The Expectant Father. Armin A. Brott

to both medicated and unmedicated births, and we’ll talk about them when we get closer to your baby’s due date. But for now, the most important thing is to be flexible and not let your friends, relatives, or anyone else pressure you into doing something you don’t want to do.

      You and your partner may be planning a natural childbirth, but conditions could develop that necessitate intervention or the use of medication (see pages 60–62). On the other hand, you may be planning a medicated delivery but could find yourself snowed in someplace far from your hospital and any pain medication, or the anesthesiologist may be at an emergency on the other side of town.

      WHO’S GOING TO HELP?

      At first glance, it may seem that your partner should be picking a medical practitioner alone—after all, she’s the one who’s going to be poked and prodded as the pregnancy develops. But considering that more than 90 percent of today’s expectant fathers are present during the delivery of their children, and that the vast majority of them have been involved in some significant way during the rest of the pregnancy, you’re probably going to be spending a lot of time with the practitioner as well. So if at all possible, you should feel comfortable with the final choice, too. Here are the main players.

      Private Obstetrician

      If your partner is over twenty, she’s probably been seeing a gynecologist for a few years. And since many gynecologists also do obstetrics, it should come as no surprise that most couples elect to have the woman’s regular obstetrician/gynecologist (OB/GYN) deliver the baby.

      Private OB/GYNs are generally the most expensive way to go, but your insurance company will probably pick up a good part of the bill. Most private OBs, however, aren’t strictly private; they usually have a number of partners, which means that the doctor you see for your prenatal appointments might not be the one in attendance at the birth. So make sure that you’re aware of and comfortable with the backup arrangements—just in case your baby decides to show up on a day when your regular doctor isn’t on call. Labor and delivery are going to be stressful enough without having to deal with a doctor you’ve never met before.

      Researcher Sandra Howell-White found that women who view childbirth as risky, or who want to have a say in managing their pain or the length of their labor, tend to opt for obstetricians.

      WHY TO HAVE THE BABY AT HOME

      • The surroundings are more familiar, comfortable, and private.

      • You don’t like—or are afraid of—hospitals and doctors. Or you had a negative experience with a previous birth.

      • You’ve already had one or more uncomplicated hospital births.

      • You can surround yourselves with anyone you pick.

      • The birth is more likely to go exactly as you want than it might anywhere else. And your partner will be treated less like a patient than she would be in a hospital.

      • You can pay attention to the spiritual aspects of the delivery, an intimate matter that you might be discouraged from, or feel embarrassed about, in the hospital.

      • Hospitals are full of sick people and it’s best to stay far away from them.

      • It’s cheaper.

      WHY NOT TO HAVE THE BABY AT HOME

      • Your partner is over 35 or has been told by her doctor that she’s “high risk.”

      • She’s carrying twins (or more) or you find out that the baby is breech (feet down instead of head down).

      • She goes into labor prematurely.

      • She developed preeclampsia, a condition that affects about 10 percent of pregnant women and that can have very serious complications if it’s not detected and treated early (see pages 61–62 for more on this).

      • She has diabetes or a heart or kidney condition, has had hemorrhaging in a previous labor, has had a previous Cesarean section, or smokes cigarettes.

      • No insurance coverage.

      Family Physician (FP)

      Although many FPs provide obstetrical care, not all do, so check with yours to see whether he or she does. If not, he or she will refer your partner to someone else for the pregnancy and birth. One of the big advantages of going with your family doctor is that after the birth, he or she often can see your partner and baby on the same visit. The time saved running around from doctor to doctor will be welcome.

      Like most doctors, FPs are frequently in group practices, and there’s no guarantee that the doctor you know will be on 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

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