Who's Who in the Birth World
You may have already done your homework prior to your positive pregnancy test and have a practitioner already chosen. If for some reason you need to leave your current doctor or midwife, start your search as soon as possible. The longer you wait, the harder it gets. While you can change your practitioner as late in the game as labor, it is nice to have the practicalities completed early on.
But who is who in the birth world? There are several different types of practitioners who can help you give birth.
PerinatologistA perinatologist is a doctor who has gone through an obstetrics and gynecology residency, as well as completing a fellowship (extra schooling) to specialize in maternal fetal medicine, the care of high-risk pregnancies and babies who are ill in utero. This specialist is used for the sickest of mothers, those with chronic medical problems and high-needs pregnancies, like higher order multiples. They usually have privileges at the hospital with the highest level of nursery care. Their care of the baby ends at birth.
Always be sure to check out any practitioner's certification. Don't assume a white coat means that they have all of their credentials in order. For most of the specialties and subspecialties in obstetrics you can check the American Board of Obstetrics and Gynecology for the certification history of your doctor:
An obstetrician has completed a four-year obstetrics and gynecology residency past medical school where he or she learns normal obstetrics care and some forms of care of high-risk patients. They usually practice in all sorts of hospitals from large city hospitals, to small community hospitals. Some obstetricians also practice in birth centers and a handful even do home births. Their care of the baby ends at birth.
Family PractitionerThis is a doctor who has completed medical school and a three-year family practice residency. She or he may have also completed an extra fellowship in obstetrics to allow them more surgical care of their patients if needed. These doctors usually treat only low-risk women. They also practice in many different hospital settings, birth centers, and give home births. Given their specialty is family medicine, they will usually be your child's doctor as well. You might really enjoy this continuity of care.
Certified Nurse Midwife (CNM)A nurse midwife has finished a bachelor's degree in nursing and furthered his or her education by specializing in midwifery. Midwifery is the care of the low-risk woman before, during, and after pregnancy. Midwives are also trained in well-baby care through one year of age. Nurse midwives practice in many settings, including hospital, birth center, and home birth settings. They are legal in all fifty states. Sometimes they are a part of a physicians' group and other times they are merely associated with a group — making it easy for them to get a consult from a physician when complications arise. They can also take care of your baby through the age of one, though in most instances a separate pediatrician or family practitioner is used.
The American College of Nurse Midwives is the governing body for certified nurse midwives. They can answer many questions about using a modern midwife and what her role is in obstetrical care today. You can find them on the Web at:
A direct entry midwife is a midwife who may or may not be a nurse. Her role is for taking care of ultra low-risk women and their families during the childbearing year. Many of these midwives practice only in home birth or birth center settings. Some are affiliated with a medical practice while others are not associated with any practice.
Your Infertility SpecialistIf you experienced infertility, you may wonder about keeping your infertility specialist. While a few do combine their infertility practice with obstetrics, it is not as common as you might believe. If your infertility specialist does have a combined practice you can certainly stay. Usually, they either work in a group with other obstetricians or have a referral list for their patients.
