Certified nurse midwives are always paired with a physician during a woman's pregnancy and delivery. Depending on where she works, a midwife may or may not be able to accommodate higher risk cases. Those partnered with a perinatologist at a large urban hospital are more likely to take on women expecting multiples or those attempting a vaginal birth after Cesarean (VBAC). Midwives at smaller centers or those partnering with a family practice physician will probably refer high-risk pregnancies to an OB-GYN. During your preconception visit with a CNM, ask her which situations she and her staff (including the attending physician) are equipped to handle.
What CNMs cannot do is surgery, including Cesarean deliveries (C-sections). Should you need a C-section while laboring with a midwife, the partnering physician would perform it.
Special Health Issues
Do diabetics have to see an OB-GYN?
Not necessarily. Under specific conditions, women with metabolic disorders, cardiac irregularities, and unusual obstetrical histories can use midwives for their prenatal care and delivery.
"If you are a woman with a medical problem, particularly if you are in an urban area, you may well find an academic medical center or a practice where the midwives are collaborating with perinatologists," says Summers. "That way, you can have the best of both worlds."
If you feel more comfortable seeing an OB-GYN, make sure to ask about his or her experience with cases such as yours.
"Some general obstetricians are set up to follow a pregnant diabetic," says Dr. Sharon Phelan, MD, FACOG. "In smaller communities, where there may not be an obstetrical specialist, you may end up seeing two people. You need to find out which provider in your area is best able to meet the needs of both your illness and your pregnancy."