Finding the Right Doctor or Midwife & Questions to Ask

If you decide to choose a doctor you will be taken care of by either a Family Physician (FP) (who has training in all aspects of family medicine, including obstetrics) or an Obstetrician (OB). The OB/GYN (obstetrician-gynecologist) is trained to handle pregnancy, labor, delivery, and the postpartum period. 90% of women choose an OB/GYN. The Family Physician has training in primary care, maternal care, and pediatric care. Unlike the OB, the FP has not had postmedical school training in women's reproductive and general health. (NOTE: I had a FP and absolutely loved her and my son now sees her).

If you choose to use a midwife you will be able to choose from whomever serves you locally:

• Certified Nurse-Midwives (CNMs) are registered nurses who have taken additional training in midwifery and who have been certified by the American College of Nurse-Midwives Certification Council. CNMs are legal to practice in all 50 states and the District of Columbia. The emphasis here is on you, the mother, not you...the patient. A CNM will take extra time to talk to you not only about your physical condition, but your emotional state of mind while pregnant. She'll offer you things like nutritional advice and breastfeeding support, and will probably be more "natural" birth oriented. They deal with low-risk pregnancies and uncomplicated births. Some provide ongoing routine gynecological care and some newborn care. Most CNMs work in hospitals, but others work in birthing centers and/or do home births. CNMs do have the right to offer you an epidural and other forms of pain relief, but typically, a birth attended by a CNM is less likely to include those types of interventions. CNMs have a lower c-section rate than physicians and higher VBAC (vaginal birth after cesarean) success. Studies show that births attended by CNMs are just as safe as those attended by physicians. Also, the cost of a CNM is less than an OB/GYN. Most CNMs use a backup physician in the event that a mother needs to be transferred due to complications. Around 8% of women in the USA use a CNM (Midwives attend over 70% of births in Europe and Japan!).
• Certified Midwives (CMs) are midwives with training in a health-care field other than nursing. They have received specialized training through a midwifery education program accredited by the American College of Nurse-Midwives Division of Accreditation. Check your state laws for legal status. Check your state laws for legal status.
• Independent Midwives (also known as Direct Entry or Lay Midwives) have apprenticed with other midwives, but haven't received any formal training in midwifery. They are more likely to attend home births, but some also deliver in birthing centers.
• Certified Professional Midwives (CPMs) are independent midwives that have met the certification standards athat have been set by the North American Registry of Midwives. Check your state laws for legal status.

You can check legal statuses by state by visiting  the web sites of the:
American College of Nurse-Midwives http://www.midwife.org/
and the:
Midwives Alliance of North America http://mana.org/

When you decide on either a doctor or a midwife, you may want to look for the following:

• If you know from the get go that your pregnancy is likely to be high-risk, you need to find a doctor who has experience with those issues. In may cases, that would be an OB. If your pregnancy will be low-risk, a family physician or a midwife would be just fine. If you start with a low-risk pregnancy and end up being high-risk, you can be transferred to an OB or an OB can consult on your case. Once you choose a doctor, the door isn't slammed shut; you still have the option to change.
• If you already have a family physician and you have a very good relationship with him/her, you may consider choosing that doctor. And the opposite is also true; if you don't get along with your regular doctor, you may want to choose someone else.
• When looking for the doctor that will care for you and your baby for the next few months, its important to find someone who shares the same views on pregnancy and childbirth that you do. You may have strong feelings about your pain options, breastfeeding, etc. and you'll want to find a doctor who has those same values.
• If your caregiver works with other doctors or other midwives, you may want to be sure that you feel comfortable with everyone in the practice in case one of them has to step in for the birth. 
• If you're not comfortable with a male caregiver, you may want to be sure you'll only be cared for my females.

Some questions you may want to ask a potential caregiver are:

• How long have you been practicing? How many births have you attended? What percentage of your patients' babies have you delivered?
• If you can't be present at my birth, for whatever reason, who else might be? Will I have the opportunity to meet those potential caregivers at some point before delivery?
• If there is an emergency, how can I reach you? Will you be unavailable to take my call at times, and if so, who would I call instead?
• How often are you on call? Do you expect to be on call when my due date arrives?
• Do you involve residents, interns, or student midwives in your practice? Will they play a role in my care?
• Are you affiliated with any other hospitals and/or birth centers?
• Do you attend home births?
• What is the standard schedule for my prenatal visits?
• Under what circumstances would you need to see me more often?
• How long is each appointment?
• What types of tests would you recommend I take during pregnancy?
• Are there any circumstances where I would be transferred to another provider?
• Do you recommend me writing a birth plan? 
• What is the percentage of women that you care for, that use medicated births vs. non-medicated births? What methods are they choosing (epidurals, laboring in water, freely changing positions, a doula, narcotics, etc.)? Do you encourage women to attempt non-medicated births?
• What would you recommend if my water breaks before contractions have started? Would you induce me if my labor doesn't start on it's own if my water has already broken?
• Under what circumstances would you induce labor? 40 weeks, 41 weeks, 42 weeks? 
• Will I be free to labor at my own pace, or do you believe in active management? (Note: some doctors will want to break your water [artificially rupture the membranes] or give something like Pitocin if your not progressing at 1cm/hour).
• Do you have suggestions for natural induction? 
• How much time will you spend with me while I'm in labor?
• How do you feel about the use of a doula or another type of labor support, if I choose to use one?
• Do you routinely use electronic fetal monitoring during labor? IVs? Internal fetal monitoring? Epidural? Artificially rupturing the membranes? Forceps/vacuum?
• What percentage of women in your care receive episiotomies?
• How often do the women in your care end up delivering through c-section? (Note: a doctor who specializes in high-risk pregnancies may have a higher c-section rate). What factors do you believe contribute to that rate?
• What percentage of the women in your care who are attempting a VBAC (vaginal birth after cesarean) are able to deliver vaginally? What are your protocols for VBAC?
• Will I be able to choose which position I can push in?
• Will my baby be able to remain with me after the birth? Do you support skin to skin?
• Do you provide breastfeeding support?
• How often will I see you during the postpartum period? Will my baby see you, or another care provider?
• Will I be able to eat and drink during labor? 
• (For midwives - home birth) What is your rate of transfer to the hospital? Who are your consultant OBs an will I be able to meet them?