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Choosing a Health Care Provider

There are many things for a pregnant woman to consider in choosing whom she would like to provide her pregnancy care. Melissa Boll, a certified nurse midwife at the Madsen Health Center at the University of Utah, says there are four basic things to consider when choosing a pregnancy care provider:

  1. Accessibility of the practice in terms of location and operating hours
  2. The hospital or birthing center at which that provider delivers babies  
  3. The special needs that an individual woman may have, such as the need for a provider who speaks another language or can handle her high-risk conditions,
  4. And, how to match her care provider choice with her insurance.

Boll says the types of providers who can provide those services vary from specialty or family physicians to midwives and a few in between.

“Most women in this country do choose and ob-gyn for their health care provider, but there are other options,” says Boll. “Certified nurse midwives in the state of Utah are all masters prepared. They were originally nurses who usually worked in labor and delivery, and went on to advanced education and take care of normal healthy women. Direct entry midwives can have varying educational backgrounds. They are required to take an exam, a national exam and state licensed, but they are not nurses.”

The training of lay midwives, however, varies by region. They also focus more on home births and do not practice in a hospital. You also need to choose whether home or the hospital is best for your labor and delivery.

“If you're goal is to have an un-medicated birth and be in a tub,” says Boll, “you might want to choose a certified nurse midwife who is an expert in those kinds of things.”

Research shows that, in most pregnancies, the outcomes are the same for all three types of medically-trained providers. In higher-risk pregnancies, the involvement of an obstetrician as the main provider, or as a consultant to a family physician or midwife, is a wise idea.

Are other services besides medical care important to the pregnant woman?
Family physician practices, including our own, provide onsite nutritional consultation, psychological counselling, and health education. A family physician offers a pregnant woman the opportunity to have ongoing pediatric care from the same physician that has provided her prenatal care.  In most family medicine practices, other family members (children, the baby's father, the woman's parents) are also welcome in the practice.  The same additional support services are available to other family members. This opportunity to for a family physician to be available to a pregnant woman's family allows that doctor to understand more clearly what is important to the pregnant patient, and her family, when it comes to health care.
Does the opportunity to get complete medical care, not just pregnancy care, appeal to a pregnant woman?
Consider whether the opportunity to have a long-term medical relationship that extends beyond the pregnancy is important to the pregnant woman.  If that is the case, a family physician may be the best fit for that pregnant woman.  Family physicians can manage greater than 90% of the health concerns that a pregnant woman, or her family, may have at one office site.
Who will deliver your baby if your usual provider is not available? 
Ask how the doctor or midwife takes call.  Ask if you can meet some of the other doctors who might be called should your usual docor not be available.  In our practices, we have our pregnant patients meet the physician who will be most likely to be called in the event that the usual doctor is not available.

Visit the Maternal Infant Health Program to help you make informed decisions about the type of health care provide you would like to see during your pregnancy.