Obstetrician-gynecologist (OB/GYN)

An obstetrician-gynecologist (OB/GYN) is a medical doctor who specializes in the care of pregnant women and in delivering babies. Obstetricians also have special training in surgery so they are capable of doing episiotomies and cesarean sections. Women who have health problems or pregnancy complications should see an obstetrician.

Certified Nurse-Midwife (CNM) or Certified Professional Midwife (CPM)

A certified nurse-midwife (CNM) and a certified professional midwife (CPM) specialize in prenatal care, labor, and delivery. Both can be a good option for healthy women at low-risk for problems during pregnancy, labor, or delivery. A CNM does not need experience delivering babies in home settings and most practice in hospitals and birth centers. A CPM is required to have experience delivering babies in home settings because most practice in homes and birthing centers. Both should have a back-up arrangement with an obstetrician in case of a problem or emergency.

Doula

Some women also choose to have a doula assist with labor and delivery. A doula is a professional labor coach who gives physical and emotional support to women during labor and delivery. They offer advice on breathing, relaxation, movement and positioning. Doulas also give continuous emotional support and comfort to women and their partners during labor and birth. Doulas and midwives often work together during a woman’s labor. Check with your health insurance company to find out if they will cover the cost of a doula. When choosing a doula, find out if she is certified by Doulas of North America (DONA) or a comparable group.

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Hospitals are the number one choice for women, but there are two other alternatives: birthing centers and your own home.  If you are wondering which choice is the best for you, let us offer a synopsis of each option.

Keep in mind that you will need to check your insurance policy to verify your coverage.  Many companies offer little or no insurance at all at birthing centers or at home.

Hospital

Women with health problems, pregnancy complications, or at risk for labor and delivery need to give birth in a hospital. Hospitals offer the most advanced medical equipment and highly trained doctors and medical aids specifically for delivering babies.  (Actually, you should check into the qualifications of the hospital and doctor before deciding who you will use).  Epidurals and other pain management options are available only in a hospital.  Should some emergency arrive, the hospital is the place to be to get an emergency c-section.

Only certain doctors and midwives have privileges at each hospital.  Before you choose a doctor or midwife, learn about the hospital they are affiliated with.  Here are some considerations:

• Is the hospital close to your home?
• Is an anesthesiologist at the hospital 24 hours a day?
• Do you like the labor and delivery rooms?
• Are private rooms available?
• How many people can you invite into your room?
• Does it have a neonatal intensive care unit (NICU)
• Can the baby stay in the room with you?

More and more hospitals offer the choice of a birthing center.  The obvious advantage is that in case of an emergency, the full services of the hospital are right there.

Birthing Centers

Healthy women who are at low risk for problems during pregnancy, labor, and delivery may also choose to deliver at a birthing center (also known as a birth center).   Birthing centers strive to provide a cozy, homelike setting in which to deliver your baby.  They try to provide a warm, family friendly atmosphere.  Normally certified nurse/midwives, not obstetricians, deliver the babies at a birthing center.

Many birthing centers have showers and tubs in their rooms, for the comfort of the mothers.  They also tend to have large beds and rocking chairs for a more homey atmosphere.  In general, the centers allow more people in your room along with you.

Generally, birthing centers do not provide the “normal” birthing procedures.  You will not be hooked up to an IV.  You will not be attached to an electric fetal monitor at all times.  However, from time to time the nurse or midwife will check your baby with a hand held monitor. Once your baby is born he/she will be attended to in your own room.  The experience of a natural and personal birth without the high tech intrusions is a goal of a birthing center.

Although some pain medications may be available at a birthing center, epidurals are not.  The centers are not equipped for cesarean sections, so if one becomes necessary, you will have to be moved to a hospital.  Some basic emergency care for you and your baby is usually available, but only to make due until you can be transported to a hospital.

Birth centers can sometimes be in a hospital, or affiliated with a hospital, or completely independent.  If you are seriously interested in using a birthing center, make sure it is accredited by the Commission for the Accreditation of Birth Centers.  These accredited centers have affiliated doctors at a nearby hospital in case of problems.

Home Birth

Healthy pregnant women with no risk factors are good candidates for home delivery.  There are some nurse/midwives and doctors who are willing to assist you in your home.  Again, you should check with your insurance company to see what they may cover in a home birth.

In the United States, planned home births are still pretty controversial.  Finding a doctor who will encourage a home birth, even in the best of circumstances, is a rare thing.  They feel that the best and safest place to be for delivery is the hospital.

The main advantage to having a home birth is that you will be able to have the comfort and privacy of being in your own home.  Not to mention the financial benefit.  At home, you will have the advantage of being in control.  You won’t have to deal with the routine procedures of a hospital, or a birthing center.

The disadvantage is that if an emergency arises, you will not have the facilities of a hospital there to back you up.  You will have to wait until you and your baby can get to the hospital.  This is something to look into if you are considering this option.  Find out what you can expect as far as getting an ambulance to your home.  How long is the response time?  Also, women who give birth at home have no pain relief options to speak of. If you live far away from a hospital, home birthing is probably not a choice for you.  In addition, you should have a licensed, experienced midwife with you.  She should also have access to a physician 24 hours a day.

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