Because there are a variety of different approaches and patient needs, there are a variety of health-care providers you can choose to care for you during your pregnancy and delivery. Keep in mind that you are able to switch to a different provider during your pregnancy if your needs change.

Family Physician

A family physician is trained to handle pregnancy and delivery. If you have a family physician you see for the rest of your health care and feel comfortable with, you may want to continue to see her for pregnancy care.

You should ask if she has had additional training in obstetrics beyond her family physician training. The advantage with family physicians is that they can treat pregnancy as part of the larger picture of your overall health and may also be able to treat your child once he is born.

Most family physicians are not able to do C-sections (according to the American Academy of Family Physicians, only 4.1 percent of its members do so). Many family physicians will refer a woman over age 35 to an obstetrician or maternal-fetal medicine specialist, but this varies with the family physician's training level. Family physicians attend 20 percent of U.S. births. In general, if everything about your pregnancy is low risk, your family physician may continue to care for you.

Most family physicians have at least one or two OB/GYNs with whom they regularly work and consult. Family physicians must have obstetrical backup as part of their hospital privilege requirements. It is probably wise to ask your family doctor about her obstetrical backup and whom she may consult if you develop problems during labor or develop a pregnancy problem.

Obstetrician

Most obstetricians are actually OB/GYNs, meaning they care for women's reproductive systems in general (gynecology) as well as handling pregnancies (obstetrics). If you already see your OB/GYN for yearly visits, you may decide you are comfortable continuing to see her for your pregnancy care. Many obstetricians consult with a maternal-fetal medicine specialist about patients who are over 35, sending the patient to the specialist for ultrasound and other diagnostic tests. Patients who are at high risk may be transferred completely to a maternal-fetal medicine specialist.

Maternal-Fetal Medicine Specialist

Also called a perinatologist, a maternal-fetal medicine specialist is an obstetrician who has completed an additional two to three years of fellowships after the obstetrical residency that follows medical school. Maternal-fetal medicine specialists provide care for the mother and developing baby in pregnancies that are considered complicated. This kind of specialist may take over the care of the pregnancy or consult with an obstetrician, midwife, or family physician about the pregnancy, including performing ultrasounds and other diagnostic tests.

Midwife

There are several types of midwives. A certified nurse-midwife is a nurse who has been trained and licensed to deliver babies. A certified midwife has completed training and licensing but does not have a nursing degree. There are also midwives who are not certified or licensed. Different states have different requirements and standards for unlicensed midwives.

Midwives often work as part of a larger obstetrical practice. All midwives should have an obstetrician they can consult with and to whom they can refer patients. Midwives have at least one or two OB/GYNs with whom they regularly work and consult. Midwives who deliver in hospitals must have obstetrical backup as part of their hospital privilege requirements. It is probably wise to ask your midwife about her obstetrical backup and who she may consult if you develop problems during labor or develop a pregnancy problem.

Midwives cannot perform C-sections. Midwives deliver babies in hospitals, birth centers, and at home births. Some women prefer midwives because they feel they get more personal attention and a more natural approach. Should a complication occur during a midwife-assisted birth, you will be transferred to a hospital (if you are not already in one) and cared for by a physician.

Home births are a controversial area in obstetrics, and most states have laws governing home deliveries. The pregnancy should be low risk; many would argue that advanced maternal age alone is a risk factor that would preclude home birth. You should make sure that the midwife handling a home birth is in compliance with state regulations, is complying with safe guidelines to determine pregnancy risk, is licensed in the state he or she practices in, and has an obstetrical backup and plan should problems arise.

Doula

A doula is a birth assistant who provides support, encouragement, comfort measures, and companionship to a mother during labor. Doulas are trained in assisting women and their families through the birth process. Some statistics show that a woman supported by a doula is likely to have a shorter labor and is less likely to have a C-section, epidural, forceps delivery, or augmented labor. A doula is not able to deliver the baby or provide prenatal care. You can use a doula in addition to your physician or midwife if you choose. To find a doula, you can contact Doulas of North America (DONA) at www.dona.org.