You should choose a midwife. Really, what did you think I was going to say? Seriously, I obviously believe very strongly in what I do, but there are several options for prenatal care, providers, and birth sites, and you will choose what is right for you. There are several good articles on choosing a provider, so I’ll refer you to those for the basics. I’d like to add a few other notes from someone on the inside.
The first thing you should do is discuss with your partner, and think about yourself, what would you like from your prenatal care and birth experience? Actually thinking about this may be something you have avoided for quite some time. When you stop and think, you may realize that what you imagined when first planning a pregnancy is not what you want one or more years later. Some women are so anxious after trying so hard to conceive, that doing something feels better than doing nothing and they want every test and bit of technology to feel secure. Some women have the opposite reaction: after so many procedures and medications, you may be up for a more natural approach than you saw for yourself originally.
Allow me to let you in on medicine’s dirty little secret: it’s not as easy as it looks on TV. There are general guidelines for care, but within those guidelines there are still options. Midwives as a general rule favor less intervention and focus more on educating women to take care of themselves, easing anxiety, and encouraging women to listen to their bodies. That being said, I’ve worked with physicians who are less conservative than I am with intervention. I’ve had many midwifery colleagues with a wide range of experience and comfort levels. Before you choose a provider ask yourself: Are you more comfortable doing something rather than nothing? Would you prefer your provider make decisions about care, or would you rather be educated and make the decisions yourself? Most providers know themselves where they fall on the spectrum of caution and should tell you if you ask.
The following link contains other questions to consider asking your provider. http://www.parentingweekly.com/pregnancy/delivery-options/choosing-an-ob-or-midwife.htm The few women who ask me some of these questions always ask if I mind being questioned. I can speak for most of my colleagues when I say, no! I’m always surprised when women ask less questions of me than I did when interviewing wedding photographers! One of the questions listed for midwives is to ask what obstetrician will back them up. I think another question you should ask is, “How are complications managed?” In other words, if you develop a complication during pregnancy, will you need to transfer care completely to the MD or will the midwife still care for you in co-management with the obstetrician?
I’d like to say a word about choosing a large or small group practice. Possibly not knowing the doctor or midwife who will be with you in labor is a cause of angst for many women. For better or worse, the days of a solo obstetrician who is on call 24/7 are gone. There are some home birth midwives who deliver all their own patients, so if you would like highly personal care and natural child birth, this may be a good option for you. Many groups have 3 or 4 obstetricians and/or midwives, and patients see all of them throughout the pregnancy. Just remember, the larger the practice, the less time you have developing a relationship with any particular provider. The other thing I like to share with women who see me is something a former colleague of mine said: “Everyone gets the midwife they need.” I know when I take care of women whom I’ve never met, we are old friends after about an hour! It’s a very intimate time, and you usually develop a relationship very quickly. I knew most of the midwives in the practice I went to because I worked with them. In labor, I got the one midwife I’d never met. It turned out, she also had been through IVF and was able to provide exactly the support I needed.
Most women will have traditional prenatal care, where you schedule appointments every few weeks and have about a 10-15 minute visit. There is a new trend in medicine called shared medical appointments. One particular type of shared prenatal care is called Centering Pregnancy. http://centeringhealthcare.org/pages/centering-model/pregnancy-overview.php In general, I highly recommend this style of prenatal care, because women get much more time for questions and information during the appointments, and the support from the other women in the group is invaluable. There are several studies that show that women who have been through group prenatal care have lower anxiety levels, and lower incidence of some pregnancy complications. However, if you’re still feeling like you don’t fit in with other pregnant women, group prenatal care may not be for you.
Transferring to obstetric care may be difficult. You’ve spent lots of time getting to know your RE and developing a relationship with a new provider at a time when you may already be feeling anxious and uncertain may be difficult. In addition to the questions listed in the above article, you may want to ask your doctor or midwife if they have much experience with IVF pregnancies, and if there is an opportunity to schedule longer appointment times if you think you need them.
For further resources:
originally published March, 2014