The Expectant Father. Armin A. Brott

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СКАЧАТЬ call the day the baby comes. So, if you can, try to meet with the other doctors in the practice, as well as any OB/GYNs your family doctor might work with. (Most FPs can’t do C-sections or assisted deliveries, and will need OB/GYN backup. In addition, since malpractice insurance covering maternity care and childbirth is very expensive, many FPs will refer pregnant patients to an OB who already has that coverage. Make sure you’re comfortable with this person, since he or she may be doing the delivery if things get complicated.)

      Midwife

      Although midwives are not as common in the United States as they are in Europe and other parts of the world, they’re becoming increasingly popular. And you might want to consider bringing one into the process, even if your partner has a regular OB.

      In Howell-White’s study, women who expect their partners to be actively involved in labor and delivery and who place a high value on getting information on the birth process are more likely to opt for a midwife. Interestingly, so are women who have no religious affiliation.

      Certified nurse-midwives (CNMs) are licensed nurses who have taken a minimum of two or three years of additional training in obstetrics and passed special certification exams. They can deliver babies in hospitals, birthing centers, or at home. But because their training is usually in uncomplicated, low-risk births, CNMs have to work under a physician, just in case something comes up.

      Some states have created a new designation, certified midwife (CM), which allows practitioners who aren’t nurses, but who go through the same training and take the same exams as CNMs, to work as midwives.

      Many standard OB/GYN practices, recognizing that some of their patients might want to have a midwife in attendance at the birth, now have a CNM (or in some cases a CM) on staff. Officially, then, your partner is still under the care of a physician—whose services can be paid for by insurance—but she’ll still get the more personalized care she wants. Keep in mind, though, that because midwives aren’t MDs, they can’t perform surgery and they’re able to handle only low-risk cases.

      If you’re considering using a CNM or a CM and need some help with your search, the American College of Nurse-Midwives (midwife.org) can put you in touch with one in your area and fill you in on any applicable regulations. If you’ve already found a midwife but want to be sure she’s properly certified, visit the American Midwifery Certification Board (www.amcbmidwife.org).

      There are also plenty of midwives out there who are neither certified nor licensed. Lay midwives have a lot of experience working with pregnant women and may even have a lot of specialized training. But they’re not regulated and may not have passed any specific midwife exams, which means that in most cases they can work in home settings but not in hospitals or birthing centers.

      Like CNMs or CMs, lay midwives must work with a physician, in case of an emergency. The Midwives Alliance of North America (MANA.org) can help you find out more about lay midwives and make contact with one near you.

      Doula

      Although it sounds like it should mean “a little duel,” doula is actually a Greek word that means “a woman caregiver of another woman.” Many doulas have had children of their own, and all of them go through an intensive training period in which they are taught how to give the laboring woman and her partner emotional and physical support throughout labor, and information about the delivery. Doulas have become increasingly popular over the years, and we’ll talk a lot more about them on pages 165–67. For now, though, as you’re just beginning the process, there’s one very important thing to think about.

      Doulas are not medical professionals, they’re generally not regulated, and they may not be particularly welcome in hospitals. Here’s how childbirth educator Sarah McMoyler and I described, in our book The Best Birth, the sometimes combative relationships that can develop. “The problem is that some doulas have an agenda and see their role as protecting mom and baby from what they believe are unnecessary interventions. Sometimes they take that agenda a couple steps too far and start playing doctor, inserting their non-medical opinion into a science-based hospital arena. As you can imagine, this can create tension and confusion, and is, frankly, completely inappropriate.” Because this kind of attitude can interfere with the medical team’s ability to do its job, a number of OB/GYN practices and hospitals around the country have banned doulas from their delivery rooms. That said, several studies have shown that having a doula can reduce the length of labor. But before you plunk down a deposit, check with your OB.

What to Ask Your Prospective Practitioner

      Besides a medical school degree, OB/GYNs may have little else in common. Each will have a slightly different philosophy and approach to pregnancy and birth. The same (except for the medical school part) can be said for midwives. So before making a final decision about who’s going to deliver your baby, you should get satisfactory answers to the following questions and any others you can think of. (If at all possible, make a separate appointment to do this. You’ll never be able to get everything in a fifteen-minute appointment. And no, there are no stupid questions—we’re talking about your partner and baby here.)

      ESPECIALLY FOR OB/GYNS

      • How do you feel about the father being there for prenatal exams and attending the delivery? Are you enthusiastic about it or just tolerant?

      • Do you recommend any particular childbirth preparation method (Lamaze, Bradley, and so on)?

      • At which hospital(s) do you deliver your babies?

      • Are you board certified? Do you have any specialties or special training?

      • How many partners do you have and how often are they on rotation?

      • What percent of your patients’ babies do you deliver? What are your backup arrangements if you can’t be there?

      • Where do you stand on the natural-vs.-medicated debate?

      • What’s your philosophy about Cesareans, labor inductions, and episiotomies?

      • What’s your C-section rate, and how do you make the decision to proceed with the surgery?

      • Do you permit fathers to attend Cesarean sections? If so, where do they stand (up by the woman’s shoulders or down at the “business end”)?

      • What is your definition of a “high-risk” pregnancy?

      • What kind of monitoring do you recommend? Require?

      • How do you feel about the mother lifting the baby out herself if she wishes?

      • How do you feel about the father assisting at the birth?

      • Do you routinely suction the baby or use forceps during delivery?

      • Do you usually hand the naked baby straight to the mother?

      • Do you allow the mother or father to cut the umbilical cord?

ESPECIALLY FOR MIDWIVES

      • Are you licensed or certified? By which organization?

      • How many babies have you delivered?

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