When you first discover you're pregnant, it's like trying to walk across a very busy intersection. The cars zip by at break-neck speeds. The huge tractor-trailers brush you back off the curb. Traffic rushes past from the right and the left, from in front and from behind. How are you supposed to get safely to the other side? What you need is a kind and understanding crossing guard who will step into the fray, blow his whistle to stop the traffic dead, and invite you to cross without risking your life.
Your health-care provider is your crossing guard. He or she will make a path through all your fears and uncertainties and guide you safely through your pregnancy, labor, and delivery. The person you choose to direct the traffic at this crossroads should be someone who is experienced and competent (after all, somebody in your support group needs to know what's going on) and with whom you feel comfortable enough to entrust with your life. This is a decision you should take some time to consider. You'll have to choose this individual from the list of practitioners participating in your insurance plan.
Luckily there are lots of options for health-care providers, but their credentials can be a little difficult to decipher. Most women are familiar with "OBs," but what on earth is an "FP" or a "CNM"?
Family Practitioner: The family practitioner (FP) is an updated version of the old family GP (general practitioner) who treated all family members for whatever ailed them. The FP has had special training in obstetrics and can be your primary care provider, your obstetrician, and eventually your baby's primary-care physician. Some people like the continuity and the familiarity of this kind of practice.
Obstetrician: The majority of women in this country choose an obstetrician to care for them during their pregnancies and to deliver their babies. These doctors are specially trained in the field of neonatal and maternal health care. They are usually gynecologists as well, so you might already be under the care of an obstetrician. But the person who has prescribed your birth control or cured your yeast infections might not necessarily be the person you want to see you through this pregnancy. It's okay to change to a new doctor at this point. Spending nine months with a doctor who will deliver your baby is different than the once-a-year hello-good-bye relationship you might have now with your gynecologist. Take your time and think about what kind of doctor you really want.
Until the mid-1700s in America, physicians did not attend at childbirth. Expectant women looked to female friends and family for help and comfort. They turned to midwives for skilled assistance.
Nurse-midwife: In many areas of the country, the use of certified midwives has risen dramatically, and their services are usually covered by health insurance. Certified nurse-midwives (CNMs) are licensed health-care practitioners who have been educated in both nursing and midwifery at a medical institution accredited by the American College of Nurse-Midwives (ACNM). They are certified and active in all 50 states and the District of Columbia. The ACNM says that California has the largest number of CNMs, followed by New York, Florida, Pennsylvania, Illinois, and Massachusetts. In some states women are being trained and licensed as midwives without first becoming nurses. In these cases they are called certified midwives.
If you are looking for a health-care provider who is known for giving that extra personal touch and an emphasis on natural deliveries with minimum high-tech intervention, you might want to investigate midwifery. Most midwives today are employed by physicians, hospitals, or birth centers, but they also attend at home births. Some CNMs work independently with women who are expected to have low-risk pregnancies. An independent CNM should always be affiliated with a physician, whom the CNM can call on for consultation or in case there is an emergency. Nurse midwives cannot assist in the care and childbirth of women who develop problems during the pregnancy. In this case, the woman is considered "high-risk" and is referred to a physician who will manage the rest of the pregnancy and birth.
Excerpted from The Complete Idiot's Guide to Pregnancy and Childbirth © 2004 by Michele Isaac Gliksman, M.D. and Theresa Foy DiGeronimo. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Alpha Books, a member of Penguin Group (USA) Inc.
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