With Mayo Clinic certified nurse-midwife Mary Murry, R.N., C.N.M.

Just as no two snowflakes are alike (I'm in Minnesota; we had snow this week), not all obstetricians are alike. I thought today I'd talk about the types of care providers available for women to choose from.

The majority of pregnancies are normal or low risk. For those women who have medical problems or major complications, a maternal-fetal medicine doctor may be the best provider. These doctors are obstetricians who have had advanced training and education in high risk pregnancy. They may be associated with teaching hospitals, major medical centers and private practice.

An obstetrician is a physician who has completed a residency in obstetrics and gynecology. They do surgery and care for women throughout their lifespan. These doctors can be found in just about every city or town except in rural areas.

Some family physicians provide prenatal care and deliveries. Check with your local family medicine doctor to see if this service is available.

Of course there are certified nurse-midwives (CNM). We are nurses with advanced training and education in pregnancy, birth, family planning and care for women throughout their lifespan. Nurse-midwifery is licensed in all 50 states. Some nurse-midwives deliver at home, some in birth centers and some in hospitals.

There are 2 other types of midwives. There are certified midwives. Standards were developed by the American College of Nurse-Midwives in order to ensure that certified midwives (CM) are educated in a manner that is equivalent to the CNM.

CMs are not registered nurses, but may hold other professional designations in health care. Currently CMs are licensed to practice in New York, New Jersey and Rhode Island.

There are also lay midwives. There are not strict regulations regarding training or certification.

The important thing about choosing your OB provider is having some idea of what your expectations are for your care. After you have decided that, you should research what type of providers are available in your area. Talk to other women who have had babies in the community about their experiences.

You are not tied by contract with your provider. If you find you can't establish a relationship, if you feel you are not being heard or your wishes are being ignored, talk frankly with your provider. If nothing can be done to improve your confidence or relationship, look for another OB provider. This is too important an event in your life and your baby's life to be dissatisfied throughout your pregnancy.

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