How to choose a prenatal caregiver

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Every pregnant woman needs regular prenatal care, right from the start. But what type of prenatal caregiver to choose? Midwife, obstetrician, family practitioner? Dr. Keith Eddleman, author of Pregnancy for Dummies, explains the factors to consider.

How to choose a prenatal caregiver
  • Take into consideration your overall health and any special medical issues you may be facing.
  • Research the care and delivery options available in your area.
  • Remain flexible. Pregnancy is a fluid situation; you may make an appropriate choice at the beginning of your pregnancy but find that you have to adjust to new factors later on.
  • The OB/GYN can take care of virtually all routine complications of pregnancy. You could also choose a family practice physician or a midwife, but if you have serious complications, you may need to see a specialist.
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I'm Stacey Tisdale for Howdini. You're pregnant, congratulations. Now you have to choose who's going to take care of you and your baby to be. An obstetrician, a midwife, a nurse? Joining us to help navigate through all of those choices, Dr. Keith Eddleman. He's the Director of Obstetrics at Mount Sinai Hospital in New York, and the author of two books, including Pregnancy for Dummies. Dr. Eddleman, thanks for joining us today.

 

Thanks for having me.

 

What are some of the things that people should consider when they're deciding on their prenatal care?

 

Well, first of all, you need to step back and look at your own specific factors, look at your own health. Are there issues that you need to consider? Because if you have some sort of medical problem, for example, like diabetes or high blood pressure, then you really need to take that into consideration in choosing your prenatal care provider, because you want to choose somebody who has expertise in dealing with that particular problem in conjunction with the pregnancy. So that's number one, is really to step back and look at your own individual factors.

 

Number two, you want to decide sort of where do you want to deliver? What type of hospital do you want to deliver in? Where do you live? How close is that to the hospital? If you choose a hospital that's three hours away, and you go into labor and go through labor rapidly, you may not make it to the hospital. So you really need to think about those types of issues.

 

Let's break those two points down, OK? I've taken my special circumstances into consideration, now what are my options? Let's say a woman has diabetes, or has some other medical condition. What should she be looking at in terms of prenatal care?

 

Well, why don't we take it at the most basic? Like the provider that most people know most about is just a general OB/GYN, or obstetrician gynecologist. That's somebody who's gone through medical school and then four years of a specialized residency in learning how to take care of pregnant women. And most general obstetrician gynecologists can take care of the routine complications that come up with pregnancy, like diabetes as you mentioned, or like blood pressure problems. If they're of a typical variety, then most general obstetricians can take care of those types of things. They can perform caesarean deliveries if the need be, if the need arises, and they can take care of problems like twins, things that are very typical.

 

The next type of provider that people may have heard about is something called a family practice physician, and that's someone who's done a residency really in general types of medicine. They can take care of not only pregnant women, but also they can do pediatrics. They can do general medicine for adults. So their education is a lot more broad based. And because of that, they haven't had as much specialized training in some of the complications of pregnancy. So if you do have a complication, then you're more likely going to be transferred to somebody at the next higher level of care. Probably the next provider that people have heard about, maybe a midwife. A midwife is--

 

Sure, and this is good for people who don't have complications. That's better for them to consider things like that.

 

Correct. A midwife is a registered nurse who's done additional training in the care of pregnant women, and midwives are great at taking care of pregnant women. But they should be women who really don't have a lot of complications during pregnancy, because they don't have the same skill at dealing with those complications as maybe, say, an obstetrician would. Oftentimes, a woman will start out with someone like a midwife or a family practice physician, and then need to get transferred to someone at a higher level of care, because of a complication that occurs during pregnancy.

 

How do you balance those things? You could have a perfectly normal pregnancy, and then you see a lot of things like we've mentioned, preeclampsia, toxemia. Those happen when people go into labor. So how do you balance the right prenatal care based on how your health might be at one time, versus some of the risks that could face you?

 

Well, I think first of all, you have to be fluid in your decision. No decision is final, because you might start out being a totally uncomplicated routine pregnancy, but you might develop complications along the way. So you need to be flexible enough to know that sometimes you have to change the level of provider. Probably the most advanced provider is the maternal fetal medicine specialist, and those are people who have done their OB/GYN residency, but they've also done extra training in dealing with the more rare complications of pregnancy, both for the mother and the baby. So you need to be fluid in your decision, but be comfortable knowing that there's always somebody else that's a higher level of expertise that can take over, if you do have a complication that arises.

 

So know your body, know where you are in the change process, and know where you are literally physically from your hospital or wherever else you want to give birth. Dr. Eddleman, Mount Sinai Hospital, thank you so much for joining us.

 

Thanks again for having me.

meet theexpert
  • Dr. Keith Eddleman

    Dr. Keith Eddleman Director of Obstetrics, Mount Sinai Hospital, New York Dr. Keith Eddleman is Director of Obstetrics at Mt. Sinai Hospital in New York City. He practices Clinical Genetics, Maternal & Fetal Medicine, and Obstetrics and Gynecology. Dr. Eddleman is the author of two books on pregnancy. more about this expert »

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