Picking the Right Provider for You

How do you pick the right provider for you and your baby? There are so many factors and variables and systems to wade through that it might seem like an insurmountable task. But if you take it one step at a time and carefully review your options, you have a much better chance of picking a provider who is the right fit for you and your family. 

Let's start with types of providers. 

Obstetricians specialize in high risk pregnancies with training in second stage interventions and the ability to perform C-sections. OBs can be a great option for you if you know your pregnancy is high risk. But some people might feel more comfortable working with an OB even with a low risk pregnancy because of the quick access to emergency care if something were to go wrong.  

Family Medicine doctors can care for your whole family before, during and after pregnancy and birth. The ability to receive all your care from one person might be attractive to you. When you bring your baby in for their first newborn visit, your doctor will already know firsthand about your baby's birth experience because they were there! Not all family med doctors deliver babies, so make sure you confirm this if you are already seeing a family med provider for primary care. If you are high risk or a complication arises, your family med doctor may need to consult with an OB or transfer you to their care.

Midwives can receive their obstetrical training in a variety of different ways. Some midwives are nurses with advanced education in perinatal care. Some midwives have attended a technical program specifically for midwifery and have many hours of hands-on experience. Depending on your state and the midwife's training, midwives can practice at home or in a hospital. Midwives may come to your home for your prenatal visits or you may have to visit them at a birth center, hospital or clinic. 

When deciding between providers, it's important to think about what an individual provider's approach or philosophy is and how it aligns with your preferences for your birth. A good way to categorize providers is to use the Holistic and Medical Models of Care.

The Holistic (or Midwifery) Model of Care is woman-centered and trusts women and birth absolutely. A provider in this camp expects variations in labor, and sees the pregnant and laboring person and their baby as whole, emotional, unique beings. They believe that birth is normal and that intuition and emotion can be more important that objective facts when caring for a laboring person.

The Medical Model of Care views the body as a machine. It is predictable and every body behaves in similar patterns. A provider in this camp believes birth is inherently risky and those risks need to be controlled and managed with medical knowledge. The baby is considered another patient in need of medical care. Intuition and emotions are unreliable.

It should be noted that these models are not a dichotomy and should be viewed on a spectrum, with each model being fairly unattainable extremes on either end. Some might think that all OBs would be on one end and all midwives on the other. But this is not necessarily the case. Where a provider falls on the spectrum is unique to each provider, which is why it's important to meet with individual providers to ask about their approach and philosophy. There are some OBs who fall much closer to the holistic end of the spectrum than some midwives. What's truly important is that you and your provider fall close to one another on the spectrum. The farther apart you are, the more of a gap in your relationship there is to cross.

But sometimes you are limited in your choice of provider, not by personal preference, but by who your insurance company will pay for. If possible, keep your search and requests for recommendations limited to providers in your network.  If you are limited in your choice and don't find a provider that's an exact fit, ask your doula to help you bridge the gap between you and your provider. Together you can clarify your values and preferences and come up with questions to ask your provider and ways to advocate for yourself.

Maggie Mehr