Who’s delivering your baby? Questions to ask birth team providers
December 30, 2024
You are the hero of your childbirth story. And behind every hero should be a supportive team, with the training and skills to help in the ways you and your baby need it most.
Everyone has different goals, and different types of pregnancies and births require varying levels of care and expertise. So, it’s important to understand the roles of the people included in your birth plan, from prenatal care through labor and delivery.
For example, some birth professionals are qualified to offer emotional and physical support, but their training does not include education in human anatomy, physiology, or the various complications that can arise in pregnancy, such as performing an emergency C-section or repairing a significant obstetric laceration. Other professionals undergo extensive training to become nurses or physicians. Depending on your health coming into pregnancy or issues that arise from pregnancy through postpartum, the level of expertise required to safely meet your needs can escalate.
Tailoring your team to your specific needs ensures that you and your baby will get the most appropriate care. The best way to build your birth team is to understand the different types of childbirth support and medical professionals and their roles – and to know what questions to ask so you can be the most knowledgeable advocate for your own care.
Who might be involved in your delivery?
✔️ Doulas
Doulas are trained to provide nonmedical labor support and self-care services after delivery. They are not medical professionals – they should not provide medical information and cannot assist with procedures or prescribe medications.
That does not mean that they are not valuable members of the team! According to the American College of Obstetricians and Gynecologists, continuous one-on-one support during labor and delivery can lower the risk of C-section and improve patient satisfaction. Many doulas also have additional education and credentialing in lactation and can be of great benefit in the transition home after delivery.
Certified doulas should be able to show you their credentials from a specific organization, such as:
- DONA International
- Childbirth and Postpartum Professional Association (CAPPA)
- International Childbirth Education Association (ICEA)
- Medicaid-specific certification
Related reading: Do-it-yourself doula: Tips to choose the best labor support person
Top level of care
Clements University Hospital is a Level IV Designated Maternal Facility, which is the highest level available, according to Texas Health and Human Services. Our certified nurse midwives and doctors are available on call for medical and surgical care for even the most complex cases. Patients at Clements have access to multidisciplinary teams who work collaboratively to ensure the highest standard of care.
✔️ Midwives
The word “midwife” derives from Old English mid, meaning “with,” and wif, meaning “woman.” Midwives care for women from adolescence through post-menopause. There are different types of midwives with different levels of education, training, and credentials for supporting childbirth, prescribing medication, and providing long-term care. It can be confusing, as they are all colloquially referred to as midwives, so we will go through the various categories.
Certified nurse midwives (CNMs) are specially trained registered nurses who earn a college degree and registered nursing (RN) license and then complete a graduate midwifery education program. In Texas, certified nurse midwives must be approved by the Board of Nursing as an advanced practice registered nurse in nurse-midwifery and be certified by the American College of Nurse-Midwives (ACNM) or the ACNM Accreditation Council licensed by the Texas Board of Nursing. Additionally, those who work in a hospital setting are required to maintain credentialing for hospital privileges. Since they are considered advanced practice nurses, they can write prescriptions, with the scope of medications differing from state to state.
UTSW’s William P. Clements Jr. University Hospital has an incredible staff of CNMs who collaborate with doctors and are available 24/7 in the Labor and Delivery Unit. When possible, our CNMs stay with their laboring patients from check-in through delivery, offering consistent physical and emotional childbirth support, including assistance with C-section delivery, if needed.
Certified midwives (CMs) do not have an RN license, but they do have a college degree. They must complete a graduate degree with required health and science classes and complete related health skills training along with a midwifery education program. They are licensed to operate in only about a dozen states, which can affect whether they can work in a hospital setting. CMs are not licensed in Texas.
Direct entry midwives go by several different names such as certified professional midwife (CPM), registered or licensed midwife, or lay midwife. They are not required to have any nursing or medical training. After a high school diploma or GED is obtained, they train via self-study or an apprenticeship model. The North American Registry of Midwives (NARM) requires that the clinical component of their education last at least two years and include a minimum of 55 births. Nearly three dozen states, including Texas, offer licenses for them to operate. Most direct entry midwives work in birth centers or attend home births.
Compare CNM, CM and CPM qualifications from the American College of Nurse-Midwives.
Terminology to know
Note that certification and registration are voluntary. A license is when the state grants legal authority to practice certain jobs within a designated scope. A direct entry or certified midwife may be certified but not licensed. Simply holding a credential does not mean someone can legally deliver babies.
Providers employed by a health system or other organization are more likely to have a license. If your provider is independent, as many direct-entry midwives are, you should verify that the midwife has a current license. In Texas, you can check for a license by visiting the Texas Department of Licensing and Regulation (TDLR) website, which includes a searchable license database that is updated daily.
✔️ Doctors
Doctors (M.D. and D.O) are medical professionals who have graduated from college and an accredited medical school and then completed a four-year residency in obstetrics and gynecology. Residency provides training in general medicine, the medical complexities of pregnancy, and pelvic surgery. The family medicine residency also includes training in general medicine, pregnancy, and labor and delivery.
