Understanding the Difference in Patient Care Models: Midwives and Physicians
One of the most eye-opening experiences of becoming a parent is being exposed to all of the decisions you get to make. What to buy for the nursery, breastfeeding versus bottle feeding, public versus private school, etc. Although all of these choices may be overwhelming at first, having many options is a great thing. The first decision a pregnant woman gets to make is to decide who to see for her prenatal care and where to deliver her baby. The Charlotte region and surrounding counties provide a wide variety of options available to women and their families...OB/GYN physicians (general and high-risk), midwives, hospitals with dedicated labor/delivery/recovery rooms, birthing centers or delivery at home. For the past 50 years most women have decided to deliver their babies at the hospital and have an OB/GYN physician do the delivery. The primary reason for this shift is because of epidurals for pain management which are only available at hospitals, and require management by anesthesiologists and OB/GYNs. There are some “hospitalists” that manage labor and delivery at the hospital exclusively, but most physicians are part of hospital affiliated practices. This allows a patient to have a regular physician that manages her wellness care from adolescence through old age. In pregnancy, the physicians manage all 40 weeks of prenatal care, labor and delivery and postpartum care. Physicians attend four years of medical school after their bachelor’s degree, then OB/ GYN physicians have a four year medical-surgical residency in their specialty. Many then continue on to do sub-specialized fellowships after that. The perception of physician provided care during pregnancy, labor and delivery is that they are more likely to intervene than midwives would. Physicians are trained surgeons and since they have the ability to operate, some assume that they’d prefer to do so. A normal, vaginal delivery is always the preferred outcome...but physicians are also charged with caring for any laboring patient regardless of whether they have underlying health concerns, high risk pregnancies or little to no prenatal care. Physicians are often pulled in many different directions, managing the labors of many patients at the same time and require the help of labor and delivery nursing staff. They are also working under the policies and protocol of the hospital where they are licensed to deliver and operate. Midwifery is making a comeback nationally and in North Carolina. In 2011, 13% of births in the state were delivered by a midwife. In the Charlotte region, many midwives work in tandem with physicians and are part of physicians practices. This affiliation allows the patient the comfort of knowing that should a physician be needed (in high risk or emergency circumstances) their midwife has a relationship with an on-call physician. Most midwives have nursing degrees; registered nurses who have also graduated from a masters degree program accredited by the Accreditation Commission for Midwifery Education and passed a national certification examination (American Midwifery Certifi- cation Board). They are licensed and regulated in all 50 states and covered by health insurance if they deliver in hospitals (some insurances cover birthing centers, home births generally aren’t covered by insurance). They also provide the full range of primary health services for women through menopause and manage normal labor and delivery with a “low tech, high touch” mentality. Because of their lower patient load, they are available to spend more one on one time with their patients and make vaginal deliveries with natural pain management a priority. A patient who’d like to have a home birth would need to find a midwife as physicians generally only deliver at affiliated hospitals. Prenatal patients are at a great advantage today. There are many options available. There are a few important questions the patient and her family can consider in order to decide who and where to deliver. Is a vaginal birth a priority to you, do you want the caregiver with you during labor, what are your pain management plans, what are the hospital’s protocols, are you high risk? But most importantly where do you feel the most support and the safest?