Which pregnancy specialist is right for you?

She recalls a patient she had long treated for anxiety and obesity. When that patient got pregnant with her first child, Oshman already knew her health concerns and was able to provide supportive care for mom and baby in prenatal visits. Now that patient’s child is 5 years old and Oshman cares for the child, too.

“It’s just such a wonderful experience to get to take care of the whole family,” she said.

Whichever specialist a mom-to-be chooses, Oshman said they can’t go wrong, especially at Von Voigtlander Women’s Hospital.

“We’re very, very lucky in our community to have so many options and great team members” to pick from to receive prenatal care.

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Midwife

Midwives, who work with low-risk patients, take a holistic approach to prenatal care and childbirth and follow the same prenatal care guidelines as doctors with regard to routine lab screenings and imaging. Their care philosophy focuses on education, prevention of complications and limiting intervention unless it’s medically necessary or desired by the patient, explained Maggie Fink, a certified nurse midwife at Von Voigtlander Women’s Hospital, where she is part of the Michigan Medicine Certified Nurse Midwife Service.

Their philosophy also stresses patience and honoring this natural life experience.

Midwives watchfully wait, while encouraging different body positions, as a normal birthing process unfolds, following the mom’s birth plan. They aim for a vaginal birth and can manage certain complications – gestational hypertension, diabetes not requiring medication or preeclampsia without severe features – and emergencies like fetal heart rate decelerations, shoulder dystocias or hemorrhages. They reserve the use of surgical or assistive interventions – cesarean section, vacuum- or forceps-assisted birth – for urgent or emergent scenarios. Midwives, though, “are trained to recognize when the scenario is not normal and requires more evaluation and, if necessary, consultation, collaboration or transfer of care to an OB-GYN.”

“We always are mindful that we have two patients we are caring for, mom and baby,” Fink said. “You need to make sure that both are safe and tolerating stronger more regular contractions over time.”

Another differentiator is midwives schedule more time – 40 minutes vs. 20 minutes with OB-GYNs or family doctors – with new patients for care visits, Fink pointed out.

“That’s something we midwives fought hard for, as a group, because we really need that extra time to understand the person and where they’re coming from to really give them an understanding of what we do,” Fink said.

Midwives provide a full suite of services, including gynecologic care with routine screenings including pap tests, family planning, preconception counseling, prenatal care, postpartum care, treatment for sexually transmitted diseases, and labor and birth support.

Fink finds herself clearing up a lot of midwife misconceptions at office visits. A common one is that patients who use a midwife must avoid pain medicine, including epidurals, which isn’t true. Epidurals are allowed even if you originally thought you wanted an unmedicated birth, she explained.

Fink also finds a lot of people are surprised about how much education she has. As a certified nurse midwife, she is a registered nurse with a master’s degree in Nurse-Midwifery. She is certified by the American Midwifery Certification Board, which she received after taking exams, and is licensed by the state of Michigan as both a nurse and a midwife, and she delivers babies in hospitals.

Home births may be done by the two other types of midwives: certified professional midwives and lay midwives. A certified professional midwife is a non-nurse certified by the North American Registry of Midwives. A lay midwife is an uncertified or unlicensed midwife whose training includes an apprenticeship with an experienced midwife, workshops or classes. Some states license their lay midwives while other states don’t.

“Because there are many different kinds of midwives, I think that’s where the confusion stems from,” she said. “The truth is we just love what we do, and we study really hard. And we make sure that we are skilled and trained consistently using the highest standards before we care for anybody.”

Doula

Fink admits there is also some confusion about the difference between midwives and doulas. A doula is hired by the mom-to-be to provide physical, emotional and informative support from prenatal to postpartum to achieve a happy, healthy birth experience. Regardless of which of the three specialists a mom chooses, the doula will be present with all three of them.

“A doula’s main job is to provide continuous support to a laboring person,” Fink said.

A doula rallies around the mom, often offering physical support, like applying counter pressure to a woman’s back as contractions commence, having her change positions or helping her advocate for her birth plan.

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“Our nurses at Von Voigtlander do such a terrific job supporting mom. However, they take breaks and are not in the room with mom every moment she’s in labor,” Fink said. A doula is. “It’s helpful to have someone else there to advocate for you when you are in labor.”

At home afterward, a doula ensures mom is getting everything she needs, perhaps bringing a meal, helping with breastfeeding or checking on her emotionally. 

The more people to watch over mom and baby, the better the outcome, Fink said.