Monday, September 10, 2007

How to choose a provider

Ok, you are the woman - you just found out your pregnant. How do you choose a provider?

First the options available (depends on where you live to some extent)...

1. Certified Nurse Midwives (Of course I put this first - I am one :) -
A certified nurse-midwife (CNM) is an individual educated in the two disciplines of nursing and midwifery, who possesses evidence of certification according to the requirements of ACNM. Work in hospitals, birth centers, homebirth.

2. Certified Midwives - A certified midwife (CM) is an individual educated in the discipline of midwifery, who possesses evidence of certification according to the requirements of ACNM. Work in hospitals, birth centers, and homebirth.

3. Direct entry Midwives - generic term that includes a wide range of practitioners who enter the profession of midwifery through routes other than nursing education. While in the past most were apprentice-trained, there has been a recent trend toward credentialing DEMs following more standardized
educational preparation. Work in birth centers or homebirth.

4. OB/GYN - a physician who has received additional training in the specialty of obstetrics and gynecology. Work in hospital and rarely OOH.

5. Family Practice doctor - a physician who provides care to the entire family including birth - some provide this service and others do not. Some have received additional training, such as a fellowship. Work in hospital and rarely OOH.

6. Certified Professional Midwives - has received formal education, with no nursing background, work primarily OOH (out of hospital).

Ok, the options to consider when choosing a provider...(some may add to this list!)

1. The most important thing - whether they have caught (midwives catch, pizza is delivered) 100 or a 1000 babies, they should be as excited about your birth as you are! It is an honor, not a job, to catch someone's baby and be a prt of this special moment in their life. It should not be treated with a cavalier attitude. If they aren't excited - trust your instincts and find someone else. Which brings me to another very important point...

2. Trust your instincts!!!! If they don't feel right for you - find someone else!

3. Think about what kind of birth you wish to have. Remember, hospital does not equal the safest birth. Some may not have all options available to them depending on where you live.
Homebirth - you labor and birth in the setting and comfort of your own home
Birth center - a homelike atmosphere is created and birth is treated as a normal process
Hospital - a homelike atmosphere is faked by having pretty rooms but the general view of birth is often high technology and limited by hospital policies and procedures
Whatever birth experience appeals to you - you will need a provider capable and/or willing to work in which ever setting you choose
4. Trust your instincts ....did I repeat myself? That's because this point is very important. Talk to the provider about what type of experience you desire. If they poo-poo your ideas then perhaps they are not the right provider for you. The provider should be open to your ideas...if they have valid reasons why something might not be right for you that's one thing. But they should NOT poo-poo your ideas out-of-hand.
5. Who and where you choose will depend on your health as well. If you have a lot of health issues, you may be limited to the hospital. This is where it becomes even more important to choose a provider who will be there for you, advocate for you. I am a firm believer that the significant other has a very important role in your birth experience - it's not the role of advocate. They shouldn't have to do this role. They should be busy working with you to labor and birth. The provider should create a cocoon around the family.
Ok, my mind is going blank and my stomach is saying feed me so I will end here. But please, if you have questions - ASK!!!!!


AtYourCervix said...

If I were to (hypothetically) have baby #4, I would want a CNM who does homebirths this time. We have a couple of them in my county, so I'd have to check them all out and meet with them first.

As a back up, since I know too darn much about what can go wrong, I would also consult with my OBGYN group, which also has CNM's, but only delivers in the hospital. If I risked out of a homebirth at some point, I would definitely go back to the CNM's there, even though it's a huge practice with about 10 different midwives. I had a very nice, no intervention hospital birth with my last baby, with them, at the hospital.

Ciarin said...

I would want a birth center birth myself with a CNM :)

I don't want a homebirth cuz I don't want to deal with the mess :p

BillyBob said...

Even though our child is grown, I am learning a lot from you. :-)