One of the first choices you need to make in your pregnancy is where to go for your prenatal care. And it’s an important choice! It sets the tone for your pregnancy and sets into motion lots of other decisions, like where you’ll give birth and what services will be available to you.
This article will guide you through how to choose a care provider using the approach JustBirth Space Connector and Doula, Erica Livingston, teaches us in The Six Key Steps: Making Pregnancy and Birth Decisions.
Step 1. Know the foundations.
To know how to choose a care provider, you need to understand what is involved in prenatal care, and what types of care and support you might need during pregnancy, birth, and beyond.
People have a wide range of needs when it comes to having a healthy pregnancy and birth. These needs range from basic education, regular check-ups, and wellness services to high-risk specialty care and management of complications. It’s usually not just one provider who will take care of all of these needs – you will likely have a team of people and support services during the course of your care. By choosing a doctor or midwife, you are choosing someone to provide your clinical care (check-ups) and to connect you to a system where you can access these different services.
No matter who sees you during your appointments, your care should feel caring. In What Does Good Maternity Care Mean to You, midwife Mimi Niles describes how she knows she has delivered good quality care:
“When they come to see me in my office, do they walk out feeling whole and complete and seen? That their questions were answered and they feel respected, and whoever came with them feels respected, and they want to come back?”
The key to good care is having individualized care. That means care that is the right fit for what you need and what matters most to you.
Step 2. Explore your options.
Once you know what is involved in pregnancy and birth care, you need to explore the options that are available to you. In different communities, there are different types of providers available: you may have midwives, family physicians, obstetricians (OB/Gyns), and Maternal Fetal Medicine specialists involved in your care.
In most cases, these providers work together, so you don’t necessarily have to choose just one type. You can have a team that includes different types of providers, as well as support team members like nurses, physicians assistants, and care coordinators involved in your care.
Types of Providers
|Provider Type||Their training focus||They can LEAD your care team if…||They may BE PART OF your care team if…|
|Midwife||Wellness focus; specializes in vaginal birth.||You are generally healthy and have a low risk of problems||Your medical office offers the option to have midwives for certain visits or for care during labor and vaginal birth.|
|Family Physician||Broad training in medical care of the whole family. Not all family physicians provide obstetric care and delivery||You are generally healthy and have a low or moderate risk of problems.||You may see a Family Physician for primary care needs even if your main care provider for pregnancy is another type of doctor or a midwife|
|Obstetrician / Gynecologist||Care of pregnant people including diagnosis and management of medical problems in pregnancy, birth, postpartum and gynecological health||You don’t have high risk conditions that need specialized care like that provided by a maternal-fetal medicine doctor||They partner with your midwife to provide advanced medical or surgical care when it is needed.|
|Maternal-Fetal Medicine Doctor (also known as perinatologist)||High-risk or complicated pregnancies||You have a high-risk pregnancy or are expecting a baby with a medical condition that requires specialized care.||You need advanced imaging or genetic testing, or need to consult a specialist about a risk factor or complication.|
To learn more about these different providers and their training and focus, visit the websites of the American College of Nurse-Midwives, the National Association of Certified Professional Midwives, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Society for Maternal Fetal Medicine.
Once you know the types of providers you can choose from, you will need to pick a certain provider or practice (a group of providers who work together). Look at websites and reviews, ask trusted friends, and sign up for an orientation or call the office to ask about the services they offer and what’s involved in being a patient at that site. If you have insurance, look at the provider directory to see who is in your network. Write down and bring a list of your questions. The National Partnership for Women and Families offers a list of suggested questions for midwives and for physicians.
Step 3. Clarify What Matters Most to You
As you gather information about your options, you will need to think about what factors are important to you. Take some time to learn and reflect about your priorities with the Choices in Childbirth tool, What Matters Most During My Prenatal Care? Maybe it’s especially important to you to have an office that has convenient hours or weekend options for appointments. Maybe having a care provider who shares your cultural background matters a lot to you. Different things matter to different people. Once you zero in on the factors that make a big difference for you, you can narrow your options and eventually find the right care for you and your baby.
Step 4. Talk to Your Provider and the People Who Matter Most to You
This is your decision, but you probably have people you want to be part of that decision. If you have a partner, it’s important to involve them in exploring the options and finding a practice where they can feel involved and respected and get answers to their questions.
You may also want to consult any medical care providers who you already trust or who know you well. This is important if you have a medical condition that will need to be managed along with your pregnancy. Ask the specialists who know your condition about the pregnancy care providers they recommend for you.
Step 5. Advocate For Yourself and Know Your Rights
Choose a provider who seems like they will support you to make informed choices. This is your pregnancy and your baby, and you want a provider who respects that and sees you as the most important member of the team.
You may find that you don’t have all of the options you wish were available to you. Unfortunately, in many communities there is a limited set of choices, and some options like midwifery care or certain high-risk services are harder to access. If you end up with a provider who is not a perfect match for your needs or whose practice style isn’t what you were hoping for, you can still advocate for the choices and care you need. A doula or trusted friend or loved one can help you use your voice and advocate for yourself. Watch the Choices in Childbirth Chapter, Using Your Voice, to learn more and be inspired to speak up about what matters to you.
Step 6. Repeat and Revisit As Needed
It’s important to make a choice and get your prenatal care started early in pregnancy. But after you’ve had visits and gotten to know your provider, you may learn more about the practice – or about yourself – and realize you want a different kind of care. Don’t settle for a provider who isn’t the right fit – especially if you feel disrespected or like your concerns are not being taken seriously. Repeat the steps above and revisit your choice of care provider anytime your priorities or needs change.