VanWaardhuizen Providers ObstetricianOb gyn Family Practioner Certified Nurse Midwife DirectEntry Midwife Doula Obstetrician Physicians who are trained in every conceivable medical aspect of pregnancy labor delivery and the postpartum period ID: 913884
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Slide1
Birthing Options
Laura B.
VanWaardhuizen
Slide2Providers
Obstetrician/Ob-
gyn
Family
Practioner
Certified Nurse Midwife
Direct-Entry Midwife
Doula*
Slide3Obstetrician
Physicians who are trained in every conceivable medical aspect of pregnancy, labor, delivery, and the postpartum period
One who does all of the above plus cares for the reproductive systems of non-pregnant females is called an obstetrician-gynecologist, or Ob-gyn.
Some specialize even further into specific pregnancy issues
A definite must for a high-risk pregnancy or complicated birth
Slide4Family Practitioner
A “one stop” doctor who is trained in maternal care as well as primary care and pediatrics.
May have already seen for a check up and advice when first trying to conceive (couples without fertility issues)
Benefits are familiarity with mother and her health history, also the ability to provide continued care for the baby through it’s lifespan
In high risk pregnancies, will refer on to a specialist
Some may just provide the prenatal and postnatal care and leave the delivery to an obstetrician
Slide5Certified Nurse Midwife (CNM)
A registered nurse who has taken graduate level courses in prenatal, birth, and postnatal care who is licensed by the American College of Nurse Midwives
Typically more personally involved than a doctor
Can perform an epidural, though statistically do so less than doctors. Do have a higher VBAC rate
May not be able to deliver in a hospital
May not be covered by many insurance plans
Slide6Direct-Entry Midwife
Did not start as a registered nurse (though may have other health degrees). Those evaluated and certified by the North American Registry of Midwives may call themselves a “Certified Professional Midwife.”
Most likely to do a home birth (birthing centers are more likely to use
CNMs
)
Are not RNs, so cannot administer pain medications
Some states offer licensing and
CPMs
can be reimbursable through Medicaid or private healthcare plans.
In other states (including Iowa), it is illegal for
CPMs
to practice.
Slide7Doula
A doula does NOT medically assist with birth
A birthing assistant who supports the mother/family through pregnancy, labor, delivery, and early infant care.
Unlike friends or family members, a doula is a professional and will remain steadfast and stable through the birth
Research links them reduced incidence of C-sections, epidurals, and difficult labors
Are not covered by insurance; costs range from $300-$1000
Slide8Places
Hospital
Birthing Center
Home
Slide9Hospital
99% of North American women plan births in hospitals
Ready access to pain medications, specialists, and emergency care
Safest place to be for a high risk pregnancy
1 in 4 incidence of C-section birth
Some now offer birthing rooms/suites which offers more comforts for the family
LDR room: Labor, delivery, and at least 1 hour recovery
LDRP room: + Postpartum; stay in room until go home
Slide10Birthing Center
Designed to be a more homey/comfortable atmosphere; private rooms, whirlpool tub/shower, kitchen
Not equipped to handle major birth complications
Can administer pain medications but not epidurals
Should be located close to a hospital in case of emergencies
Typically staffed by midwives, but some have on-call OBs
Will only accept low-risk pregnancies
Slide11Home
Idea: pregnancy isn’t a sickness or disease
You literally have “all the comforts of home” and you can begin to care for your infant immediately as you typically would but still have a support staff early on
Newborn is not exposed to many strangers (and potentially their germs!)
To consider a home birth, the ACNM recommends:
You have a “low-risk” pregnancy
You have a doctor or midwife in attendance
You live within 30 miles of a hospital (10 if heavy traffic)
Slide12Options
Medicine
Medicine Alternative
Birthing Positions
Waterbirth
Slide13Medicines- Epidural
A shot or spinal tap delivering a combination of drugs to the fluids surrounding the spinal cord; numbs your lower body. Does not enter the bloodstream (not transmitted to baby). A fetal monitor will be attached to your baby.
Restriction: don’t eat or drink. Restricted to bed
Drawbacks: slows down productive labor because the numbing keeps you from pushing.
Side effects: can decrease your blood pressure and slow the baby’s heartbeat (can be helped with IV fluids and lying on your side). Can have a headache if the covering of the spinal cord is pierced. Rare incidence of seizures.
Slide14Medicines:
Combined Spinal Epidural (Walking Epidural): Delivers the same amount of pain relief with less medication. Still have control over leg muscles. Can get as soon as 2 cm dilation; caregivers prefer to wait until 4 cm
Spinal Tap: Spinal block for C-section; Saddle block for
vaginal delivery.