{ CHOOSING A PRENATAL HEALTH CARE PROVIDER }

By Margaret Comerford Freda, Ed.D, R.N.
From Pampers Baby Care Central

By now you may have thought a lot about finding a health care provider for your pregnancy and the birth of your child. Perhaps you've already made an appointment or seen someone. Whatever the case, you want to be in good hands. This is the person with whom, for the next several months, you will be making some of the most important decisions of your (and your baby's) life. How do you go about finding someone you trust and feel comfortable with?

First, think about the type of delivery you'd like to have. Do you want to give birth at home or in a hospital? Do you want your provider to speed your labor with drugs or let it progress naturally? Do you want pain relief available to you? The answers to these questions can help you determine which of the three types of prenatal provider you'd like to work with: a physician (also called a medical doctor, or M.D.), a nurse practitioner (N.P.), or a certified nurse midwife (C.N.M.).

Physicians
Medical doctors are the most popular choice in the United States. Nine out of 10 women choose an M.D.—either an obstetrician or a family physician—for prenatal care and delivery. Obstetricians have at least four years of specialized training after medical school, and they deal only with gynecology (women's health) and obstetrics (pregnancy and childbirth). Obstetricians are trained to handle any emergency that might arise during labor, including the need for a cesarean section. Family physicians have at least three years of special training after medical school, but they treat the entire family for all medical needs, including pregnancy and birth. Most M.D.s deliver babies in hospitals.

For more information on obstetricians, you can go to the American College of Obstetricians and Gynecologists Web site, http://www.webmd.com/click?url=http://www.acog.org. To find out more about family physicians, visit the site for the American Academy of Family Physicians at http://www.aafp.org/.

Certified Nurse-Midwives
About 7 percent of women in the United States use certified nurse-midwives (C.N.M.s), who are specially trained in women's health, prenatal care, and birth. C.N.M.s are nurses with either a master's or doctoral degree. A C.N.M. not only provides prenatal care but also delivers the baby. Why would you choose a C.N.M. over an M.D.? Mostly because of the difference in birthing philosophies. C.N.M.s generally believe that because pregnancy and birth are normal events in a woman's life, pregnant and laboring women don't need many, if any, medical interventions. C.N.M.s do not use drugs to induce labor, do not generally feel that intravenous fluids are necessary during labor, encourage women to use any position they want for labor and birth, and support the participation of family members in the birth. If complications arise, they refer their patient to a physician (all C.N.M.s have referral arrangements with M.D.s). C.N.M.s work in hospitals and in birthing centers, and some assist with home births. For more information, visit the American College of Nurse-Midwives Web site at http://www.acnm.org/.

Nurse Practitioners
Nurse practitioners (N.P.s) are specially trained in women's health and usually have a master's or doctoral degree. They are licensed to provide prenatal care and well-woman care, but they do not deliver babies. N.P.s usually work in clinics with an M.D. or a C.N.M., one of whom would attend the birth. You can learn more about N.P.s on the American Academy of Nurse Practitioners Web site, http://www.aanp.org/.

Questions and Answers
Once you've determined which type of provider best fits your needs, you can start your hunt by asking your friends about their experiences. Even though choosing a provider is a personal endeavor, recommendations from people you trust are a wonderful starting point.

Your next step should be to schedule appointments with possible providers and ask them about their birthing philosophies. Why is this important? Some women feel very strongly about certain aspects of their birth: They may not want to have an episiotomy (an incision made near the vagina to give the baby more room to emerge), for example, or they may want their other children present for the birth. If you have strong wishes regarding your baby's birth, you'll want to find a provider who will accommodate your desires—labor is no time to discover that your provider has a birthing philosophy that's different from yours! You should also find out whether your provider has medical partners and, if so, what their birthing philosophies are. Most providers do have partners; otherwise, M.D.s would have to be on call 24 hours a day, seven days a week! Any of the partners could end up delivering your baby.

Hospitals and Birthing Centers
You should ask the provider which hospital or birthing center she uses, and find out the policies of that place. Some hospitals have rules about who can be present during the birth, whether pictures can be taken, and whether your baby can stay with you rather than being placed in a nursery behind glass. Also, keep in mind that each provider admits patients only to certain hospitals or birthing centers, so if you have your heart set on a particular facility, be sure to ask potential providers whether they deliver there.

The best way to find the right match is to read as much as you can and ask as many questions as it takes to feel confident in your choice of a professional partner.