Published November 03, 2007 by
When you become pregnant or suspect that you are your first decision will be what care-giver to go to [the word care-giver refers to a person-physician or midwife-who cares for pregnant and laboring women]. This decision is more important than most people realize. Care-givers may differ vastly in their philosophies and beliefs about pregnancy and birth and in their level of skill. This section provides a description of the specialists who provide maternity care and the type of care after. You will also find a list of questions to ask as a way to help you decide if a care-giver will be right for you.
Medical doctors [those with a Doctor of Medicine or M.D. degree] provide most of the maternal care in North America. All medical doctors have completed college and medical school; most have further residency training. Those who care for pregnant women specialize in perinatology, obstetrics and gynecology, or family medicine.
Obstetrician-gynecologists provide most of the maternity care in the United States, while in Canada it is the general practitioners and family physicians. In order to become a specialist in obstetrics, a physician has to pass a board certified examination administered by the American College of Obstetricians and Gynecologists or the Royal College of Obstetricians and Gynecologists in Canada.
The most highly specialized obstetrician is the perinatologist. Beyond medical school and obstetrics residency, the perinatologist takes further training in the care of high-risk pregnant women, those who have underlying illnesses, such as diabetes, heart disease, and high blood pressure, and those who have complications during their pregnancies or who had complications with previous pregnancies. Perinatologists tend to practice in large cities. Most of their patients are referred to them with complications requiring not only their special expertise but also the facilities of a large hospital with all the latest technology.
Family physicians care for pregnant women as well as other family members, from infancy through old age. They tend to refer difficult maternity cases to obstetricians or perinatologists. While the family physician is the practitioner who provides most of the maternity care in Canada, the number of family physicians in the United States who provide maternity care is relatively small and seems to be decreasing. People who choose family physicians for their maternity care appreciate the fact that the physician can take care of them throughout pregnancy and birth and then continue to care for the baby and family members.
Osteopathic physicians [those with a Doctor of Osteopathy or D. O. degree] also provide maternity care and care for the entire family. Osteopaths differ from medical doctors in training and practice and have about the same legal scope of practice.
The other large category of care-giver is the midwife. In many countries of the world, midwives are the primary care-givers for pregnant and laboring women. In North America their place is not as well established. All states have provisions for the legal practice of midwifery. In Canada, most provinces have active midwifery promotion groups who have made significant efforts in establishing midwifery as a legal form of maternity care.
The emphasis of the midwife’s training is that birth is a normal physiologic event. They learn methods for supporting and promoting women’s physical and emotional health to optimize the reproductive process. The care they give consists of thorough physical assessment and prevention of complications through education in self-care, emotional support and nurturing of the woman throughout her pregnancy and labor. Midwives do not care for women with complications of pregnancy, underlying illnesses, or other high risk conditions. Should any of these problems arise; a midwife will refer the woman to an obstetrician.
Within the broad category of midwife, there are several subcategories. In the United States certified nurse midwives are the most numerous. They are registered nurses who have taken additional one or two years of training in midwifery. Many receive master’s degrees when they complete their nurse-midwifery training. They usually practice in close cooperation with physicians in hospitals, birthing centers, and the home setting. Nurse-midwives are certified after passing an examination administered by the American College of Nurse-Midwives.
In some states other types of midwives are recognized and are licensed to provide maternity care. Licensed midwives practice in at least seven states. They receive training that is more compatible with that in midwifery training programs in Europe. They are called direct-entry midwives and do not necessarily possess a background in nursing. They usually have received some college education followed by a two or three year program in midwifery training. At present most midwives practice outside the hospital providing care for home-births and birthing center births. Their orientation and pattern of care are similar to those of nurse-midwives.
In addition, lay midwives, sometimes called empirical midwives, practice in a number of states. Most of them have received informal training-apprenticeship to an experienced midwife, participation in short courses or study groups, or extensive independent study. Their qualifications, experience and standard of care vary; some practice within the law, and others practice without legal sanction. Lay midwives emphasize the spiritual aspects of birth, as well as the physiologic and psychosocial.
If your midwife goes above and beyond the call of duty, don't forget to send her a little thank you gift to show her how much she is appreciated.