Prenatal care is extremely important for both you and your baby. You and your health care provider should work together throughout your pregnancy in order to achieve your common goal-the delivery of a healthy baby and the maintenance of your own health and happiness during and after pregnancy.
How Do I Choose a Practitioner?
The practitioner who will care for you during pregnancy and delivery should be someone with whom you are comfortable and who can provide the type of support you need both emotionally and physically. Some patients want to know everything and prefer a ?high-tech? pregnancy and provider. Others feel that pregnancy is perfectly natural and desire minimal amounts of intervention. You may want to talk to friends who have delivered and ask them what they liked and disliked about their experiences. You will also need to learn which providers are covered by your insurance plan.
Who Should Deliver My Baby?
For the average, low-risk, healthy woman, an obstetrician, family practitioner, or certified nurse-midwife are all qualified to deliver your baby.
Talking to Your Doctor
Ask your family practitioner how many babies she delivers each year. This can give you a good idea of her experience.
If you have a positive and long-standing relationship with a family physician who is qualified to perform deliveries, having her care for you during the pregnancy and for the baby after the birth can be a great experience. Family practice residents train in obstetrics for a minimum of two months. Depending on their desires when they go into practice, they may or may not want to focus on obstetric care.
A certified nurse-midwife (CNM) is another option for women desiring family-oriented, well-woman care. CNMs tend to use less technologic or invasive interventions during labor and instead, will strongly advocate for you to have a natural delivery (that is, with minimal medications and intervention). In general, a family practitioner or CNM will refer you to an obstetrician or other specialist if complications of pregnancy develop or if you require a cesarean delivery. Before these complications develop, you should know who this specialist would be, under what circumstances you would be referred to this doctor, and whether obstetrical back-up would be available immediately in an emergency situation.
Who are the Residents?
Residents are physicians who have completed medical school and are medical doctors. First-year residents are also called interns. Most doctors spend three years in residency, during which time they train under the close supervision of experienced physicians. During labor and delivery, a resident may admit you to the hospital, complete a history and physical examination, or perform your cesarean delivery. Residents do not work independently. Your physician ?calls the shots.? Although some women do not want residents participating in their care, others recognize the potential benefits. Hospitals staffed with resident physicians are teaching hospitals and, generally speaking, practice state-of-the-art medicine. Residents can increase the quality of your care by providing another set of eyes and hands. In addition, most residents enjoy helping with your delivery and will do their best to optimize your experience.
An obstetrician is qualified to provide prenatal care and labor and delivery care to women who have medical problems or particular concerns during their pregnancy. They are experts in performing cesarean or operative (vacuum- or forceps-assisted) vaginal deliveries. Any woman with high-risk medical or obstetrical problems is usually referred to a maternal-fetal medicine specialist (or perinatologist), an obstetrician who has received additional training in caring for complicated pregnancies. If you deliver your baby in a hospital setting, residents may help your obstetrician with the delivery.
What Kind of Obstetrical Practice Should I Seek?
Health care providers (family practitioners, midwives, and obstetricians) work in various types of offices and practices. These range from single practices (rare in obstetrics), to partnerships, group practices, and large HMO-type practices. Family practitioners and midwives usually work with a back-up obstetrician in case their patient requires a cesarean delivery or complications arise.
It is not always possible for the obstetrician who has provided a woman with prenatal care throughout her pregnancy to attend her delivery. Due to the demanding nature of practicing obstetrics and gynecology (sleepless nights, busy office hours, technically challenging surgeries, etc.), many obstetricians have joined group practices to consolidate their work efforts. This often involves a ?call schedule? for attending deliveries and may mean that another obstetrician in the group will deliver the baby.
Some practices may be arranged so that you will see the same obstetrician throughout your entire pregnancy. If you go into labor on a weekday, this obstetrician will deliver the baby. However, if you deliver on the weekend, the partner who is on-call for that weekend might deliver the baby.
In other group practices, you may receive your prenatal care on a rotating basis from all the obstetricians in the practice. Your baby will be delivered by the doctor who is on call that day, night, or weekend. In this case, it is important that you feel comfortable with all the providers in the group. Some practices provide prenatal care from both doctors and midwives and then have you choose the type of provider you want to attend your delivery depending on your preference in style of management.
Where Should I Deliver the Baby?
Most babies in the are delivered in a hospital setting. Some women may desire a home birth. The drawback of this situation is that if complications should occur, the mother's or baby's life may be in jeopardy because of a lack of emergency operating room services and other life-saving technologies.
Accredited birth centers now exist in the and are strong advocates of family-centered care and natural childbirth. Some are off-site (not within the confines of a hospital) and others are on-site (within the confines of the hospital, with labor and delivery or operating room suites around the corner). Both types of birth centers provide family-centered, home birth-like atmospheres, with varying degrees of access to emergency medical services.
Accredited birth centers now exist in the United States and are strong advocates of family-centered care and natural childbirth. Some are off-site (not within the confines of a hospital) and others are on-site (within the confines of the hospital, with labor and delivery or operating room suites around the corner). Both types of birth centers provide family-centered, home birth-like atmospheres, with varying degrees of access to emergency medical services.
Talking to Your Doctor
Ask your doctor about the hospital. He or she will know about the availability of anesthesia, special pediatric care, and whether there is 24-hour coverage. Ask you doctor under what circumstances patients or babies require transfer to another hospital and where they would go if an emergency should arise during delivery.
The standard community hospital will have labor and delivery suites and operating rooms for emergency cesarean deliveries. In the not-so-distant past, a woman would go through labor in one room, be taken to another room (a more ?sterile? appearing room) for delivery, be moved to another room to recover, and finally be transferred to the postpartum unit to rest for a couple of days in the hospital. Most hospitals now have LDR (labor/delivery/recovery) suites, large rooms that are usually comfortable and inviting and are equipped for labor, delivery, and recovery. Hospitals with LDR suites have separate, sterile operating rooms for cesarean or more complicated deliveries. Most low-risk women with uncomplicated pregnancies will be comfortable in an on-site birth center or the LDR setting, both of which combine the home-like, family-centered setting with the security of an operating room nearby in case an unexpected emergency should arise.
Tertiary Care Center
However, when a woman has a high-risk pregnancy that requires a scheduled cesarean delivery or when the baby will require immediate intensive care support or surgery, a tertiary care center (usually a university-based hospital) with a level III nursery (one that has ventilators or breathing machines for premature babies and access to other advanced medical technology for intensive care of sick babies) may be most appropriate. There are no consistent national guidelines for classifying hospital perinatal centers as level I, II, or III. In general, a level I center is capable of caring for low-risk patients who deliver babies at term. A level II or II+ center can handle more complicated cases and care for babies greater than 32 to 34 weeks old. If you go into labor at a level I or level II center and you have complications prior to delivery, you may be transported to a level III perinatal center. If your newborn baby is extremely premature or quite sick, the baby may be transported to a level III center.