blessed to know a DEM who is a client of my husband's, and she had actually offered her services to me in my last pregnancy, but I wasn't ready to make the switch from OB to midwife or hospital to home at that time. She has 10 children of her own, and 15 years of experience with home births, and she is also willing to work with us in trading for most of her services to help keep costs down. I have talked with her on the phone, but not met with her personally yet. I get a good feeling about her, and that goes a long way for me. My husband also knows her very well and has a good working relationship with her, and that also goes a long way for me. I feel strongly that everyone present at my baby's birth should be able to work together well and as a team. I will meet with her next week and schedule my first prenatal checkup at that time. If at any point during the pregnancy I don't feel right about working with her, I am open to choosing a different caregiver. Afterall, this my pregnancy, my baby, and my choice.