How to Find an Obstetric or Gyn Provider
The start of a new year often includes new goals or intensions for the twelve months that follow. If your year’s intensions include establishing gynecological care, trying to conceive, or having a baby, this post will help you navigate how to find a Midwife or other type of provider to establish care with. If you find yourself moving in the middle of a pregnancy or simply wanting to switch providers before or during your pregnancy this post will also guide you in those decisions.
The Different Types of Midwives
Before establishing care with a provider, it’s important to understand the different types of providers because that can determine the type of care you receive both in and out of pregnancy.
While it is true you may have different specialists among doctors take part in your care (maternal fetal specialists, reproductive endocrinologist, or urogynecologist) doctors who serve as your primary gynecological/obstetric provider and attend your delivery are obstetrician gynecologists (OBGYN’s) and only attend briths in the hospital setting. OBGYNs are typically trained to view birth through a medical lens given they attend medical school followed by a residency that focuses on birth in the hospital setting only. They are trained to perform cesarean deliveries and care for high risk patients.
Midwives on the other hand are differentiated by their training, their place of practice, and their state recognition and regulation. Different types of midwives are explained below:
Certified Nurse Midwife (CNM): Receives a masters degree in nursing as well as a doctorate if desired. A CNM is recognized & certified in all states to practice in hospitals, birth centers, or homes if desired. A CNM can care for low to high risk pregnant women and work in collaboration with OBGYNs. CNMs are also trained to care for women’s gynecological needs outside of pregnancy.
Certified Midwife: (CM): Receives a bachelors degree followed by a graduate degree by an accredited school. A CM is recognized in 11 states currently and can practice in hospitals, birth centers, or homes within those states.
Certified Professional Midwife (CPM): Is attained by completing an entry level evaluation program and undergoing an apprenticeship with a CPM. CPM’s are not recognized in all states or allowed to legally practice in all states. CPMs practice in birth centers or at homes in the states that recognize them. (100% birth centers)
Lay Midwife: One that has received training strictly through the community or self study and receives no formal education. Lay Midwives are often seen practicing in homes. (100% homes)
As you can see, the level of care you require and the setting you would like to birth in can all influence the provider you choose to establish care with. If it’s important that you see your provider before, in between, and after pregnancies, it’s important to ensure they can also provide full scope GYN care. If you feel strongly about birthing outside the hospital setting, and OBGYN would not be the best provider for you. On the contrary, if aspects of your health exclude you from out of hospital birth or you feel most comfortable in the hospital setting, establishing care with an OBGYN or CNM would be in your best interest.
If this all seems a little confusing thats because it can be! While the definition of providers remains constant, the way that providers practice within different offices and in collaboration with one another can change drastically from one practice to the next. If you are stuck not knowing what is important to you and where you might feel most comfortable consider these questions:
Questions to Consider
What do I envision for my pregnancy and birth setting? Does the current health of my pregnancy and baby allow for that setting?
Is it important to me to have the same provider care for both my GYN and OB health?
Is it important to me to see the same provider and know who will be there for my delivery or am I comfortable with group care?
Do I have any medical conditions that require a specialist and if so, would my office provide that resource?
How far am I comfortable commuting for both my GYN and OB care?
Does this office provide a referral network to attend to other aspects of my care? (Breastfeeding, pelvic floor health, nutritionist, mood assessments, etc.)
What type of care provider and setting is covered by my insurance (if applicable)? And do they cover both my provider and the birth setting?
While this list of questions is not comprehensive, its a great place to start and have you thinking in the right direction. Leaning on your community of friends can also be helpful if aspects of their care were similar to what you desire for yourself and insurance differences don’t preclude you from that service/provider.
How to Search your area:
When it comes to the logistics of finding a provider that aligns with both yours needs and desires, there are a couple of ways to go about it. In the context of pregnancy you can choose to focus on the setting of delivery (a specific hospital or other birth setting) and go from there or start with a specific practice/provider and let that determine your place of delivery. Obviously, for those who desire an out of hospital birth, you must also choose a provider who attends birth in that specific setting.
When considering your hospital options, utilize this free resource that reports different aspects of maternity care outcomes and how it compares to national standards. Examples of these reports include cesarean rates, episiotomy rates, if midwives are staffed at the hospital, if doulas are welcomed at the hospital, and if lactation consultants are provided among many more. Please understand that these reports do not account for individual provider practices and vice versa. Additionally, not all hospitals in America are represented on this website as they must choose to participate in this reporting.
When considering a birth center, ensure that the center is appropriately certified. You can utilize this free resource to identify if the center you are considering is adhering to standards of quality above that of basic licensure and that the center's care is consistent with the philosophy of the American Association of Birth Centers.
If the provider who attends your birth is more important than the setting you give brith in, starting with a practice or specific provider is your best first step. If you plan to use insurance for your care, be sure to check that both your provider and the specific place they attend births are both covered by your specific plan. Furthermore, clarifying how the on-call schedule works is important to ensure that you know all the possibilities of who could be there for your delivery— especially if this is a driving force in determine your care.
In the context of GYN care, you may want to consider your specific health concerns or long term plans to help inform your provider or office choice. For example, not all OBGYNs or CNMs attend deliveries or provide OB care. If you hope to eventually have children and continue care with the same provider you’ll want to know these details ahead of time. Establishing care with a large group vs a small practice can have both its pros and cons but nonetheless is something to consider when making your choice. Lastly, if you have specific concerns (ex: endometriosis) you may want to seek out a provider who is widely known or familiar with this condition in order to best care for you.
Regardless of your women’s health or pregnancy goals for this year, I hope you find this post helpful in better understanding your carer provider options and tangible tips you can put into place during your own search.
Always on your team,