Choosing Your Doctor Or Midwife

Step One: Will you birth at home, the hospital, or a birthing center?

If you haven't already read Choosing Where to Have Your Baby, start there to decide whether you'll be delivering in a hospital, birthing center, or at home. Even if you assume you'll deliver in a hospital like most American women, it's worth checking out the Birth Venue section to see what questions you should ask as you tour your intended hospital. (Yes, it is worth touring the hospital. Hospitals have different policies, different atmospheres, and different nursing staffs. You'll find yourself with definite preferences.)

Step Two: Doctor or midwife?

If you have a serious medical condition or a high risk pregnancy, you'll want to use an experienced obstetrician to deliver your baby. The vast majority of women, however, have normal, healthy pregnancies, and a full range of options for labor and delivery.

Let's assume that any doctor or midwife you choose is fully trained and highly experienced. How do you make sure? Use the list of questions from the terrific resource Coalition for Improving Maternity Services. 

Presuming complete competence, what's the difference between doctors and midwives?

While there are exceptions, caregiver views on labor and delivery in the U.S. tend to follow the caregiver's training. The experts at Childbirth Connection describe the two models as follows:

MIDWIFERY MODEL	PHYSICIAN'S MODEL
Mother gives birth	Physician delivers baby
Birth is natural process	Birth is dependent on technology
Focus on wellness, prevention	Focus on managing complications
Low rate of intervention	High rate of interventions
Care is individualized	Care is routinized

Research shows that midwives spend much more time with patients, both during office visits and during labor. Physicians rarely spend much time with patients during labor. Since studies show that rates of caesarean section are reduced by over 50% with continuous care during labor from nurses, doulas or midwives, you may want to consider hiring an experienced labor doula to supplement your doctor if you end up choosing an M.D. What about the nurses on the delivery floor? They're often wonderful, but they're too busy to spend much time with any one patient, and they have to follow the hospital protocol, unlike doctors and midwives, who can often make exceptions.

It is possible, of course, to find midwives who think more like doctors, and vice versa, but not common.

Thinking about these different views can help you to understand your own values and ideas about pregnancy and birth, and can help you select a caregiver who is compatible with your needs and values. Many women have a clear preference for one or the other of these models.

If you're still torn between a doctor versus a midwife, you should definitely interview one of each to help you make your decision.

Step 3: Where does the doctor or midwife practice?

Ok, so you have ideas about your where you want to give birth, and you know whether you're after a doctor or midwife. You probably have a name or two, either from friends or your insurance company. Start by calling their office to ask where they deliver babies. If they practice at a hospital you've ruled out, keep dialing. If you need more info to evaluate their birth venue, click here for more info on how to evaluate a hospital or birthing center.

Step 4: Is this hospital, birthing center, or home birth covered by your insurance?

You'll want to check with your insurance company to be sure.

Step 5: Interview a couple of doctors or midwives.

Ok, so you like the hospital or birth center where your prospective caregiver practices. Now you need to interview them. In fact, you should interview a couple of prospects.

Is this overkill? Maybe. But if you were renovating your kitchen, you would compare two contractors. Not just their bids, but their integrity, references, whether you liked them enough to have them in your house for a month. Finding your baby's caregiver is a much more critical decision. Interviewing more than one caregiver will help you to compare and contrast how you feel with each of them, which means a better decision on your part.

Many doctors and midwives have special times when they welcome newly pregnant couples to tour their offices and learn about their philosophies. If they don't offer such an opportunity soon enough for you, be sure to tell the person making the appointment that you want a short interview, not an intake visit. Ask if there will be a charge for such a visit (there usually isn't) and if so check with your insurance company to see if they'll cover it (they usually do.)

Step 6: How to evaluate your doctor or midwife.

I've already suggested that you download a list of questions for midwives or doctors . Take that list with you to the interview. What else to look for?

• Does the doctor or midwife create an atmosphere of mutual respect?
  He or she should spend adequate time with you, share information, involve you in decision-making, openly discuss his or her practices, and invite you to feel comfortable discussing anything. Would you trust this person with your life?
• Does the doctor or midwife use practices that work with the physiology of pregnancy and birth to support the work of your body?
  This may seem self evident, but some choices that are fairly routine in the U.S. interfere with the work of your body. One example is doctors who insist on routine electronic fetal monitoring throughout the birth process, which requires you to remain prone and stationery. Using a hand-held fetoscope instead to check on the baby periodically allows the mom to move and walk, which supports her body in moving the baby down the birth canal.
• What percentage of the doctor or midwife's patients end up with episiotomies? C-Sections? Natural Childbirth (i.e., no drugs)?
  Forceps "assistance"? Labor "augmentation" (i.e., drugs like Pitocin that speed up labor)? In what percentage is labor induced? (More than 40% of births in US are induced. In only about 5% of births is it medically justified.)
• Do you agree with the doctor or midwife's general childbirth philosophy?
  Every woman has the right to a caregiver who shares her general childbirth philosophy. Keep looking till you find a caregiver you love.