Exploring Your Options Series – Part 2

I first thing I want to talk about are 2 very important choices. These two choices will determine what other choices you have surrounding your birth. This week we will talk about the first important choice:

Care ProvidersMidwife, Suzanne Smith

When choosing a care provider, it is important not to make assumptions about the type of care or philosophy based on the sex or type of care provider. You cannot assume that a female care provider will be more caring, flexible and less likely to introduce interventions, than a male. You cannot assume that all midwives practice from the midwifery care model and that OBs or Family Doctors will not. There are some OBs that act as excellent “midwives” and some midwives that offer a more medicalized approach to pregnancy and birth. The pros and cons I will present are generalized. What may be a con to you, may be a pro for someone else and vice versa. It is important to interview several different care providers before choosing one. Ask lots of questions!

  • Obstetrician/Gynecologist or OB/GYN
    • Pros –
      • Skills and experience to diagnose and treat serious complications during pregnancy and birth
      • Rarely would require transfer of care
    • Cons –
      • Trained surgical specialist in the pathology of women’s reproductive organs. More medicalized care. Less naturally minded.
      • Low-risk women often seen as high-risk
      • Limited repertoire; no experience in other lower risk options
      • As someone put it “If you don’t want to get cut, don’t go to a surgeon.”
      • Limited to hospital
  • Family Doctor
    • Pros –
      • Tend to introduce fewer interventions than an OB.
      • All members of the family can see one doctor.
        • This creates better doctor/patient relationships and convenience.
    • Cons –
      • Pregnancy or birth complications may mean a transfer of care.
      • Still have a “high-risk” mentality of pregnancy and birth and introduce interventions more than a midwife.
      • Limited to hospital
  • Midwife

Most midwives practice under the Midwives Model of Care. This model of care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

  • Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
  • Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
  • Minimizing technological interventions
  • Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

  • Pros –
    • Offer flexible, individualized, supportive care rather than introducing medical interventions routinely.
    • More attentive to emotional issues during pregnancy and childbirth.
    • Offer many low-risk strategies for correcting problems that may arise during pregnancy and childbirth.
    • Midwife practices, procedures and tests come closer to the recommended guidelines of official physicians’ organizations, than those of a typical OB.
    • Many midwives offer well-woman care. This allows women to continue their care postpartum with the same care provider.
    • Midwives aren’t just limited to hospital care. They attend birth at freestanding birth centers and home births.
    • Cons –
      • Pregnancy and birth complications may mean a transfer of care to an OB.
    • Different Types of Midwives
        • There are three different types of midwives that can legally practice in Utah:
          • LDEM- Licensed Direct Entry Midwife. This is someone who went straight into midwifery and is licensed by the state. He or She is a CPM (Certified Professional Midwife), having met the requirements with NARM (North American Registry of Midwives). LDEMs are licensed with the State of Utah and can carry oxygen, lidocaine (for stitching up your perineum in the case of tears), Rhogam for Rh- mothers, pitocin for a hemorrhage, vitamin K for baby, eye ointment for baby, and with a physicians approval, IV’s if needed, more medications for hemorrhage, and certain antibiotics for labor. They are not under the supervision of a doctor but practice independently.
          • CPM or DEM- Certified Professional Midwife or Direct Entry Midwife. In Utah no certification or licensure is required to call oneself a midwife. Therefore it is up to you the consumer to determine the skill level and capability of anyone calling them self a midwife. Therefore this midwife may or may not have the CPM credential. Many midwives in this category are very skilled, but once again it is up to the consumer to determine the knowledge and skill level of this midwife. This midwife can carry oxygen, but cannot carry any other medications.
          • CNM- Certified Nurse Midwife. This midwife has gone through formal nurse’s training and certification as well as midwifery training. Most CNM’s work in the hospital, they can carry medications, and write prescriptions. They are under the supervision of a doctor.


The next important choice we will talk about next week is where you will give birth.

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