Choosing Your Prenatal Team
Pregnancy Healthcare Team
• Choosing a Healthcare Team To Manage Your Pregnancy
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|Choosing a Healthcare Team To Manage Your Pregnancy
Did you know it really takes 3 to make a baby? That is: You, your partner - and at least one healthcare professional to monitor your prenatal care and delivery. Choosing a healthcare specialist can be daunting, particularly if this is your first pregnancy. Do you stick with the family practitioner that you have known for years, or seek out an OB/GYN who specializes in pregnancy or a midwife that encourages personalized birth plans? Your prenatal care will vary according to how and where you want to give birth, and the nature of your pregnancy as it progresses. One thing however is clear, as soon as you know you are pregnant, it is time to visit a doctor or specialist and begin your prenatal healthcare.
These are primary care physicians, which mean they take care of a wide range of medical problems and conditions. Many women visit their family doctor first to confirm the results of a home pregnancy test. The doctor is likely to carry out a pelvic exam, as well as a urine or blood test to check for HCG pregnancy hormones. As a doctor is based in the local community, rather than a hospital, it may be a more convenient option. Most doctors are able to manage uncomplicated pregnancies, but usually still refer you to a midwife or OB/GYN for certain appointments such as pregnancy ultrasound scans. Alternatively you may decide to give your total care to an OB/GYN and return to your family practitioner only after the birth of your baby.
If this is your first child, do check out our pregnancy guide for an overview on the 9 months ahead.
Obstetrics is a branch of medicine that is concerned with pregnancy, prenatal, childbirth and postnatal care. Gynecology and gynecologists deal with disorders in the early stages of pregnancy, such as recurrent miscarriages, in addition to fertility issues caused by uterine fibroids and ovarian cysts. In practice, many doctors combine these branches of medicines, qualifying in both and becoming known as OB/GYNs. Most OB/GYNS are hospital based, although some do run community based prenatal clinics or birthing centers. If you have a pre-diagnosed condition such as diabetes, high blood pressure, epilepsy, or heart disease or a history of pregnancy complications, you will need to choose an OB/GYN straight away. In limited cases, you may be referred to a Perinatologist, a sub-specialist branch of Obstetrics which deals in higher-than-normal birth risks.
• I have previously had a C-section delivery and would like to have a vaginal birth this time. Will you/the hospital support my decision for a vaginal birth after cesarean? (VBAC).
• In case my pregnancy experiences difficulties, how do you feel about electronic fetal monitoring and episiotomy? This will give you an indication as to their general practice and values.
• Also, ask about their practice. How long have you been practicing, are you board-certified, what tests do you usually perform on a woman with my background (history, age, ethnicity)? For example, what tests will you recommend if I am experiencing a pregnancy after 35?
• How do you feel about doulas or labor coaches being present during birth?
• Do you encourage families to be part of pregnancy? Do you recommend birthing classes or birthing centers?
• Do you have hospital privileges? You will also need to know if the particular hospital they are attached to is convenient for you. Most OB/GYNs only have privileges to one hospital. So when you choose your OB/GYN, you are also choosing where you give birth.
One of the main criteria for choosing an OB/GYN is that you should feel comfortable with them. Ask them questions and watch the way they respond - do they talk to you with respect and interest? Does he or she take your emotional concerns as seriously as your physical ones? Are they a patient explainer? What is their position on unmedicated childbirth as opposed to medicated? What is their opinion on labor induction. Also ask for their views on natural labor induction methods and on giving an epidural pain relief. This is an important relationship, at a very important time in your life. Only choose someone you feel you can work with and who understands your needs. Knowing your practitioner now limits the unpleasant surprises later.
Many women find a suitable OB/GYN by asking friends and relying on word of mouth. However, if you do not come up with any good recommendations you can always call the American College of Obstetricians and Gynecologists in Washington D.C. on (202) 638-5577 to get names of board-certified OB/GYNs in your zip code. Hospitals will also provide a list of doctors with privileges attached to their facility. You can ask the hospital to provide credentials for those doctors, but be aware that they are not legally obliged to divulge any litigations pending. You can however check with the state board of medical examiners to find out if the doctor in question has any complaints filed against them.
Not necessarily. Many group practices operate an on-duty rota, so the more doctors in a practice, the less likely you are to have your chosen OB/GYN in the delivery room. If it is important for you to have your OB/GYN deliver your baby, then it makes sense to work with a doctor from a smaller practice. That said, not even a solo practitioner can be available 24 hours, 365 days a year, so your delivery day cannot be 100 percent planned.
While most babies in the United States are born under the care of obstetricians, there are other options. You can also choose to work with either a certified nurse-midwife (CNMs) or a direct-entry midwife, in conjunction with a family physician. Most midwives operate independently when dealing with uncomplicated pregnancies, but have no hesitation in consulting OB/GYNs for any particular patient concern. Although midwives can perform a home birth (including waterbirths) the majority prefer to deliver in hospitals with the obvious advantages. The difference in the care they offer is more to do with alternative ways of managing pain and labor. They tend to be more active participants in the emotional and physical changes you undergo. Many pregnant women choose midwives because they feel their pregnancy is treated more individually and with special care. Midwives encourage you to consider all labor and delivery options including natural labor induction methods and to formulate a personalized birth plan. Many US studies show that those women with normal pregnancies who opt for care under a certified midwife have just as good an outcome as those working with OB/GYNs. If your pregnancy develops complications, your midwife will refer you to an obstetrician or a perinatalogist - even though, she will probably still remain available throughout the birth and afterwards.
If there is any history of genetic disorders in the family you may have been referred to a genetic counselor before pregnancy. A counselor helps high risks couples improve their odds of having a healthy child.
And finally, knowledge is power. Keep up to date on pregnancy magazines and all those parenting websites. When you hear or read about some new obstetrics, ask your chosen healthcare provider for his or her take.
|Related Articles on PREGNANCY
For more on preparing for childbirth, see the following:
• Paternity Testing - guide to tests before and after childbirth.
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