Three experts explain what you need to know before choosing your prenatal provider.
While selecting nursery colors and baby names may be among your first thoughts after discovering you’re pregnant, there’s another important choice to make. Who do you want on your health care team for this 40-week journey?
With 211 million pregnancies across the globe annually, a lot of women make that decision daily. Expectant moms may choose an, commonly referred to as an OB-GYN, a family physician or a midwife to bring a baby into the world. You also may add a doula to your care team.
But what are the differences and how do the different disciplines influence prenatal care and a baby’s delivery? Three Michigan Medicine specialists explain the nuances of each.
This prenatal provider focuses on your reproductive health from pre-conception to postpartum. Commonly referred to as an OB-GYN, this certification is earned after four years of medical school which is then followed by four years in an OB-GYN-focused training program called residency. In that residency, doctors focus on learning about reproductive health care and primary health care for women, which includes things like health maintenance, disease prevention, diagnosis and treatment.
These residents also gain exposure to minimally invasive surgery, gynecologic oncology, urogynecology, family planning, maternal fetal medicine, reproductive endocrinology and infertility, benign gynecology and obstetrics.
More than 90% of moms-to-be select this type of expert.
Versatility is an obstetrician’s superpower, explains OB-GYN Anita M. Malone, M.D., M.P.H., a clinical assistant professor in the Women’s Health Division at the Michigan Medicine Department of Obstetrics and Gynecology.
An obstetrician is trained for any birth situation, including:
2.Most conditions that put you in a high-risk category, including diabetes, high blood pressure or previous miscarriages
3.Twins or multiples
5.Cesarean section surgery (also known as a C-section)
6.Vaginal deliveries after a previous C-section delivery (also referred to as VBAC)
Occasionally OB-GYNs reach for additional help from maternal-fetal medicine specialists or perinatologists. They help moms with babies who may have a birth defect or other high-risk condition. Through a partnership with C.S. Mott Children’s Hospital, the Von Voigtlander Women’s Hospital established the Fetal Diagnosis and Treatment Center to assist during prenatal care, delivery and postpartum for such cases.
“Essentially, why women turn to us more often is because it’s what they know,” Malone said. “Mom had an OB-GYN, my friend had an OB-GYN, so that’s why I go to one.”
Which provider they should see depends on the patient, Malone believes. She talks to each patient to discover their goals. She’s been known to refer them to a midwife after that discussion, too. It’s a decision she’s comfortable with because her grandmother was a lay midwife in the British Virgin Islands.
“I don’t necessarily think that people have to go to a doctor to get great prenatal care,” she said. “I want you to go to a skilled clinician in prenatal care to get good prenatal care.”
One important benefit of receiving care from an OB-GYN is their ability to perform surgery should a C-section be medically necessary for the baby or mother. About a third of all births in the United States are delivered through C-sections, where the baby is delivered by a surgical incision in the uterus.
“With an OB-GYN, you have the full spectrum of services available, so you can be taken care of if things don’t go as planned,” Malone said. “Your OB-GYN will be there for you in any situation.”
A family physician is a specialist who completes four years of medical school and three years of residency training. At the University of Michigan, family doctors provide prenatal care and vaginal deliveries. Some family doctors perform C-sections and others consult an OB-GYN if a C-section is needed, said Lauren Oshman, M.D., M.P.H., a family physician and an associate professor in the Michigan Medicine Department of Family Medicine.
“Family physicians tailor their scope of practice to what their community needs,” Oshman said. “In communities where there are lots of obstetrician gynecologists, many family doctors may not deliver babies. In rural areas, we have parts of the country where family doctors are the only people in the entire county delivering babies, including C-sections and high-risk care.”
As a family doctor, Oshman can provide a one-stop shop for care. Her training combines the roles of a primary care internal medicine doctor, an obstetrician gynecologist and a pediatrician for baby.
She has delivered “hundreds of babies. I stopped counting after the first 200 and that was 10 years ago,” she said. And she has forged long-standing relationships with many of them.
“The lovely thing about having your family doctor deliver your prenatal care is that it is someone who knows you,” she said. “I knew you prior to the pregnancy, during your pregnancy, and I will continue to take care of you after your pregnancy.”
“I don’t necessarily think that people have to go to a doctor to get great prenatal care. I want you to go to a skilled clinician in prenatal care to get good prenatal care.”
Anita M. Malone, M.D., M.P.H.
