Care Provider Options: Pregnancy, Childbirth, Postpartum
It can be confusing to try to choose a health care provider during one of the most vulnerable periods of your life (pregnancy and childbirth). There are different types of providers available as well as different locations where these providers work. Hopefully this post will concisely summarize primary care available in Texas. I’ll make a separate post about different locations where someone can be cared for and a separate post about secondary support services, but this is a good start. I suggest that you and your partner talk about what type of experience each of you want and to look for a provider that matches your vision. This can be done by word of mouth, referrals and other network recommendations, but I also suggest meeting with your prospective provider with a list of questions (so you don’t forget something that is important to you). If you are working with a doula, that person can help you determine a list of questions or concerns. These questions can also be found by quick google search. Enjoy!
** Only Physicians, CNMs and LMs/CPMs are legally permitted to deliver or catch babies in Texas.
Certified Nurse-Midwife (CNM)
A CNM is an individual who has completed nursing school and is a licensed Registered Nurse (RN) but has also completed work/clinicals at a graduate level - a master’s degree or doctorate degree. The graduate level program must be accredited by the American College of Nurse-Midwives (ACNM). The scope of practice for CNMs varies by state. In Texas, CNMs manage women’s health from first menses until the end of life. This includes family planning, routine gynecological care, pregnancy, childbirth and postpartum period. They may also provide temporary and normal newborn care or primary health care for women. In this state, CNMs may have prescriptive authority delegated by a collaborating physician if the CNM meets requirements from the Board of Nurse Examiners for the State of Texas (BNE). There are approximately 350 CNMs in Texas. CNMs practice standards of care created by the ACNM, which is a national organization with the midwifery model of care in mind.
Place of practice: clinics, hospitals, medical offices or private practices, birth centers or home births.
Medicaid: recognizes CNMs as primary care providers fro women and reimburses CNMs at 85% the rate paid to a physician for the same services
Clientele: low-risk pregnancies, women's health care
Family Physicians or Obstetricians
Physicians get certified by their respective specialties: Board of the American Board of Medical Specialties, the American Osteopathic Association or the American Board of Physician Specialties. Physicians are licensed/regulated by the Texas Medical Board. A physician must graduate from college, complete medical school (graduate school), finish a residency, and also finish fellow training. To be quite honest, I’m not as familiar with the physician/OB track as I am with the CNM and LM professions. Physicians are regulated by the Texas Medical Board; they must be licensed by Texas. Physicians cover well-women health, routine gynecological needs, familying planning/preconception, prenatal, childbirth, and postpartum with the medical model of care in mind.
Place of practice: clinics, hospitals, birth centers (rare)
Medicaid: recognizes physicians
Clientele: entire range of pregnancies - based on specialty, women's health care
Licensed Midwife (LM) or Certified Professional Midwife (CPM) or Direct-Entry Midwife….specific to Texas
A licensed midwife independently provides women’s health care services during pregnancy, childbirth and the postpartum period. They are also trained to provide newborn care for the first six weeks of life. Some midwives have the training to provide family planning and routine well-woman care. LMs can purchase and use oxygen and eye ointment for the newborn. These professionals are not required to be nurses or attend nursing school. During their training, LMs must gain clinical experience/preceptorship for at least one year but not more than five years, accruing at least 1,350 clinical contact hours. In addition, they must actively participate in 20 births, serving as a primary midwife in 20 additional births, and also perform 75 prenatal exams, 20 newborn exams and 40 postpartum exams.In Texas, their training must be based on the Midwives Alliance of North America (MANA) Standards of Practice and they must pass the North American Registry of Midwives (NARM) test and skill specifications. In addition, they must also successfully complete the Texas Midwifery Basic Information and Instructor Manual and meet minimum clinical education requirements (which includes health provider CPR and neonatal resuscitation. There are approximately 200 LMs in Texas. LMs or CPMs practice standards of care created by Texas Midwifery Rules, with the midwifery model of care in mind. It is possible for an LM to be certified but not licensed, this can be easily checked by visiting the TDLR Midwives License file.
Place of practice: clinics, midwifery offices, private practices, home births or birth centers
Medicaid: recognizes LMs only if working in licensed birth centers
Clientele: low-risk pregnancies
Lastly, I would like to briefly describe the midwifery model of care and medical model of care…
Midwife Model of Care (according to NAMA)
“The Midwives Model of Care™ is a fundamentally different approach to pregnancy and childbirth than contemporary obstetrics. Midwifery care is uniquely nurturing, hands-on care before, during, and after birth. Midwives are healthcare professionals specializing in pregnancy and childbirth who develop a trusting relationship with their clients, which results in confident, supported labor and birth. While there are different types of midwives practicing in various settings, all midwives are trained to provide comprehensive prenatal care and education, guide labor and birth, address complications, and care for newborns. The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. The Midwives Model of Care includes:
monitoring the physical, psychological and social well-being of the mother/birthing parent throughout the childbearing cycle
providing the mother/birthing parent with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
minimizing technological interventions and
identifying and referring women/birthing people who require obstetrical attention.
The application of this model has been proven to reduce the incidence of birth injury, trauma, and cesarean section.”
Summary: Views mother as the primary responsible party for her own well-being and well-being of her fetus; pregnancy is a healthy natural state; view mother and fetus as one during pregnancy
Medical Care Model
The traditional Medical Care Model is disease- or illness-based. Using this biomedical approach to problems, symptoms elicited from patients are compiled. Based on these symptoms a differential of possible diseases or illnesses is constructed. Additional history is obtained in order to support or refute the possible diagnoses. The medical model is about controlled medical management of a safe, healthy pregnancy and birth. Obstetrics is defined as "the branch of medical science concerned with childbirth." Obstetricians are trained in emergencies and a high risk management of pregnancy and birth. Obstetricians are more likely to think more medically about pregnancy and birth because of their specialty training in emergency medicine.
Summary: Physician is of primary responsibility; pregnancy is understood as a pathological state in obstetrics; mother’s body as separate entity from her fetus during pregnancy
BOTH ARE NECESSARY FOR MATERNITY CARE
Resources:
https://medlineplus.gov/ency/patientinstructions/000596.htm
https://mana.org/about-midwives/midwifery-model
