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Maternity care: Knowing your options



Photo: Sandor Weisz/Flickr

 

It's helpful to know how maternity care providers differ from field to field as you’re making this important choice. Here's a quick comparison of training, philosophies and practices of midwives and doctors.

 

Licensed Midwife/Certified Professional Midwife (LM/CPM)

LM/CPMs view birth as a safe, natural, normal human process that is best approached with minimal intervention. They serve women at low risk for complications in birth and refer those with risk factors to physicians. They complete a minimum of three years of training in an approved midwifery education program, qualifying them to care for women throughout the childbearing year, from conception through postpartum and early parenting. LM/CPMs provide routine gynecological checkups, including pap smears. They conduct prenatal exams, attend women during labor and birth and provide postpartum care, breastfeeding support and newborn care.

Location of Birth: Births with LM/CPMs take place at home or at a birth center.

Insurance: Most LM/CPM care in Washington is covered by Medicaid. Several insurance companies also cover this care.

Referrals, Transfers, Emergencies: A midwife will refer a woman to a physician or obstetrician prenatally if the client has any condition that is defined as high-risk, including high blood pressure, diabetes, placental anomalies or multiples (twins or more). Midwife clients who desire pain medication during labor or those who need other medical intervention during labor are transferred to the nearest hospital and/or a backup physician.

 

Certified Nurse Midwife (CNM)

CNMs also view birth as a safe, natural, normal human process that is best approached with minimal intervention. Unlike licensed midwives, they are required to work in collaboration with a physician and are overseen by the medical chief of staff of the hospital. They also serve women at low risk for complications in birth and refer those with risk factors to physicians. CNMs graduate from a two-to-four-year nursing program to become registered nurses. They then complete a minimum of one year of training in midwifery care to serve women throughout the childbearing year. CNMs also provide routine gynecological checkups, including pap smears. They conduct prenatal exams, attend women during labor and birth and provide postpartum care for mothers, breastfeeding support and newborn care.

Location of Birth: CNMs generally assist births in a hospital under the direction of a medical doctor. Some attend births at home or at a birth center.

Insurance: CNM care in Washington is covered by most insurance, including Medicaid.

Referrals, Emergencies: A CNM will refer high-risk pregnancies to a physician or obstetrician. The CNM works in collaboration with the physicians and obstetricians on call when complications arise during labor and birth labor in the hospital. Like licensed midwives, CNMs transfer those needing medical intervention to the nearest hospital or their backup physician in the birth center or home setting.

 

Family Doctor (MD)

Family practitioners complete two or more years of additional training in family medicine and maternity care after graduating from medical school. Their focus is often on preventive care. They often continue to provide primary medical care to mother and child for the long term after birth. Family doctors, like other providers, provide routine gynecological, birth and postpartum care. They generally refer breastfeeding support to lactation consultants, and many provide newborn care in lieu of a pediatrician. They generally refer patients at high risk for birth complications to obstetricians.

Location of Birth: Family practitioners generally deliver babies in hospitals.

Insurance: Physician care in Washington is covered by insurance.

Referrals/Emergencies: Family Practice Physicians refer high-risk patients to specialists, including OB/GYNs.

 

Obstetrician/Gynecologist (OB/GYN)

OB/GYNs graduate from medical school and then undergo several more years (a minimum of three) of specific training in obstetrics and gynecology. Because OB/GYNs focus on diagnosing and treating medical complications, they generally do not stay at the bedside throughout labor, but rather consult with nurses throughout labor, and are there to deliver the baby and placenta and stay for a short while after the birth.

Like other maternity care providers, OB/GYNs also give routine gynecological checkups, including pap smears. They conduct prenatal exams, attend women during labor and birth and provide postpartum care for mothers. They generally do not provide breastfeeding support and newborn care, and refer new moms to lactation consultants and pediatricians.

Location of Birth: OB/GYNs attend birth in hospitals.

Insurance: OB/GYN care in Washington is covered by most insurance, including Medicaid.

Referrals, Emergencies: OB/GYNs refer patients to OB/GYN colleagues or other medical specialists.

 

Get the lowdown on birth providers & places

Trying to figure out where to have your baby and with whom? Get the lowdown on local birth provider and birthplace options from Parent Trust’s free Great Starts Guide. This comprehensive consumer guide explains how parents should look at policies, services and intervention rates, offers survey responses and quotes from new parents relating how they feel about the care they received, and provides hospital Caesarean section rates. Download the pdf here


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