After completing training, all physicians must be licensed to practice in their state and credentialed to provide care in a hospital, which often also requires being board-eligible or board-certified by the American College of Obstetricians and Gynecologists (ACOG) or the American Board of Family Medicine (ABFM).
Labor and delivery is typically managed by doctors who specialize in pregnancy and childbirth:
- Obstetricians (OB) or Obstetrician/Gynecologist (Ob/Gyn): Doctors who focus on care of women from adolescence through senior years. They provide prenatal care throughout pregnancy, labor, and delivery. They diagnose and manage maternal medical complications, care for women with medical conditions that can affect a pregnancy, can handle routine vaginal or C-section delivery, and can repair complex perineal lacerations.
- Maternal-fetal medicine (MFM) doctors: These specialists complete an additional three-year fellowship in maternal-fetal medicine after an Ob/Gyn residency and then complete a second board certification process by ACOG. They manage high-risk pregnancies (maternal or fetal) and complex fetal conditions. Many work in academic center labor and delivery units as attending physicians who teach Ob/Gyn residents. Some also provide delivery service in the community. Others work in consultation with Ob/Gyn doctors or midwives to care for complications or provide specific fetal diagnostic care. Some provide fetal interventional care (such as intrauterine blood transfusions or fetal shunts) or complex delivery planning.
Read more: Get more information about planning a home birth.
Questions to ask birth team professionals
As you assemble your birth team, use these questions as a starting point to understand each provider’s skills, certifications, and perspectives on your birth plan, such as pain management and where you wish to deliver.
Pregnancy care and delivery can be a team event, and we enjoy working collaboratively. For example, you may see an MFM specialist because you have triplets but still be cared for at delivery by your OB. Or you may see an Ob/Gyn during pregnancy because you have hypertension, but if it remains well controlled, just having that diagnosis may not preclude you from having a CNM for your labor and delivery care.
What are your qualifications?
You have the right to know the qualifications of the people who care for you. For example, doulas, midwives, and CNMs are not qualified to perform C-sections, though certified nurse midwives can assist the doctor with the procedure if they have been credentialed to do so at a particular hospital.
Ask how many births the provider has attended or managed as well as how long they have been practicing. Medical school, certified nurse midwife, and certified midwife training and certified doula support have different requirements for training hours and experiences. Talk with an Ob/Gyn about what level experience might be appropriate for your pregnancy.
What do your services cost?
Medicaid, Medicare, and most insurances will cover care provided by a doctor and a CNM, with variable co-pays and deductibles depending on your policy and whether the providers are in or out of the insurance company’s network. In Texas, services rendered by certified midwives and licensed direct-entry midwives are not reimbursed by Medicare and Medicaid and generally would not be covered by insurance.
Several states cover doula support through Medicaid, but Texas does not. Generally, out-of-pocket doula costs are upwards of $1,500 to $2,000, and some have sliding fee options.
Can you provide references or testimonials from previous parents?
Asking for references is a great way to learn more about your provider. Online reviews can also be helpful.
In Texas, offenses by doctors and nurse midwives are reported to the National Practitioner Data Bank. Offenses by direct-entry midwives are not reported. This means that a direct entry midwife could have had license violations or malpractice judgments that would not follow them and would not prevent them from practicing in another state.
Where do you deliver and what are your perspectives on an out-of-hospital birth?
You may prefer a particular hospital, so ensure that your doctor or CNM has privileges at that facility. Additionally, different hospitals can provide different levels of care to mom and baby, so be sure that the hospital you are considering can meet your anticipated needs.
If you are considering an out-of-hospital birth, such as at a standalone birth center or home birth, ensure that your care provider has the education and training to identify abnormal issues. Ask how they will handle unexpected emergencies, such as the need for an unplanned C-section or neonatal complications. Be aware that rapid intervention at a birth center or in a home delivery setting is not at the same level as what a hospital can provide. This can have implications for maternal and infant health.
Talk with an Ob/Gyn at your prenatal care appointment to explore whether home delivery is reasonably safe for you. ACOG highly recommends a hospital birth if the baby is in breech position (bottom-down), if you’re having twins or more, or if you’ve had a previous C-section or complicated pregnancy. It is also important to note that a low-intervention, natural childbirth can still be accomplished in the hospital setting.
What is your approach to pain management during labor?
Ask about the specific support services the provider offers. Doulas, certified midwives, and lay midwives who cannot administer medications can help in different and effective ways with nonmedical pain management, such as breathing exercises, massages, and counterpressure.
With delivery in a hospital setting, certified nurse midwives and Ob/Gyn physicians can help you plan the level of pain management you want. That includes access to an epidural from a physician anesthesiologist or certified registered nurse anesthetist. These providers will honor your nonmedical pain management if this is part of your birth plan.
What are your policies on visitors and support people during labor?
Ask your intended care provider how many individuals are allowed to be present and whether they allow nonmedical, nonfamily support people such as doulas. Each hospital or birth center has different policies, so be clear before you start making plans.
Every patient deserves to feel empowered and supported throughout the childbirth journey. By understanding the roles and qualifications of different birthing professionals and asking the right questions, you can build a team that aligns with your needs and preferences.
To talk with a professional about your birthing plan, request an appointment online.
