Picking a Practitioner for Care while Pregnant

Midwives, obstetricians, maternal-fetal specialists — many kinds of professionals can help you through pregnancy and delivery. Be sure to choose a practitioner with whom you feel most comfortable. Here is a list of the basic four:

  • Obstetrician/gynecologist: This physician has four years of special training in pregnancy, delivery, and women's health. He or she should be board certified (or be in the process of becoming board certified) by the American Board of Obstetrics and Gynecology (or an equivalent program if you're from a country other than the United States).

  • Maternal-fetal medicine specialist (also known as a perinatologist or high-risk obstetrician): This type of doctor has completed a two-to-three-year fellowship in the care of high-risk pregnancies, on top of the standard obstetrics residency, to become board certified in maternal-fetal medicine. Some maternal-fetal medicine specialists act as consultants, and some also deliver babies.

  • Family practice physician: This doctor provides general medical care for whole families — men, women, and children. He or she is board certified in family practice medicine. This kind of doctor is likely to refer you to an obstetrician or maternal-fetal medicine specialist if complications arise during your pregnancy.

  • Nurse-midwife: A nurse-midwife is a registered nurse who is certified in the care of pregnant women and is also licensed to perform deliveries. A certified nurse-midwife typically practices in conjunction with a physician and refers patients to a specialist when complications occur.

    When you're deciding on a practitioner, be sure to ask yourself the following key questions:

  • Am I comfortable with and do I have confidence in this person? You should trust and feel at ease not only with your practitioner but also with the whole constellation of people who work in the practice. Would you feel free to ask questions or express your anxieties to them? Another point to keep in mind is how your general personality fits in with the philosophy of the practice. Some women prefer a low-key, low-tech approach to prenatal care, while others want to have every possible diagnostic test under the sun. Your past medical and obstetrical history will also influence the approach you take to your pregnancy.

  • How many practitioners are involved in the practice? You may end up choosing between a practitioner who works with one or more partners and one who is in solo practice. In a group practice, you usually rotate through appointments with each of the doctors, getting to know them all so that you feel comfortable having any one of them deliver your baby. Practically speaking, you're likely to bond more with one or two people in the practice than with others. This is natural, given that most women and most practitioners have many varied personalities. A practitioner who practices alone should tell you who handles deliveries when he or she is ill, off duty, or out of town.

    Be sure to ask your practitioner about his or her policy for after-hours problems or emergencies — including questions you may need to ask by telephone on evenings or weekends.

  • What's the hospital like? If your pregnancy is uncomplicated, any good hospital or birthing center will be fine for you. If you're at risk of some complications, you may want to ask whether your hospital has a labor and delivery suite and a nursery equipped to handle any problems that may arise if, for example, the baby is born early. You may also want to ask

• Is an anesthesiologist on site 24 hours a day, or can your doctor call in an anesthesiologist quickly in case of an emergency?

• Can the hospital provide you with anesthesia (a form of pain control during labor)? If epidural anesthesia is not readily available, or you're not interested in this form of pain relief, you should find out what other options are available for pain management.

• Are you allowed to room in — that is, keep the baby in your room as much as possible — after delivery? Also, are accommodations available for your partner to stay with you during your postpartum hospitalization?

  • Are specialists close by? Consider whether you may end up needing the services of a maternal-fetal medicine specialist or a neonatologist, a physician who specializes in the care of infants who are born early or who have other medical problems. Ideally, your practitioner can refer you to someone quickly if anything comes up.

  • Will my insurance plan cover the costs of this doctor? Now that managed care has become an important part of the health insurance industry, it may be important to you to know whether your practitioner of choice is covered by your plan. Some places allow you to select physicians from "outside the network" if you pay part of the cost yourself.

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