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Congratulations, You're Pregnant! Now What?

Step 1 - Shop around for a great health care provider.

Congratulations, you're pregnant!  You’ve seen the positive results of your pregnancy test, decided who to tell (or not) and might be wondering…what next?

While most health care providers feel it’s important to get your pregnancy "dated" with vaginal ultrasound sometime within the first 10 weeks of pregnancy, not much else is happening within your body that needs medical attention. Too often, women enter into an "arranged marriage" with their OB physicians before their own opinions on prenatal meetings, how late pregnancy should be managed, and what style of care they might want during childbirth are fully formed. The first trimester (0 - 13 weeks) is the perfect time to begin shopping for the person who will care for you in pregnancy and childbirth.

Youroptions:

Licensed Midwives and Certified Professional Midwives (LM or CPM) – These care providers have completed at least 3 years of midwifery training and passed their state’s licensure exam and/or the NARM exam.  Most LMs and CPMs practice out-of-hospital birth in their own birth centers or their clients’ homes.
Pluses – Prenatal visits run typically 20 – 60 minutes or more.  Midwives typically allow a lot of discussion time for nutrition, healthy lifestyle, mental health and all of the expectant woman’s worries and concerns.  Building a personal relationship before childbirth is a paramount concern for these health care providers.  LMs and CPMs attend mothers throughout childbirth and remain with her up to four hours after birth.
Minuses – Out-of-hospital midwives can only provide care to very low-risk women.  If a woman or her baby develops health issues outside of the midwife’s scope of practice, she must refer her client to another care provider.

Certified Nurse-Midwives  (CNM) – Some folks consider CNMs the “best of both worlds” straddling both the midwifery and OB worlds.  These care providers have completed nursing school and have 1 – 2 years of specialized midwifery training.  Over 70% have masters degrees.  Most CNMs practice within the hospital or free-standing birth centers closely associated with hospitals. Pluses – Prenatal visits typically run 20 – 30 minutes.  Patient education, increasing knowledge about healthy lifestyles and encouraging the normal process of pregnancy and childbirth is the focus of CNM care.  Certified Nurse Midwives work closely with nurses and will attend you from active labor throughout the birth and immediate postpartum care.
Minuses – In busy hospital-based practices, with shared call schedules, you may be not be attended by the same midwife who provided your prenatal care.

Family Practice Doctor (MD) – A great option if your primary care physician offers maternity care.  These physicians have completed medical school and three years of family medicine.  These doctors care for low-risk women, similar to certified nurse midwives.  
Pluses – You may already know and have a great relationship with your family practice physician.  In turn, they know your history, health, and personal concerns and can adapt their care to your specific needs.
Minuses – Only about 25% of family physicians provide maternity care.

Obstetrician (MD) – Best for women who are currently high-risk or expecting complications with their pregnancies.  Obstetricians have completed medical school and 3 – 4 years of additional training in identifying and correcting the pathologies of pregnancy and childbirth.  This is a surgical specialty.  The focus of an OB’s care is identifying and treating maternal disease or problems with the growing fetus.
Pluses – Women who are ill, high risk (chronic high blood pressure, pre-gestational diabetes, heart or vascular disease) require the attention of an obstetrican who can monitor and provide early identification of maternal disease during pregnancy.  OB care increases the odds of a positive outcome for sick women and babies.
Minuses – For low-risk women, prenatal appointments average between 6 – 16 minutes.  Medical interventions and cesarean birth are more common for low-risk women seeking OB care. 

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