How to Choose a Healthcare Provider for Your Pregnancy and Childbirth

Getting pregnant and preparing to welcome a new baby into the world is a life-changing experience. Choosing a healthcare provider to help care for you during this is time is a big decision.

Different types of obstetric healthcare providers can fill these needs. Angela Washer, APRN-CNP, recommends exploring your options and thinking carefully about what’s most important to you as you go about choosing the best provider for you.

Health care providers to consider

Certified nurse midwife (CNM)

Midwives are registered nurses with a master’s degree in nursing, with a strong emphasis on clinical training and midwifery. “They provide comprehensive, family-centered maternity care from the first prenatal visit through labor and delivery, and after the birth of your baby,” Washer says.

They work with obstetricians who are always available to assist if complications happen during pregnancy, labor or delivery.

Obstetrician-gynecologist (Ob/Gyn)

This type of medical doctor is trained to provide medical and surgical care to women. Ob/Gyns spend four years after medical school in a residency program studying reproduction, pregnancy and female medical and surgical problems. They are certified by the American Board of Obstetrics and Gynecology.

Perinatologist

Also called a maternal-fetal medicine specialist, a perinatologist is an obstetrician who specializes in the care of women who might face special problems during their pregnancy. These include women who:

• Are under age 18 or over age 35.
• Have certain medical conditions such as diabetes or hypertension.
• Have an inherited (genetic) disorder.
• Have had problems during previous pregnancies.

Perinatologists can help manage high-risk pregnancies and provide preconception counseling and sophisticated prenatal diagnosis and treatment.

Doula

A doula is a professionally trained labor and birth assistant who can provide education and physical and emotional support during labor and birth. Some doulas provide both pre- and post-birth services. When you choose and meet with your doula, you can discuss how they can best help you during labor, birth or postpartum. It’s important to note that most insurance providers don’t cover the costs of a doula.

Questions for choosing an obstetric healthcare provider

Try to schedule an introductory visit to meet with the provider you think you’d like to work with and determine if you feel comfortable with them. Consider the following questions to help you form an opinion about the provider and determine whether they’re a good fit for you:

• How long has the provider been in practice? When and where did they receive training?
• Is the provider board-certified? Have there been any problems with the provider's medical practice? (Your state medical licensing board will know this information.)
• What are the provider’s general philosophies about pregnancy, labor and delivery? How do these fit in with your own beliefs?
• How many babies does the provider deliver per week?
• Is the provider in a group practice? Will you see every provider with whom they rotate? Do you have a choice about who you see and who assists in your delivery?
• If the provider is a doctor, will you see them at every visit, or will a nurse see you during prenatal visits?
• At what hospital/facility does the provider have privileges? This will determine where you have to go if you want that person assisting in your delivery.
• Will the provider be in town around your due date? (Note that there are no guarantees that a specific provider will deliver your baby since no provider is available 24 hours a day.)
• If you have a question, who do you call? Does the provider accept questions via email?
• If you create a birth plan, will it be respected?
• What is the provider’s policy on inducing labor if you go beyond your due date?

How should you choose where to have your baby?

You also have many options when it comes to where to have your baby.

Hospitals

If you’ve already selected a healthcare provider, ask where they deliver babies. If it’s a hospital, you might ask about the following:

• Is the hospital within a reasonable driving distance?
• What are the standard procedures when a woman arrives in labor?
• Is there an anesthesiologist on duty in the birthing unit, or is the anesthesiologist on call? This might be important if there is an emergency or if you want pain relief. It will take longer if the anesthesiologist is not on duty at the hospital.
• What is the nurse-to-patient ratio? “One nurse per two women during early labor and one nurse per woman in the pushing stage of labor is ideal,” Washer says.
• Is the hospital a teaching hospital? Will medical students or residents attend your birth? Can you limit that if you are not comfortable with it?
• What is the hospital’s policy on the use of electronic fetal monitoring? If fetal monitoring is required, what is the required length of time?
• Does the hospital have perinatologists or neonatologists on staff?
• Does the hospital have a Newborn Intensive Care Unit?
• Does the hospital have an option where you can labor, deliver and recover in one suite? Some women prefer to stay in one room for their entire stay.
• What are the features of the birthing? Are birthing balls, peanut balls, squat bars or birthing chairs available?
• Is there access to a whirlpool/tub or shower for women in labor?
• Does the hospital support skin-to-skin care after birth?
• What is the hospital’s cesarean rate? Epidural rate?
• What methods of pain relief are available to women in labor at the hospital?
• Can your partner or another support person be with you at all times during labor and birth? Can your partner be in the operating room if you have a C-section?
• Is photography or video recording allowed in the birthing room?
• Can your partner spend the night in your room after delivery? What type of sleeping arrangements are available?
• Are there lactation consultants on staff?
• When can family and friends visit? Are children welcome? Is visitor parking free?

Birthing centers

Although most births take place in hospitals, more women are choosing to have their babies in other locations such as at birthing centers. These are usually located near a hospital and are run by certified nurse-midwives or doctors. If you’re thinking of giving birth at a birthing center, be sure to research the staff’s credentials. Though it’s rare, problems during labor and delivery can arise, so you’ll want to be sure you can get the best care possible.

Home deliveries

Home birth is common in other parts of the world, but in the U.S., very few babies are born at home. Most doctors and midwives won’t agree to do a home delivery. “The reason is simple: life-threatening complications can happen fast during labor and delivery, and most homes are too far away from a hospital where you can get emergency care,” Washer says.

If you have any questions about your birthing options, don’t hesitate to reach out to some of the healthcare providers you’re considering for your pregnancy care.