Wednesday, January 1, 2014

7 Steps to Choosing a Maternity Care Provider

Do you know that when it comes to choosing a care provider you are a consumer?  You make the choices that best suit your situation and your family.  This guide to selecting a care provider will help you to become a better informed consumer.

The majority of American women spend 7-12 months planning their weddings.  (  Far less time is spent choosing a care provider for pregnancy.    Most women take the list provided by their insurance company and call around to get an appointment.  They may ask friends who they used, but rarely do they interview providers or even switch providers after discovering an incompatibility. 

If you are not currently pregnant, start doing your research now.  Read about pregnancy, labor, and birth.  Learn about routine newborn procedures.   Evaluate your own health and know if you have any conditions that would cause you to be considered high risk during pregnancy.  Research the different options for careproviders—Midwives (CPMs, LMs, CMs), Certified Nurse Midwives (CNMs), Family Practice or General Practioners, and Obstetricians (OBs)—know what they specialize in, their strengths and weaknesses, and where they will assist you in giving birth.  Review your insurance coverage, know what is covered, what isn't and whether or not you should change your policy based on the research you've done. 

If you are pregnant, even if you've already selected your provider, it's not too late to reconsider.  (this will be a whole other post)

Here are 7 things to consider when choosing a care provider:

  1. What type of care do I need?  Most women fall into the low-risk category.  This means you are in relatively good health, any conditions you have are minor or well-controlled.  Midwives, CNMs, and Family Practice doctors are an excellent choice for low risk women.  Obstetricians are, by definition, surgeons.  They will see women of all risk categories, but their specialty is in surgery.   
  2.  Where do I want to give birth?  You have many options—home, birth center, and hospital.  Which one resonates with you?  What is available in your area?  You probably have more options than you realize.  Where you want to birth will have an impact on who you choose as a care provider.
  3. When you call for an appointment, will the provider do a consultation or interview, or do they insist on doing an exam?   Any provider who refuses to do a consultation should move to the bottom of your list.  You shouldn’t have to get undressed just to meet the provider. 
  4. Ok, so now you have your appointment.  What questions do you ask?  I highly recommend that you download the 10 Questionsto Ask PDF  from The Coalition to Improve Maternity Services (CIMS).  This is one of the best sources of information regarding evidence-based maternity care.  In addition to those questions, ask what the provider's Cesarean rate is.  Not knowing what their Cesarean rate is should speak volumes about how high it is.  For a homebirth midwife ask what the transport rate is.  Pay close attention to how the provider answers your questions. 
  5. What is your gut-reaction to the provider?  Do you feel that you can ask any of your questions?  Do you feel like the provider talks down to you or down-plays your concerns?  Were any of your questions brushed off?  No question is too small, too far off to be addressed.
  6.  How far are you willing to drive for your ideal care?  The sad fact is that many women will choose the provider closest to where they live.  Some have a fear of birthing the baby in the car if they have to drive quite a distance.  Others are worried about what could go wrong if they aren't close to the chosen place of birth.  Are you willing to drive an hour to see a provider who respects you and your choices?
  7. The least important factor is cost.  I know, I know, you're thinking that cost should have been number one.  If you have insurance you are more inclined to make a choice based on that.  Are you willing to pay out of pocket if your desired level of care isn't covered?  Did you know that they cost of a homebirth midwife is typically LESS than the total of the co-pays for prenatal visits & hospital birth?
Now that you have these seven items to consider, do your research.  Educate yourself.  You are a consumer, you have choices in care providers, choose wisely.