Models of Care
There are two broad models of care currently practiced: the medical model of care and the midwifery model of care. These models shape how providers are educated and how they practice, as well as the populations best served by each. Consider interviewing different types of providers to get a sense of different approaches to care--and there are very different approaches!
For low-risk pregnant people, the midwifery model care has been shown to result in better outcomes and greater satisfaction, largely because there is less routine reliance on medical interventions that introduce risk into a normal physiological process. Learn more about the medical model vs. the midwifery model of care, which populations are best served under each model, and how models of care impact outcomes here.
Care Provider Options
This one's for my doula clients. Thoroughly research the options available in your area, and familiarize yourself with the differences between the medical and midwifery models of care. If you are planning an unmedicated, low-risk birth, then identify a provider or group practice that demonstrates a commitment to supporting you. Don't be afraid to switch providers--they work for you, you don't work for them.
You can learn a lot about a practice by looking at their cesarean rates and VBAC rates and comparing them to other practices. Lower is better! You can also learn about providers by asking local doulas, childbirth educators, prenatal yoga teachers, etc.
If you're interested in genetic screening, ask about Non-Invasive Prenatal Testing (NIPT). NIPT is a recently developed test that pulls fetal cells from maternal blood from a simple blood draw. The test, actually a screen, tells you the likelihood that that your baby has a given disorder (such as Trisomy 13, 18, or 21). It can also tell you the sex of baby--with 100% accuracy--by 10 weeks of pregnancy. NIPT has vastly reduced the need for riskier forms of testing, including amniocentesis.
The amount of ultrasound (U/S) offered to you will depend on the practice that you're working with.
I offer an initial dating U/S, which is most accurate prior to 12 weeks. This is helpful if you're not sure when your last period started. Around this time I might also suggest an U/S if you've had bleeding or cramping and we want to confirm your pregnancy. If you're doing genetic testing, you may be offered an optional nuchal translucency screen, which measures the thickness of the tissue behind the baby's next and may identify cases of Down's Syndrome.
Next up is a mid-pregnancy "fetal survey," a head-to-toe visualization of the baby's body that can identify the baby's sex, congenital abnormalities, placement of the placenta, and other features.
After that, U/S is unnecessary unless there are questions about whether the baby may be breech, concerns about the pregnancy, or if we want to check in on how the baby is doing if you've gone past 41 weeks of pregnancy (what's called a "Biophysical Profile").