Professional caregivers

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Choosing a caregiver

Questions to ask
It is quite acceptable to "shop around" for appropriate health care, and interviewing potential caregivers can be rewarding.

Choosing a birth place
The environment in which a woman labours and gives birth has a major effect on the birth.

Many parents give little thought to choosing a midwife or doctor, and rely on recommendations from friends or their family doctor. However, choosing a caregiver to assist your partner is the most important decision that you will make, in terms of how healthy the mother and baby will be at the end of the birth day.

It is worthwhile discussing your goals for the birth with your partner and then working together to seek the caregiver who you feel is most likely to enable you to achieve this outcome. It is quite acceptable to "shop around" for appropriate health care, and interviewing potential caregivers can be rewarding. See questions to ask your caregiver for further suggestions.

To find the names of health professionals who offer pregnancy and birth services in your area, you could contact the local hospital, the community health centre, women's health clinic, or baby health centre.

The Midwife

The World Health Organisation recommends that midwives should be regarded as the best caregivers for normal, healthy pregnant women, and indeed, around the world, most babies are born with the assistance of a midwife, either in a hospital or at home.

A midwife has training in the management of normal pregnancy, birth and newborn care. She (there are a few male midwives, but most are female) can recognise any problems that arise and will refer to specialists as necessary. They have wide experience of normal birth and offer a range of non-medical techniques for promoting safe outcomes and dealing with the pain of labour. Midwives have a separate training from nurses, and are recognised, not as "obstetric nurses" but as practitioners in their own right.

Most maternity hospitals are fully staffed with midwives (except in the USA where hospitals are usually staffed by "obstetric nurses" or "nurse-midwives" who may have limited experience and responsibilities). If you are a public patient, or using standard health care services for the pregnancy and birth, your partner will see a midwife for her pre-natal check-ups and have a midwife to assist at the birth and also post-natally. There may be no choice in who she sees, although some hospitals offer special clinics staffed by midwives alone, or a team midwifery program where a small permanent team of midwives care for a designated group of women. You can enquire about these services at the hospital. Hospital based midwifery services are usually free.

In some areas, independent midwifery is available, either on a private (fee paying) basis, or as an outreach program from the local hospital. In the UK, many midwives work in the community, offering maternity care, often including home births. An independent midwife will provide all the care during pregnancy, labour, birth and in the first weeks after the birth. She may work on her own or with a partner to provide back up. Independent midwives usually offer homebirth but in some locations they have visiting rights at the local hospital and can assist at births in that setting.

Midwives in private practice charge a range of fees according to their services. Should it become necessary, the midwife can refer to a doctor (probably an obstetrician) for specialised tests or to manage complications if they arise. You may have to pay additional fees for these medical services. Be sure to ask about the costs involved for all these services in advance, and to check whether they are covered by any medical insurance that you may have.

The General Practitioner

In some communities General Practitioners (GPs) offer maternity care. Although not as comprehensively trained as obstetricians, they usually have undertaken additional training in obstetrics and are able to perform Caesarean sections and forceps births. They are more common in rural areas where no obstetrician is available. Sometimes, a GP may "share care" with a midwife, alternating visits or just seeing the woman once or twice during the pregnancy. In other locations they provide the pre-natal care for hospital patients who will eventually give birth in the local hospital assisted by either the midwife on duty or by themselves.

Because you may already know them, and as they will usually care for your family following the birth, seeing your GP throughout your pregnancy offers the advantage of continuity of care over a longer period of time.

GP services are usually free as part of the public health system, but in some places, an additional fee may be charged, especially where patients have private health insurance. It would be wise to check this in advance.

The Obstetrician

The obstetrician is a specialist in the management of complicated pregnancies and births. Any client that a midwife considers "high risk" would normally be referred to an obstetrician who would take over the case and assist the woman to give birth in an appropriate hospital setting. If a woman has an existing health condition, such as diabetes or high blood pressure, other specialists may be consulted. Additional fees will be payable for these specialised services, however most of these costs should be covered by the public health system or by private health insurance.

Some expectant parents choose to engage an obstetrician even for a birth which they expect will be normal and uncomplicated, in case a problem develops later that requires specialised assistance. The statistics show however, that this approach carries the risk of higher rates of interventions in normal birth, resulting in Caesarean sections or forceps deliveries. The reasons for this are unclear however a likely cause is that many obstetricians follow the medical model, which anticipates problems rather than managing birth primarily as a natural process.