Café Recap: Choosing A Maternity Care Provider


  Our panelists: Katie Page (CNM at CMG Women's Center) and Debbie Perdew (DONA), and our moderator, Lauren Barnes.

As mothers, choosing a Maternal Care Provider can be one of the most important decisions we make. Today our goal is not to prove one care provider’s skills better than another, but rather, to get you thinking about your personality, your needs, your desires, and provide you with some resources so that you can choose the best care provider for you! All women are different and each of us have different needs. You are each deserving of respect regarding your choices. My hope is that today you would see that there are choices that are right for each woman. We are not a “one size fits all group.”

Choices in Childbirth is a great resource for this topic, and shares this advice, "Once you’ve identified what’s important to you, you’ll be able to clearly communicate your wishes and choose a care provider and birth environment that will respect and honor your choices.”  They suggest a 3-step process for choosing a care provider:

Step 1: Understand Your Provider’s Philosophy (and Make Sure it Matches Yours)

Step 2: Reflect on Your Experiences so Far, Watch Out for Red Flags and Trust Your Instincts

Step 3: Ask Around and Compare Your Options

Care provider options are generally Physician, CNM (Certified Nurse-Midwife),CM (Certified Midwife), and CPM (Certified Professional Midwife). The majority of physicians who care for women and deliver babies are OB-GYN (Obstetricians/Gynecologists), who specialize in women's care. Some physicians are family doctors who care for the whole family and also deliver babies. Physicians attend births in a hospital. CNMs and CMs are educated with master or doctoral degrees and are certified by the same board (American Midwifery Certification Board). CNMs are trained first as nurses and then as midwives (CMs are not nurses before their midwife training). CMs are not licensed to practice in VA. Most CNMs attend births in hospitals, though some do attend birth center and/or home births as well. CPMs are certified by a different organization (North American Registry of Midwives) and are licensed in some states (including Virginia). CPMs are educated in schools of midwifery or through apprenticeship and are specifically trained in out of hospital birth. In Virginia, CNMs are licensed to prescribe a wide variety of medications, while CPMs are not allowed to prescribe. CPMs do, however, utilize a variety of herbal medicines to meet some needs of their clients. Direct-Entry or "lay" midwives are another type, and are not certified nationally, nor licensed or regulated by the state. Their training varies, though most are apprentice-trained.

Here are two models of care two consider:

a) “... the belief that birth can have potentially pathological outcomes and that medical and technological management reduces the likelihood of these outcomes.”

b) “...the belief that for healthy women, birth is a normal life process that results in healthy outcomes and is best left alone unless a complication arises.”

Knowing which (or both) of these models sits well with you can help you to choose an appropriate care provider. Debbie recommends that decision making during labor is best avoided. Think about your options beforehand and discuss them with your care provider, so that you are going into labor with as few last minute decisions as possible. As a doula, Debbie says that her role is not a care giver and that patients should trust and listen to the care givers they have chosen to have on their team.

One common suggestion is to interview your care provider. Katie says that we should feel comfortable in doing this. She says that there is a spectrum of types of care, from passive to active. Taking a very passive role would be trusting your provider to make all choices for you, while an very active role would mean making all of your own choices; in the middle is teamwork between patient and provider. Physicians and midwives alike fall at various places within the spectrum.

Sometimes it is helpful to remember that your care provider really is there to care for you. When we have questions or consider making decisions that go against what our care provider might recommend we often meet with resistance. This can be difficult as a patient, but if we remember that their job and their passion is our safety, we can sit and have reasonable discussions to pick the best path of care.