For most of us, the very first decision we will make once we’ve become pregnant is WHO is going to be the provider we trust to take care of us during pregnancy and delivery. I often notice newly pregnant moms looking for recommendations for who they should see - usually asking for a recommendation for an OBGYN - which is not surprising, since the majority of births in Nebraska (and the US) are attended by OBGYNs. While I’m not anti-OBGYN, I do want you to know that you have other options you can explore to find the provider that is best for YOU and your pregnancy.
First, let’s talk about the different options you have in general for providers:
OBGYN
An OBGYN is a medical doctor who is specifically trained in women’s health, including pregnancy and birth. They are also trained in surgery, and can provide a c-section if necessary/desired. While it depends a lot on the provider themselves, it’s important to keep in mind that an OBGYN is trained in pregnancy/birth pathology, as well as surgery - which most definitely will affect how they approach their care of you during pregnancy and birth. OBGYN’s are important to have in our healthcare system as they are highly trained in the things that can go wrong during pregnancy/birth, but it's sort of like putting a full blown cast on a bruised finger - it's a little overkill if you are healthy and have no history of pregnancy complications. If, however, you know that your pregnancy will be risky due to personal health conditions or previous issues during pregnancy/delivery, or you prefer to have a medical birth, then an OBGYN might be a good choice for you.
Certified Nurse Midwife
A certified Nurse Midwife (CNM) is a midwife who became a Registered Nurse first, then completed additional study in midwifery to provide holistic care to moms during pregnancy, labor and delivery. The midwifery model of care assumes that pregnancy and birth is a natural process that does not require medical intervention most of the time. Although midwives are often associated with “natural birth”, it is a common misconception that they do not provide pain medication during labor/delivery. In fact, you can hire a midwife to care for you during pregnancy AND still be able to get pain medication and/or an epidural during birth.
In Nebraska, CNM’s deliver babies in hospitals under the supervision of an OBGYN, and are legally prohibited from attending out-of-hospital births. The only exception to this is a free-standing birth center associated with CHI Health in Lincoln (The CHI Birth Place). If you are planning a hospital delivery, or like the idea of delivering at a birth center and do not have any known health or pregnancy complications, a CNM might be a great option for you.
Traditional or Certified Professional Midwife
There are several different types of midwives that do not fall under the “Certified Nurse Midwife” category. The most common are Certified Professional Midwives (CPM) and Traditional Midwives. A CPM is a midwife who did not complete a nursing degree prior to midwifery training, but rather completed an accredited program to become a direct entry midwife. CPMs are trained in out-of-hospital birth. A traditional midwife is similar, but they may not have completed any formal or accredited program as a midwife. Often, a traditional midwife is trained through an apprenticeship - though not always.
Neither traditional midwives nor CPMs are legally recognized in the State of Nebraska - meaning there is no path for them to practice in Nebraska as a “licensed” provider. These providers are not authorized to deliver babies at hospitals or birth centers, but instead attend home births. (Side note - if you've heard about an "unlicensed midwife" attending a home birth in Nebraska, the "unlicensed" does not mean untrained. Nebraska does not currently have a path to licensure for out-of-hospital midwives, so the midwives who attend home births are not able to obtain one). If you have your heart set on a home birth, but do not feel comfortable going unassisted, a traditional midwife or CPM might be a great option for you.
Prenatal care only - unassisted birth
You may also choose to birth at home without a provider, but still have prenatal care throughout your pregnancy - perhaps with your family doctor. If you choose this option, it may be difficult to find a provider who will see you, but it is possible. Having an open and honest conversation with your provider about your goals will help you determine if they are the right fit for you.
No prenatal care / unassisted birth
Contrary to popular belief/opinion, you CAN choose to have no provider for your pregnancy or delivery, and provide your own prenatal care based on self-education. If you have done your research, trust your body and the pregnancy/delivery process, and have done your own risk/benefit analysis, then this option could work for you.
To find the provider that’s right for you, first ask yourself what you really want out of your birth experience. You may already know exactly what you want. But if you are unsure or overwhelmed, start with asking yourself a few questions to discover what you already know, what you want to learn more about, and what you ultimately want for this experience:
What is your personal philosophy about birth? Is birth a means to an end? Or do you want to experience it as more than that?
What does your ideal birth look like?
Do you want a natural birth or want/require a medically managed birth?
What does a “natural” birth mean to you? What does "medical" birth mean to you?
What interventions during birth are you okay with? Which are you not? Do you even know which interventions you need to be aware of?
Do you have any health risks you are concerned about?
Do you have a history of complications in pregnancy?
What testing during pregnancy do you want/not want?
Do you want to be an active participant in your experience? What do you already know about pregnancy and birth? What do you want to know more about?
When it's all said and done, how do you want to feel about your experience?
When you begin to search for a specific provider, choose a few and interview them before you pick one. You can ask them the same questions as above to see how well they align with your own view of this pregnancy. You can also ask them these questions to get a better understanding of what you can expect if/when you hire them as your provider:
Ask about their C-section rates
Ask about their induction rates (as well as when/how they induce)
Ask about their philosophy/beliefs about birth
Ask about the interventions they most commonly use with patients
Ask about your options with monitoring, moving, eating, drinking and positioning during labor/birth
Ask what they like to do in their spare time, what their favorite food is, and what TV shows they enjoy - because let’s be real. A relationship is about more than the black and white questions about a single topic. This is going to be someone you trust during your most vulnerable time and with your most precious gift - they should be a person you genuinely LIKE and click with!
If you get nothing else out of this article, I want you to know this: You are hiring this provider to work FOR YOU. This is YOUR birth and YOUR experience, and you should feel free / welcome to make the decisions as you go along - from what you wear during labor to what interventions you're willing to allow.
Do your research, be informed, and be fully involved in every decision made through this exciting process.
And remember, you don’t have to choose a provider right away. This is an important decision and it’s okay to take your time. It’s also never too late to switch if you decide your provider is no longer a good fit for you. Your provider is your ally - not your boss. YOU are in charge, momma!
If you love the idea of a comfy home birth, but are choosing to give birth at the hospital for your own unique situation, check out my post about How to Make Your Hospital Birth More Like Home
