Your pregnancy and birth are very important life events for you and your family.
Choosing the right health care provider is an important decision that could affect not only you but also your new baby’s health. Your birth experience also provides memories which most women recall in vivid detail for years to come.
Please read on to learn more so that you and your family can make an informed decision about the provider and the birth location which are right for you.
TYPES OF BIRTH CARE PROVIDERS
Lay Midwife (AKA direct entry midwife or DEM) is not licensed by the state and is not required to have formal education or to have consultation/back-up services with a physician. Lay midwives attend women in the home setting, and typically have little contact with other health care professionals regarding pregnancy and delivery.
Licensed Direct Entry Midwife (LDEM) is also known as a Certified Professional Midwife (CPM), which is the name of the credential granted by the North American Registry of Midwives (NARM). LDEMs have been licensed by the state for several years. CPMs may enter midwifery practice from a variety of routes and thus have widely varying levels of training, education and experience. Some candidates may be certified as CPMs without any formal didactic education and solely on the basis of apprenticeship. Others complete one of a variety of training programs, some of which are accredited by the Midwifery Education Accreditation Council (MEAC). CPMs are licensed to care for low-risk healthy women and are required to consult with or refer to a physician if certain complications occur during pregnancy, labor, birth or postpartum. LDEMs have primarily delivered at home in Utah but are now attending deliveries in some birth center settings.
Certified Nurse-Midwife (CNM) is certified by the national American Midwifery Certification Board (AMCB). CNMs have both Registered Nurse (RN) training and credentials, as well as a Master of Science in nursing with emphasis in obstetrics and gynecology. CNMs have been licensed by the state for many years, and typically practice with a written agreement for 24/7 physician consultation and referral services. Nurse-midwives may also assist the surgeon during a Cesarean section. They attend births primarily in hospitals but a few attend women in birth centers and at home.
Family Practice Physician is a (preferably) American Board of Family Medicine board-certified physician. A Family Medicine physician has 4 years of medical school followed by 3 years of Family Medicine residency, which includes 14 weeks of focused training in obstetrics. Family physicians provide general health care for all family members, including your newborn. They provide prenatal care and attend deliveries in hospitals, and will consult with obstetrician/gynecologists (OB/gyns) for a woman with complications during pregnancy, labor or delivery.
Some receive additional surgical training which allows them to perform Cesarean sections; otherwise a family physician can assist the OB physician in a Cesarean.
Obstetrician (OB/gyn) is a (preferably) American Board of Obstetrics and Gynecology board-certified physician, or (preferably) an American Board of Osteopathic Obstetrics and Gynecology certified osteopathic physician (DO).
These physicians attend 4 years of medical school and then 4 years of OB/gyn residency, where they specialize in obstetric and gynecologic surgery and procedures and the management of more difficult pregnancies.
Perinatologist is a subspecialist in the field of obstetrics and gynecology. After the 4 year ob/gyn residency, a perinatologist completes an additional 2-3 year fellowship which focuses on the medical and surgical management of the most high risk pregnancies. Perinatologists are board certified by the Society of Maternal Fetal Medicine, and care for patients who are complex and referred by midwives, family physicians as well as obstetricians.
TYPES OF BIRTH FACILITIES
Home: A midwife or other type of provider attends a laboring woman in her home for delivery. If complications arise, an ambulance or private vehicle is used to transport the woman and/or newborn to the nearest hospital.
Birthing suite: This term may be used interchangeably with the term “birth center” but refers specifically to a one-room birthing facility. A birth suite is designed to be homelike and to provide a home birth experience without having to birth at home. One room birthing facilities in Utah are neither licensed nor regulated by the state, and there are several currently operating in Utah. If medical complications arise for mother or newborn, transport to the nearest hospital must be initiated.
Out of hospital birthing center: This is a multi-room birthing facility designed to provide a homelike environment for birthing with more stringent safety supports and more defined clinical regulations in place. These centers are licensed and regulated by the state. Currently there is one of these centers operating in Utah, in Hildale. As with birth which occurs at home or in a birth suite, if complications arise at this type of birth facility, ambulance or private vehicle transport to the nearest hospital must be done.
Differences in the requirements for operation between the two types of birth centers mandate that multi-room birth facilities have physician back-up services, prenatal blood tests, second person licensed in adult and newborn CPR in attendance at delivery, facility quality assurance program, and stipulations for waste and dirty equipment handling.
Hospital: A hospital setting provides the maximum level of medical support for labor, birth and newborn care, although hospitals differ in the level of complications they are equipped to manage in both mother and child. Generally speaking, any hospital which offers maternity care will have specially trained RNs to attend the mother and newborn, and can manage full term deliveries (37 weeks) without known maternal or infant complications. Delivering providers could include CNMs, family physicians and obstetricians. Maternal or infant higher-risk conditions, including preterm delivery, are best managed in a facility which routinely accepts and cares for this type of patient. Although infants requiring a higher level of care may be transported after delivery to a hospital which is better equipped or staffed to address their specific medical concerns, it is preferable for high risk mothers to deliver in facilities that routinely handle critical care, as transport of a newborn increases the possibility of further complications.