Comfort Measures in Labor: Caregivers
A mother has several options for the type of caregiver she choses to oversee her pregnancy, labor, and delivery. There are four main options for a mother: obstetrician/gynecologist (Ob/Gyn), family physician, midwife, or no provider. I will briefly go over some of the main characteristics for each of these with the exception of no provider or what is often referred to as unassisted birth. I do not offer my doula services for planned unassisted births and do not feel comfortable speaking on the subject. There several other sites that speak on the subject so if that is something that interests you, please do your research first.
Obstetrician/gynecologists are physicians. They have been to medical school and then continued their education by specializing their studies in female reproduction.
Ob/gyns most often have a practice separate from the hospital where women are seen in the office for their appointments. These physicians will see women typically from the onset of puberty (or when a girl first gets her period or becomes sexually active) throughout her life. Ob/gyns will deliver babies in a hospital.
Many women feel very comfortable with an ob/gyn due to their extensive training and specialized education in handling complicated births and medical situations. Some women are not comfortable with this type of physician because they feel their desire for a specific birth type may not be as welcomed. Women seeking a natural birth are often nervous that their ob/gyn may say they are in support of natural birth but then pressure her later for induction, interventions, and even cesarean section.
It is very important for an expectant mother to be very open with her ob/gyn about the birth she desires from the earliest moment possible. If she feels that her ob/gyn is not listening or respecting her desires, she will need to find another caregiver. The more time you have to find a new caregiver, the better.
Women may also worry about who will actually be at the delivery of her child. Most ob/gyns work in a practice with a group of other ob/gyns who backup for each other. A woman may see one physican throughout her pregnancy only to be surprised to meet another physician for the first time when she is in labor. If you choose to have a ob/gyn as your caregiver, ask to be able to meet the other ob/gyns that may be called during your labor. This will at least give you the chance to recognize the face of someone who may be at your birth. Keep in mind that this situation my occur with any caregiver you choose.
Some family physicians will also provide care to you throughout your pregnancy and some will even deliver babies. These physicians have been to medical school but do not have the specialized training that ob/gyns have. They may have just as much experience as an ob/gyn, however.
A family physician will meet a mother in his practice’s office for regular visits and will deliver at the hospital. If the physician notices any abnormalities or concerns during the pregnancy he/her will refer the mother to an ob/gyn.
Some women feel more comfortable with their family physician because they have a long history with him/her. The physician may have cared for her entire family and know all about her and her family’s medical history and nuances. She may feel more comfortable with a family physician who has more specialized medical training than a midwife but may not be quite so keen to jump to c-section as some ob/gyns. A family physician is a happy medium for some families.
Other women feel uncomfortable not being treated by someone with the specialized training of an ob/gyn or may feel that a family physician may still be too hasty to suggest interventions than a midwife. Whether the family physician will be available for her birth concerns some women, as well. Most family physicians do not practice in a group or have backups. If they do, their backup may not deliver babies. If a woman goes into labor and her family physician is unavailable, she will probably be cared for by the ob/gyn that is on-call for the hospital.
There are actually two types of midwives in Texas: certified nurse-midwives (CNMs) and certified professional midwives (CPMs).
A woman often feels more comfortable with a midwife over a physician if she is seeking a natural, unmedicated, no or low intervetion birth. Some women don’t feel comfortable with a midwife due to not having the specialized training of medical school.
Midwifery has a long history of very impressive birth statistics. However, keep in mind that midwives transfer patients that indicated complications or concerning medical situations to ob/gyns. Ob/gyns may have less impressive statistics because the system works. They will provide care for the more complicated birth situations due to their specialized training. This does not mean that physicans have a lower rate of success but that they are seeing more serious birth situations than midwives who only typically provide care for uncomplicated, normal birth situations. A midwife is trained to handle emergency situations but she never wants to be in those situations so she will refer any potential cases to ob/gyns when a such a situation presents itself.
Certified nurse-midwife (CNM)
A CNM is a nurse who has additional training in midwifery. “They are registered nurses who have graduated from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education. They get “certified” when they pass an exam overseen by the American Midwifery Certification Board, and are licensed by their state to practice nurse-midwifery. All 50 states license CNMs, and most midwives who practice in the United States are CNMs.” (Childbirth Connection)
CNMs provide prenatal, labor and delivery, postpartum, and newborn care. They also can provide well-women care throughout a woman’s life. They will attend births in hospitals, birth centers, or home births. CNMs can be a part of an ob/gyn practice, a midwifery-owned practice, employees of a hospital, employed by an insurance company or health plan, or employees of public agencies.
Certified professional midwives (CPMs)
CPMs are midwives who have gone through a certification process and have passed the North American Registry of Midwives (NARM) exam. They are not nurses but have been educated in midwifery care and have experience caring for women prenatally, during labor and delivery, and in the postpartum period as well as newborn procedures. They also have approved practice plans that include an emergency care plan.
A CPM will attend a delivery in a birth center or at home births.
No matter what type of caregiver you choose for your birth, what is important is that you are comfortable with him/her, feel he/she is listening and respecting your birth goals, and you have confidence in the care he/she provides to you.