She recalls a patient she had long treated for anxiety and obesity. When that patient got pregnant with her first child, Oshman already knew her health concerns and was able to provide supportive care for mom and baby in prenatal visits. Now that patient’s child is 5 years old and Oshman cares for the child, too.
“It’s just such a wonderful experience to get to take care of the whole family,” she said.
Whichever specialist a mom-to-be chooses, Oshman said they can’t go wrong, especially at Von Voigtlander Women’s Hospital.
“We’re very, very lucky in our community to have so many options and great team members” to pick from to receive prenatal care.
Midwives, who work with low-risk patients, take a holistic approach to prenatal care and childbirth and follow the same prenatal care guidelines as doctors with regard to routine lab screenings and imaging. Their care philosophy focuses on education, prevention of complications and limiting intervention unless it’s medically necessary or desired by the patient, explained Maggie Fink, a certified nurse midwife at Von Voigtlander Women’s Hospital, where she is part of the Michigan Medicine Certified Nurse Midwife Service.
Their philosophy also stresses patience and honoring this natural life experience.
Midwives watchfully wait, while encouraging different body positions, as a normal birthing process unfolds, following the mom’s birth plan. They aim for a vaginal birth and can manage certain complications – gestational hypertension, diabetes not requiring medication or preeclampsia without severe features – and emergencies like fetal heart rate decelerations, shoulder dystocias or hemorrhages. They reserve the use of surgical or assistive interventions – cesarean section, vacuum- or forceps-assisted birth – for urgent or emergent scenarios. Midwives, though, “are trained to recognize when the scenario is not normal and requires more evaluation and, if necessary, consultation, collaboration or transfer of care to an OB-GYN.”
“We always are mindful that we have two patients we are caring for, mom and baby,” Fink said. “You need to make sure that both are safe and tolerating stronger more regular contractions over time.”
Another differentiator is midwives schedule more time – 40 minutes vs. 20 minutes with OB-GYNs or family doctors – with new patients for care visits, Fink pointed out.
“That’s something we midwives fought hard for, as a group, because we really need that extra time to understand the person and where they’re coming from to really give them an understanding of what we do,” Fink said.
Midwives provide a full suite of services, including gynecologic care with routine screenings including pap tests, family planning, preconception counseling, prenatal care, postpartum care, treatment for sexually transmitted diseases, and labor and birth support.
Fink finds herself clearing up a lot of midwife misconceptions at office visits. A common one is that patients who use a midwife must avoid pain medicine, including epidurals, which isn’t true. Epidurals are allowed even if you originally thought you wanted an unmedicated birth, she explained.
Fink also finds a lot of people are surprised about how much education she has. As a certified nurse midwife, she is a registered nurse with a master’s degree in Nurse-Midwifery. She is certified by the American Midwifery Certification Board, which she received after taking exams, and is licensed by the state of Michigan as both a nurse and a midwife, and she delivers babies in hospitals.
Home births may be done by the two other types of midwives: certified professional midwives and lay midwives. A certified professional midwife is a non-nurse certified by the North American Registry of Midwives. A lay midwife is an uncertified or unlicensed midwife whose training includes an apprenticeship with an experienced midwife, workshops or classes. Some states license their lay midwives while other states don’t.
“Because there are many different kinds of midwives, I think that’s where the confusion stems from,” she said. “The truth is we just love what we do, and we study really hard. And we make sure that we are skilled and trained consistently using the highest standards before we care for anybody.”
Fink admits there is also some confusion about the difference between midwives and doulas. A doula is hired by the mom-to-be to provide physical, emotional and informative support from prenatal to postpartum to achieve a happy, healthy birth experience. Regardless of which of the three specialists a mom chooses, the doula will be present with all three of them.
“A doula’s main job is to provide continuous support to a laboring person,” Fink said.
A doula rallies around the mom, often offering physical support, like applying counter pressure to a woman’s back as contractions commence, having her change positions or helping her advocate for her birth plan.
“Our nurses at Von Voigtlander do such a terrific job supporting mom. However, they take breaks and are not in the room with mom every moment she’s in labor,” Fink said. A doula is. “It’s helpful to have someone else there to advocate for you when you are in labor.”
At home afterward, a doula ensures mom is getting everything she needs, perhaps bringing a meal, helping with breastfeeding or checking on her emotionally.
The more people to watch over mom and baby, the better the outcome, Fink said.