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Health & Fitness Midwife, family doctor or obstetrician: Who should handle my prenatal care?

The question: I'm recently pregnant and wondering who to see for my prenatal care: a midwife, family doctor or obstetrician? Any suggestions and is one option better than the other?

The answer: Pregnancy and birth are life-changing experiences that involve many physical and emotional changes, so it's important to feel comfortable and confident in the care and guidance you receive from your health-care provider.

Ultimately, the decision of who to see for your prenatal care is a personal choice that depends on your wishes for how the pregnancy and birth will go, your previous pregnancy history and if you are considered high or low risk. For some, where you live will also influence what choices you have due to availability of the different types of providers.

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Midwives, family doctors and obstetricians are all qualified to provide safe and comprehensive prenatal care for women during their pregnancy, labour and birth. They can all order the same tests during pregnancy such as ultrasounds and blood work. Each type of health provider offers a different style of care which will match different people's preferences.

The first thing to consider when making this decision is the level of one-on-one interaction you prefer from your health-care provider. If you are looking for a more personalized experience with minimal intervention, a midwife could be a good option. Midwives tend to spend more time with their patients, with the average visit length being approximately 30 to 60 minutes. Family doctors tend to spend approximately 10 to 15 minutes per visit, while obstetrician visits are often shorter.

In general, most midwives follow their patients throughout their pregnancy and will be there for the labour and birth. For family doctors and obstetricians, they are usually part of a call group that rotates evenings on-call so it is not a guarantee that you will be with the same doctor who has followed you through the pregnancy. If this is a concern for you, most family doctors and obstetricians do offer a "meet and greet" evening, so that you can be familiar with the other potential doctors in their call group who may be there for the delivery.

Midwives tend to be non-interventional in their approach, with their focus of care being to guide you toward as natural a birth as possible. They tend to do less monitoring during the labour process and will use techniques other than medication for pain management. This being said, if medication or an epidural is needed for pain relief, they could still access this in the hospital setting.

The next consideration is if your pregnancy is considered high or low risk. If you have a preexisting medical condition such as epilepsy, high blood pressure, heart disease, or diabetes, you may be considered high risk. If this is the case, you may be referred to an obstetrician for support. This may be a one time visit and then the obstetrician may do shared care with either your family doctor or midwife, or they will assume care for the remainder of the pregnancy depending on the situation.

If you are followed by a midwife or family doctor and a complication arises in the labour or delivery process, an obstetrician can be called upon for support.

It's important to consider postpartum care as well. For midwives, they will do a visit in the home after birth and help with breastfeeding and baby care until approximately six to eight weeks. For family doctors, they will see your baby in the office within the first few days of birth, can support breastfeeding concerns that arise, and then often will follow you and the baby for ongoing care. Obstetricians will do a check in at six weeks postpartum and then you would return to your family doctor for your ongoing primary care.

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Access is the final consideration. Midwifery is not available in all parts of the country and it is only covered by provincial health plans in British Columbia, Alberta, Manitoba, Ontario and Quebec. In more remote areas, only family doctors are available to provide prenatal care.

Regardless of the reason, in the end, the most important factor to consider is finding someone who respects your wishes, is appropriate for your individual needs and practices in the right setting for you for this important time in your life.

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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