Earlier this month, I was fortunate enough to attend the Maternal & Infant Summit sponsored the Mayor of Washington D.C., Muriel Bowser. The conference was attended by 1,400 people, all concerned about the state of health of moms and babies. This included healthcare providers, those providing community services, moms, dads, and babies.
It’s fitting that this discussion took place in Washington as the city is facing some of the worst maternal mortality (death) rates in the country. In the District, about 41 women die for every 100,000 births according to a 2016 analysis by the United Health Foundation. That is double the national rate. And 75% of maternal deaths in D.C. between 2014-2016 were African Americans (Washington Post, 2018). Washington is fortunate to a have a mayor and Health Director in Dr. LaQuandra Nesbitt who are committed to improving these statistics.
Although 97% of Washingtonians have health insurance, they often still get prenatal care late and from multiple providers resulting in fragmented care. When a woman is not able to build a relationship with her provider, she is less likely to see the importance of receiving care from one provider throughout her pregnancy. In Washington, D.C., (and I would venture to guess in many other cities) this is even more prevalent when mom is also an immigrant. When I talk with friends who are not healthcare providers, I often find that they are confused about the different types of prenatal care that’s available. So, let’s talk about the different types of available providers.
- OB/GYN – An obstetrician/gynecologist, is a medical doctor who specializes in women’s health. He or she has expertise in female reproductive health, pregnancy, and childbirth. Ob/Gyns can conduct office visits, perform surgery and assist with labor and delivery. They can provide services through a solo or private practice (Healthline, 2016). Women who have had complications in past pregnancies or who have certain medical conditions will choose an obstetrician as their pregnancy care provider. They normally perform deliveries in a hospital (American Pregnancy Association, 2016).
- Certified Nurse Midwives – These are registered nurses who have graduated from a nurse-midwifery education program and have passed a national certification exam.
- Direct-Entry Midwives and Certified Professional Midwives– These have extensive training in midwifery even though they do not have a nursing degree. (Most midwives offer flexible individualized care with little medical intervention. They usually limit their care to low-risk pregnancies. Many midwives offer deliveries in homes, birthing centers, or hospitals (American Pregnancy Association, 2016)).
- Doulas – A doula is a professional trained in childbirth who provides emotional, physical, and educational support to a woman who is expecting, is experiencing labor, or who as recently given birth. The doula’s purpose is to help women have a safe, memorable, and empowering birthing experience. Doulas can be referred to as labor companions, labor support specialists, labor support professionals, birth assistants, or labor assistants. The goal of the doula is to help the mother experience a positive and safe birth. After the birth, doulas will spend time helping mothers begin breastfeeding and encouraging bonding between the new baby and other family members (American Pregnancy Association, 2017).
It’s important that women understand that they have choices to make about the pregnancy experience and that their providers play a key role in that experience. It’s also important that they feel comfortable and develop a good relationship with their chosen providers. Pregnancy is full of changes that are new and sometimes scary.
Encourage the women that you know who are pregnant or who are thinking about getting pregnant to learn about the types of providers available. As part of that process, encourage them to think about what type of birth experience they are looking for. Once a provider is chosen, it’s very helpful to stick with that provider throughout pregnancy. This allows the provider to understand your specific medical needs and preferences about your birth experience.