January 3, 2020

Choosing a pregnancy path: Strengths of doctor-led and midwife-led care

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When it comes to labor and delivery, you’ve got options. Here’s how to pick the right birthing method.

Having a baby is one of life’s most joyful milestones, but it comes with an array of decisions that go beyond what color to paint the nursery. Birth is deeply personal. Your core values, your hopes and your culture all shape what matters to you most. Everyone approaches it a bit differently, and there’s no single right way to have a baby. It’s important to find providers and a healthcare system that are the right fit.

We asked Ali Sevilla de Cocco, MSN, a certified nurse midwife at Vanderbilt Center for Women’s Health to explain the strengths of the different approaches to pregnancy care offered at an academic medical center like ours. Understanding what’s important to you, and the options available, will help you make a choice that best fits your medical needs and birth plan.

What is team-based care?

You might envision your pregnancy with the same OB-GYN throughout, including during labor and delivery. But increasingly, hospitals are turning to teams to help provide the best care for you and your baby. You may see a midwife, nurse practitioner, resident or attending OB-GYN physician during your pregnancy. You may also see a maternal-fetal medicine specialist, if needed.

In the hospital, team-based care becomes more obvious. For vaginal delivery, an attending midwife and a resident physician are likely the core of your care team. An attending physician is always available should the need arise. For a medically necessary C-section, an experienced OB-GYN leads the procedure. Physicians are trained surgeons, while midwives are experts of labor support. Team-based care encourages all of our providers to perform at the highest ability of their education, certification and experience.

Team-based care is often medically appropriate for women at higher risk of pregnancy complications, which could exist because of multiples, chronic conditions such as diabetes of high blood pressure, or a history of pre-term birth.

What is a midwife-led approach?

Midwives may collaborate with OB-GYNs as part of team-based care or work independently, and they can be found in a hospital setting or birth center. Certified nurse midwives are graduate-level educated and nationally certified healthcare professionals whose scope includes primary care, gynecological and family planning services, preconception care through delivery of a newborn and the postpartum period. Midwives are embraced at Vanderbilt as a critical part of both models of care.

A midwife-led approach, also referred to as total midwifery care, is provided through Vanderbilt University’s School of Nursing Midwives. “One of the hallmarks of midwifery is helping women to make decisions about their healthcare that feel appropriate for both themselves and for their families,” Sevilla de Cocco said. “For women who want a provider to be involved in all aspects of their preconception or their prenatal services and then also labor and delivery and postpartum care, a midwifery model is great for that.”

If you choose the midwifery model, you still have access to physicians if needed. If it’s determined that you’ll require a C-section, for example, or if forceps or a vacuum are necessary to aid the delivery, the midwife calls in an attending physician. “Midwives advocate for low intervention when there are no complications,” Sevilla de Cocco explained. “But we are well-equipped to utilize evidence-based interventions and resources when necessary.”

Which birthing method should you choose?

Sevilla de Cocco suggests patients consider two points when making a decision: your level of risk, and your goals.

The midwifery-only plan is more of a low-risk model, she explained. If you have a known medical complication, such as pre-existing insulin-dependent diabetes or chronic hypertension, a team-based approach may be the best fit.

“Some women will think that they’re high risk when really they’re not,” Sevilla de Cocco added. “Some will think, ‘Oh, I had an emergency C-section, so, therefore, I have a high-risk pregnancy with this pregnancy.’ And that is not always the case.” To find out if the midwifery model makes sense for your needs and with your medical history, Sevilla de Cocco suggests making a preconception or initial appointment for a screening at any of the clinics.

If you are low-risk and still aren’t sure which plan to choose, consider your goals. If your aim is to interact with just one provider rather than several and to have a midwife-led labor and delivery, then the midwifery model might be right for you.

Sevilla de Cocco said that physicians and midwives are sometimes physically located in different clinics, but there’s a high level of collaboration among the teams. Patients who begin care with one method and practice but find it’s not the right fit can change their mind. She added, “Our physicians and midwives work together to find the best option for you.”

pregnancy jitters

Find your ideal provider. Explore team-based care at vanderbiltwomenshealth.com or get to know the Vanderbilt University School of Nursing midwives at vanderbiltnursemidwives.org.