With so many options for prenatal care, it is easy to become daunted by your choices.
Primary care physician, general practitioner, gynecologist, obstetrician, midwife, perinatologist, doula: what do they all mean? Who confirms the pregnancy? Do you need to choose one, or must you visit all of them during your pregnancy?
Of course in theory a young woman in her early twenties does not need to visit a doctor to confirm her pregnancy: home pregnancy tests are very accurate. Once confirmed, routine visits to her primary care physician to monitor the pregnancy and deliver the baby are all that is required. But most pregnancies are not this simple.
Most women now give birth later, making them candidates for a high-risk pregnancy, and modern technology makes it possible to discover and manage problems while they are still in utero. The pressures of the modern world, the possibilities offered by modern technology and the limitations imposed by insurance liability mean that you will probably have a combination of doctors monitoring your pregnancy. You just need to decide which combination is best for you.
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During the first ten years of the twentieth century, the infant mortality rate was thirteen percent (13 in 100), with over half dying during their first month of life. Nearly one pregnant women in every 100 (0.85%) died in childbirth. Improvements in prenatal care during the following one hundred years have reduced the infant mortality rate to 0.69% (7 in 1000) and the maternal mortality rate has fallen to 0.007%.
Today women have an almost overwhelming choice of professionals to guide and monitor them through their pregnancies. In the early 1970s, midwives were once again recognized as an important asset in pregnancy, and now highly trained and certified midwives play a valuable role in prenatal care.
The age of most first time pregnancies now ranges from thirty to forty five. Since most of these pregnancies can be considered 'high risk' they receive a level of attention that may leave younger mothers wondering why they are being overlooked. In fact all pregnancies are different and many factors will need to be considered when choosing the type of prenatal care you will need for your pregnancy.
There are some issues that you should consider, and your doctor may well ask you during your first prenatal visit. These include your age, you (and your family's medical history to determine whether you predisposed to hereditary conditions), your sexual history, your preexisting diet and nutrition and whether you used to smoke, drink or use drugs. The type of birth you want, perhaps a natural childbirth or a home birth, will also influence the type of prenatal care you receive.
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One of the first decisions you will need to address is the type of birth you would like. Your birth options include hospital birth, birthing center or home birth. If you decide to have a home birth you should discuss it with your doctor or midwife early in your pregnancy. If complications develop during your pregnancy or it is considered high risk your doctors will advise you to have a hospital birth.
You probably already have a primary care physician who performs an annual physical and monitors your general health. Your primary care physician may be a general practitioner, who can monitor all aspects of your general health and refer you to a specialist if necessary, or an ob-gyn (obstetrician/gynecologist), who has specialist training in the female reproductive system and childbirth. Because of the liability associated with obstetrics (childbirth is considered a high-risk activity), not all general practitioners, or obstetrician/gynecologists for that matter, carry the insurance required to practice obstetrics.
Your primary care physician may be part of a group practice or a solo practice. Doctors who operate a solo practice have the opportunity to build a closer relationship with their patients, but may not be available when she goes into labor.
If your doctor is part of a group practice you may be seen by other doctors or midwives during your routine office visits. Although you have less of an opportunity to build a relationship with your doctor, one of the medical professionals will be on call when you go into labor and you will probably already have met the person who will deliver your baby.
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