Learning Objectives
By the end of this section, you will be able to:
- Differentiate among the types of physicians providing perinatal care
- Differentiate among the types of midwives providing perinatal care
- Analyze considerations when choosing a health care provider for the perinatal period
When a person becomes pregnant, choosing a health care provider for their perinatal care is not always an easy choice. Some people choose a perinatal care provider based on the recommendation of a friend or family member. Others select a perinatal care provider based on their choice of place to give birth or on their health care insurance carrier.
Physicians
Physicians are people who completed medical school and passed a state licensure exam to practice medicine. Physicians often specialize and complete a residency in a specific practice area. The specializations of obstetrics, family practice, and maternal-fetal medicine provide the training to give medical care during the perinatal period. Most physicians in the United States who manage labor and birth attend births only within hospitals.
OB/GYN
An OB/GYN is a physician specializing in obstetrics and gynecology. These physicians completed a residency program in which they learned to provide gynecologic and perinatal care for persons assigned female at birth. OB/GYNs take a written exam after completing their residency program and become board eligible. OB/GYN physicians become board certified after they complete an oral exam (American Board of Obstetrics and Gynecology [ABOG], 2023).
Family Practice
A family practice physician specializes in providing medical care to the entire family, and part of their residency program includes providing perinatal care. Unless a family practice physician takes additional surgical training, their privileges at a health care facility will not include the ability to perform a cesarean section. Family practice physicians are expected to have practice guidelines with a board-certified OB/GYN to be on call if a cesarean section becomes necessary or a complex perinatal complication arises when caring for pregnant persons (American Academy of Family Physicians, 2023).
Maternal-Fetal Medicine Specialist
A maternal-fetal medicine specialist is an OB/GYN physician who has an additional 2 or 3 years of training in the management of high-risk pregnancies. Maternal-fetal medicine specialists provide care to pregnant people with a medical condition or complication of pregnancy affecting the person or their fetus that requires complex or specialized care (Society for Maternal-Fetal Medicine, 2023). Pregnant persons who receive care from a maternal-fetal medicine specialist still see their OB/GYNs because most specialists do not offer delivery services.
Midwives
Midwives are people who have had formal or informal training in pregnant people and birth. Depending on their training, midwives may or may not be licensed. In the United States, multiple routes exist to becoming licensed to practice midwifery.
Certified Nurse-Midwives
A certified nurse-midwife (CNM) is a registered nurse who completes an accredited midwifery program (usually 2 or 3 years) that provides either a master’s or doctorate degree with training in gynecologic and family planning services, perinatal services, and newborn care. CNMs are required to successfully pass the national certification exam and maintain a license to practice. CNMs provide care during labor and birth in hospitals, birth centers, and at private homes and have protocols and agreements with a board-certified OB/GYN (American College of Nurse-Midwives [ACNM], 2021).
Certified Midwives
A certified midwife (CM) is a person who has a 4-year college degree and specific science and health courses and then completes an accredited midwifery program (usually 2 or 3 years) that provides either a master’s or doctorate degree with training in gynecologic and family planning services, perinatal services, and newborn care. CMs are required to successfully pass the national certification exam and maintain a license to practice. Some states provide licenses to CMs. When licensed, CMs provide prenatal and postpartum care in offices or homes as well as care during labor and birth in hospitals, birth centers, and at private homes. They have protocols and agreements with a board-certified OB/GYN (ACNM, 2021).
Certified Professional Midwives and Traditional Birth Attendants
A certified professional midwife has received formal training in perinatal care only through a training organization and apprenticeship. The training provides a certificate, and certification can be obtained in many countries and in some states in the United States. Certified professional midwives provide prenatal and postpartum care in offices or homes and care during labor and birth in birth centers and at private homes (ACNM, n.d.).
Traditional birth attendants, sometimes known as lay midwives, are people who may or may not have received formal training in providing perinatal care and many times learn through apprenticeship (Mwoma et al., 2021). They provide prenatal and postpartum care in offices or homes and provide care during labor and birth at private homes. Traditional birth attendants are not licensed. It is important for the pregnant person to ask the birth attendant about their training and experience in perinatal care before choosing the birth attendant as their provider.
Choosing a Health Care Provider
When choosing a health care provider, the pregnant person should determine if they have any risk factors. Pregnant persons who have risk factors such as diabetes or hypertension require multiple ultrasounds and fetal monitoring to prevent an adverse outcome for themselves or their fetus. The recommended choice for these pregnant persons is an OB/GYN or a CNM who works in an OB/GYN office. Pregnant persons who have no risk factors may choose an OB/GYN, family practice physician, CNM, CM, or licensed certified professional midwife. If a risk factor develops during the pregnancy, the recommendation is for the pregnant person who chose a CM or licensed certified professional midwife to change providers because a hospital birth may be indicated.
Link to Learning
Understanding the types of health care providers available to patients can help you guide them in their selection.