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Decision focus: your childbirth experience

By Jenilee Matz, M.P.H., Staff Writer, myOptumHealth

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Stroller? Check!

Breast-feeding ? You’ll give it your best.

Name? Narrowed it down to two family favorites.

With a few key decisions taken care of, you are ready to think about the childbirth experience.

Which type of health care provider will deliver your baby? Your family doctor or an OB-GYN? What about a midwife? Where will the birth take place? A hospital, birthing center or in your own home?

The answers to these questions are personal. Certain options will fit your needs better than others. Your choice should be based on both medical considerations and personal preference. Learn about your childbirth options so you can make an informed decision.

Who will manage my pregnancy and deliver my baby?

You can choose a doctor or a midwife to deliver your baby.

Doctor

  • Obstetrician. Many babies born in hospitals are delivered by obstetrician-gynecologists (called “ob-gyns”). Ob-gyns are doctors who specialize in women’s health, pregnancy, labor and birth. They can perform surgery, such as cesarean section, and diagnose pregnancy-related conditions. Ob-gyns have extensive training. After medical school, they complete four years of rotations in reproductive health and then pass board exams. An ob-gyn is your best option if you have a high-risk pregnancy.
  • Family practice. Some women feel more comfortable with their family doctor. Family doctors have training and experience delivering babies too. They typically handle low-risk pregnancies and can consult with an ob-gyn as needed.

Midwife. Midwives are trained professionals who care for women of childbearing age. They encourage women to make their own decisions about their childbirth experience. Not all midwives are the same. Each has different training and certifications. You should be sure that the one you choose is certified and licensed and that they have medical backup in place in case it is needed.

  • Certified nurse-midwives (CNM) are registered nurses and are licensed in midwifery by the American Midwifery Certification Board. They have at least a bachelor’s degree, have taken coursework in midwifery and must pass a national board exam.
  • Certified midwives (CM) have at least a bachelor’s degree but not a nursing degree. They are also certified in midwifery by the American Midwifery Certification Board.

Midwives offer a wide range of care, including:

  • Family planning and pre-conception counseling
  • Gynecological exams
  • Prenatal care
  • Labor and delivery
  • After-birth care of the mother and newborn
  • Preventive care

Where should I give birth?

Most babies are born in hospitals. Birthing centers and home may be options, too. No matter where you choose, make sure to tour the facility and ask about their policies before you check in. Each environment has its pluses and minuses.

Hospital. Typically, if you want an ob-gyn or family doctor to deliver your baby, you will give birth in a hospital. Certified nurse-midwives may also deliver in a hospital.

If you have a high-risk pregnancy, it’s best to give birth in a hospital. Hospitals have advanced technology and trained specialists. They deal with emergency situations every day. Being in a hospital may put your mind at ease even if your pregnancy is not high-risk. Many hospitals also have neonatal intensive care units in case a newborn needs special care.

Hospitals may have more rules about procedures and visitors. For example, you may not be able to videotape the birth, eat when you want or have as many family members present at the birth as you’d like.

Birthing center. Midwives often work in birthing centers. Doctors may work there, too. Some hospitals have a birthing center attached to them and work along with the hospital. If they don’t, the birthing center should be able to transfer you quickly to a hospital in an emergency.

This may be an option for you if you have a low-risk pregnancy. Birthing centers aim for a more natural birth experience. They usually do not:

  • Give medication for pain relief
  • Induce labor
  • Deliver by cesarean section

Birthing centers may have fewer restrictions than some hospitals. They may offer more personal care and a “home-like” atmosphere. Moms-to-be may be able to have their own room, stay in their own clothes until delivery and have as many family members around them as they’d like.

Check if your health insurance covers care in a birthing center. Not all insurers do.

Home. Home births are usually attended by midwives.

Births at home may be appealing because they cost less than hospital deliveries. They also allow mom to be in a familiar environment with more control over it.

Home births are not advised for high-risk pregnancies. Make sure your midwife has a backup doctor in case of an emergency. If there are any problems, you and the baby will need to be transferred to a hospital. Remember to think about how much time it would take to get to the hospital when considering a home birth. A long car ride may waste valuable time in an urgent situation.

View the original Decision focus: your childbirth experience article on myOptumHealth.com 

SOURCES:

  • American College of Nurse-Midwives. Differences between nurse-midwives, other midwives and doulas. Accessed: 04/22/2009
    • American Association of Birth Centers. What is a birth center? Accessed: 04/22/2009
      • American Pregnancy Association. Birthing choices: health care providers and birth locations. Accessed: 04/22/2009
        • American College of Obstetricians and Gynecologists. Planning your pregnancy. Accessed: 04/22/2009
          • Bailey JM, Crane P, Nugent CE. Childbirth education and birth plans. Obstetrics and Gynecology Clinics. 2008;35(3):497-509. Accessed: 04/21/2009
            • American Pregnancy Association. Home birth. Accessed: 04/22/2009

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