Pregnancy Caregivers

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Through August and September, I wrote a Thoughtful Thursdays series on my Facebook page describing the different medical professionals who you can choose for your pregnancy care. I've pooled that information here as well.

Obstetricians: These physicians are specialists who deliver medical and surgical care to women. They receive a Bachelor's degree, and then an MD or DO degree, for a total of 8 years of institutional education. OBs then complete a 4 year residency in obstetrics, and must pass a board exam to obtain certification from the American Board of Obstetrics. In Lincoln, OBs often arrive after your baby's head is crowning at the perineum, and leave shortly after catching your baby and placenta, and stitching any tears. The hospital nurses will provide your labor and postpartum care. Lincoln OB offices also differ in their level of continuity of care - whether the OB you see for your appointments is also the OB who comes when you are giving birth - so ask your OB whether they offer continuity of care, or an on-call schedule for births. As skilled surgeons and experts in obstetric pathology, OBs offer expertise in managing medically-complicated pregnancies and births. You can find individual OB Cesarean rates and other information about their services at amino.com.

Family Medicine Physicians: Family medicine is a specialty devoted to comprehensive health care for people of all ages. Family doctors can choose to include or not include maternity care in their practice. Family doctors complete a Bachelor's degree and an MD or DO, for 8 years of institutional education, and then complete a 3 year Family Medicine residency. They must pass board exams and certification from the American Board of Family Medicine. They can also complete an optional fellowship for training in Cesarean section. In Lincoln hospitals, an OB must be present for a Cesarean, but in smaller hospitals with fewer OBs, such as Seward Memorial Hospital and Nebraska Medicine-Bellevue, family doctors who have received training are allowed to perform Cesareans. Family doctors in Lincoln often arrive earlier in the pushing process than OBs, come to check in on their patients during labor more often, and often practice continuity of care, coming to their own patient's births, but the hospital nurses will provide the bulk of your labor and postpartum care. They refer complicated pregnancies to OBs when necessary. Family doctors can also provide pediatric care, which offers a level of care for whole families unavailable with all other practitioners. Family doctors can offer an appealing blend of the individualized whole-woman maternity care typical of midwives and the medical skills typical of OBs. You can also find family doctor Cesarean rates on amino.com.

Certified Nurse Midwives: CNMs are Advanced Practice Registered Nurses (APRNs) who provide comprehensive well-woman gynecological care and maternity care in all 50 states. CNMs complete a Bachelor's degree and then an APRN degree (2 year Master's or 4 year Doctorate) in Midwifery, for a total of 6-8 years of institutional education. CNMs then take board examinations through the American Midwifery Certification Board. In Lincoln, CNMs will spend more time with you in labor, as their other responsibilities allow, as well as postpartum. CNM prenatal and postpartum appointments are longer as well, offering you plenty of time to ask questions and have detailed discussions about your care with your midwives. CNM practices also differ in their level of continuity of care, but longer appointment times do allow you to get to know all the CNMs who may be on-call for your birth. CNMs are specialists in normal pregnancy and birth, and are trained in early identification of complications and refer women with complications to OBs. In the state of Nebraska, CNMs are required to have a signed practice agreement with a backup surgeon in order to practice midwifery, so all CNMs in Nebraska have an OB provider with whom they work closely. According to Nebraska's Department of Health and Human Services, in 2015, CNMs attended 6% of all births, and 9% of all vaginal births. CNMs offer low-intervention, woman- and family-centered, personalized care with excellent outcomes for mothers and babies. CNM Cesarean rates are not yet available on Amino's website, but CNMs are often very familiar with their intervention rates, they tend to be low, and you should be able to ask and receive an exact answer.

Other caregivers: Nebraska law states that a Certified Nurse Midwife may not attend a home birth. However, Nebraska's Department of Health and Human Services reported that in 2015 there were 81 births at home. According to birth certificates, 27 of those home births were attended by an MD, while the remaining 54 had an "Other" Medical Attendant. These "Other" attendants may include family members, who would likely not be providing prenatal care, EMS providers, and non-nurse midwives, such as Certified Professional Midwives and Certified Midwives from other states and countries, and Direct-Entry, Traditional, or Community midwives who may or may not have formal institutional training. While main-stream American culture regards formal education, degrees, licensure, and certification as highly valuable, American sub-cultures, such as Amish and indigenous groups, greatly value the preservation of religious and cultural traditions in informal, community midwifery care. Although Nebraska bars a CNM from attending births at home, no other caregiver is restricted, but finding one willing to attend your birth out of hospital may be challenging. 

I hope you learned something about the different types of professionals who can attend births in Nebraska! Note that I did not include information in this series about Maternal-Fetal Medicine specialists, as these high-risk providers typically do not provide primary maternity care.

Joyce Dykema