Part I: How to Choose a Pregnancy Care Provider

This is Part I of our three part mini-series on Pregnancy Care! On today’s episode, Drs. Alicia and Sarah address a question they get asked a lot: how to choose a pregnancy care provider! It’s one of the first major decisions you make in pregnancy, and often an overwhelming one as you try to navigate the different options and which one is best for you. Read on to review the different options and how to choose the best one for you. 

Top Three Types of Pregnancy Care

There is an underlying expectation that all types of care providers provide the same basic standard of care to all pregnant patients, regardless of where you are or who you choose as your care provider. You should ensure that the care provider you are considering is licensed to provide pregnancy care and is in good standing. There are other care providers who may support you through your pregnancy, such as physiotherapists, naturopaths or chiropractors, but they are not medically trained to support you through your pregnancy, childbirth, and postpartum journey independently.

Most communities offer some combination of these three different options:

1. Midwifery 
2. Family Physicians
3. Obstetricians

Midwifery

• Midwives are medically trained in healthy birth and pregnancy. 
• They generally complete a four-year degree, which covers caring for low risk pregnant and postpartum people, as well as the childbirth period. 
• Some midwives have education prior to midwifery school, such as a nursing or other undergraduate degree, but some have no prior medical training. 
• Midwives have a defined scope of care within which they must work and if a patient is or becomes medically complex, they either share care with a specialist or physician, or transfer care to a family doctor or obstetrician, depending on the circumstances. 
• The midwifery model is unique in that it often offers longer appointments than family physicians or obstetricians, as well as home birth, including possible postpartum home check-ups. 
• Midwives can work solo or they can work as a part of a group providing shared care for a community of clients. These groups generally tend to be a bit smaller than physician groups, approximately four patients in care at one time. Midwives can care for up to 40 clients per year. 

Family Physicians

• Generally most family physicians who provide maternity care are specialized in maternity care.
• Training for family physicians usually includes at least four years of an undergrad degree, four years of medical school, and at least two years of residency training. 
• Some residents who are interested in maternity care tend to spend more time during the residency focusing on that, while others do extra focus training after residency to further hone their skills. 
• Some family physicians in rural areas do extra training in epidurals, C-sections, and assisted vaginal deliveries if there is a need in their community.
• Family physicians generally have a much broader medical training than both midwives and obstetricians, so they are able to help support pregnant people with medical needs outside of pregnancy, such as mental health concerns, prescribing medications, thyroid issues, migraines, bowel concerns, etc.
• In some communities you might follow along with your regular family physician until about 20 weeks, and then transfer to a specialized midwife, family physician, or obstetrician.
• Family physicians generally start to see pregnant people at about six to eight weeks of pregnancy and care for them all the way through to two months postpartum. 
• Family physicians are also trained in more complex care of postpartum issues and newborn issues such as high blood pressure and poor growth in infants. 
• The amount of patients family doctors care for annually can vary hugely - some provide maternity care for those patients in their own practice (approximately 10 to 20 patients a year) while some providers only do maternity care and can provide care for up to a hundred patients or dyads a year.
• Some family doctors are on call only for their own patients, but often they work in groups of 4 to 10 physicians to provide care for the patients that are under the group.

Obstetricians

• Obstetrician gynecologists have a minimum of a four-year undergrad, four years of medical school, five years of residency and some do a few extra years of training on top around high risk pregnancies. These physicians are known as ‘maternal fetal medicine physicians’ or ‘perinatologists’. 
• It's important to note that obstetricians do not care for newborns. You will either need a family doctor or pediatrician to provide newborn care after your delivery. 
• In terms of the model of care, similarly to family physicians, obstetricians can be seen in office visits, attend your birth in the hospital, and do postpartum visits for maternal health in the office as well. 
• Obstetricians can care for all pregnancies, even very high risk pregnancies, starting at early gestation (generally the 6-7 week point).
• It is also important to know that obstetricians do not do general medical care - you may need to see your family physician during your pregnancy for non pregnancy-related conditions like asthma, acne, etc. 
• The amount of patients seen per year can vary largely depending on the community, but most obstetricians do group practice. What this means is that you'll generally see one or two obstetricians in the office and they rotate through a group on call, just like family physicians, where there's generally anywhere from 4 to 8 obstetricians that you might see during your delivery

Location of Birth

When choosing where to give birth, the main options are in a hospital, at home, or at a birthing center (which is not too available around Canada, but is becoming more so). When choosing a location, consider that your provider might have varying privileges. For example, usually only obstetricians and family physicians are trained to provide C-sections, while family physicians generally do not perform home births, while midwives do. 

Check out our She Found Motherhood Podcast episode on What is a Birth Doula with Jay Duncan!

Tune in to today’s podcast to learn even more about choosing a provider, or subscribe to The Pregnancy to Parenthood Podcast Series. For the low, one-time cost of $47, get full access to over 40 informative episodes supporting you week by week, focused on the trimester and stage of pregnancy you are in. Tune in every week, or binge listen all at once and come back to the episodes you found most helpful as you move through pregnancy to parenthood!