How To Pick Your Pregnancy Team: Support Roles during Pregnancy
Assembling your healthcare team is an important step to a healthy pregnancy & postpartum experience. But it can be confusing and overwhelming choosing which professionals would benefit you most. In this blog we hope to explain the roles of different specialists, as well as what to look for when trying to choose the best fit for you and your family.
Pelvic Floor Women’s Health Physical Therapist (PFPT)
Women’s Health Pelvic floor physical therapists are crucial during your pregnancy as well as during the postpartum period. I recommend everyone see a pelvic floor PT at the beginning of their pregnancy to assess their baseline but also to help with any pregnancy-related changes that may result in pain or dysfunction. Your pelvic floor physical therapist can help you to safely strengthen your core to avoid (& treat if needed) diastasis recti and to help you exercise safely throughout pregnancy. Physical therapists are movement specialists, so they can go over simple things like bed mobility, how to position in bed for better sleep, how to sit to help with low back pain, and even how to have safe, comfortable sex throughout pregnancy. Pelvic floor therapists can also help to prepare you for labor with a “push-prep”. This is really helpful for moms to learn different breathing techniques they can use during labor & pushing. It also allows them to practice pushing in different positions, that way when they go into delivery they feel confident in what their body can do and feel empowered during the birthing process. Pelvic floor women’s health PTs are extremely helpful during the postpartum period as well. They can educate on breastfeeding positions, treat blocked milk ducts, teach you how to lift/carry your baby and how to return to activities safely. Some other common conditions that PFPTs treat are: diastasis recti, urinary incontinence, fecal incontinence, constipation, pain with sex, pelvic pain, back pain, and carpal tunnel.
Things to Ask When Finding Your Women’s Health Pelvic Floor Physical Therapist (PFPT):
-What are you credentials and training? (Most PFPTs have their doctorate in physical therapy and then another women’s health pelvic floor certification through the APTA or Herman & Wallace)
-How do you feel about exercise during pregnancy and postpartum?
-What are your philosophies about treatment & care during pregnancy and postpartum?
Midwife
“Midwives are health care professionals who provide an array of health care services for women including gynecological examinations, contraceptive counseling, prescriptions, and labor and delivery care.” Midwives tend to be more holistic. They are often supportive of natural approaches to pregnancy and open to more non-traditional approaches to labor and delivery. Some midwives are also nurses, known as Certified nurse midwives (CNMs). CNMs can provide general reproductive care, prescribe medication, order lab tests and diagnose conditions as well as provide care during pregnancy & delivery. Certified Midwives (CMs) have a masters in midwifery but do not have a nursing degree. They are still able to provide pregnancy care and delivery as well as prescribe medications. However, this may vary depending on what state you live in, so be prepared to check your local guidelines and policies. Midwives are different from OBGYNs because they do not attend medical school and therefore cannot provide all of the same services an OBGYN can. For this reason, midwives are recommended for low risk pregnancies, while if you are considered higher risk, it is encouraged that you see an obstetrician since they can manage high risk pregnancies and complications using medical or surgical interventions that aren’t available to midwives. However, Midwives will refer people to Ob/Gyns if their pregnancy or birthing experience becomes complicated or high-risk.
Questions to Ask When Choosing Your Midwife:
-Where will I deliver my baby?
-What kind of training do you have?
-How long have you been a midwife?
-How many births have you attended?
-What are your philosophies or values when it comes to childbirth?
-What kind of tests or screenings do you perform during pregnancy?
-Does insurance cover any of the cost?
-Do you work with any local Ob/Gyns?
Doula
There are different types of doulas but often we think of a labor doula who is “a trained professional who provides continuous physical, emotional and informational support to their client before, during and shortly after childbirth to help them achieve the healthiest, most satisfying experience possible.”
The goal of a doula is to help the mother experience a positive and safe birth by providing physical & emotional support. It is best to think of a doula as an advocate for the mother during delivery. Doulas do not have medical training. The care they provide is emotional and informational, not medical. For this reason, doulas CANNOT prescribe treatment (such as pelvic floor exercises) or provide medical care such as pelvic or vaginal exams, taking blood pressure or temperature, fetal heart tone checks, or postpartum clinical care.
If your doula is also a healthcare provider such as a physical therapist, nurse practitioner, or MD they may not refer to themselves as a doula while providing services outside of a doula’s scope of practice. If the doula has qualifications in alternative or complementary modalities (such as aromatherapy, childbirth education, massage therapy, placenta encapsulation, etc.), they must make it very clear to their clients and others that those modalities are an additional service, outside of the doula’s scope of practice.
Doulas are able to assist you in acquiring knowledge to help you make the most informed decisions regarding your pregnancy and birth. The key thing to ask when trying to find a doula is do they make you feel comfortable and does their philosophy regarding childbirth align with yours.
Things to Ask When Picking Your Doula:
-What training have you had?
-What services do you provide?
-What are your fees?
-Are you available for my due date?
-What made you decide to become a doula?
-What is your philosophy regarding childbirth?
-Would you be available to meet with me before the birth to discuss my birth plan?
-What happens if for some reason you are not available at the time I give birth?
Board Certified Lactation Consultant
A lactation consultant is a health professional who specializes in chest-feeding. “The lactation consultant who is board certified has gone through comprehensive training and board testing to qualify as someone who can offer extensive support in the most complicated breastfeeding problems. Hospitals sometimes will have IBCLC’s as part of their staff on the postpartum floor or may offer a breastfeeding support center staffed with these types of lactation consultants.” Lactation consultants can help with painful nipples, milk supply, breastfeeding positions and other common nursing problems. A board-certified lactation consultant is trained to work with infants and their parents to solve any feeding challenges they are experiencing and improve a parent's chances of breastfeeding for as long as they choose.
Questions to Ask Your IBCLC:
-How do I make my nipples feel better?
-What is the best way to get my baby to latch?
-What is the best position to breastfeed?
-How do I increase my milk supply?
-How do I know if my baby is eating enough?
-How long should I feed on each breast?
-Are you supportive of formula feeding if breastfeeding doesn't work?
Newborn Care Specialist (NCS)
We all know that sleep deprivation can be one of the biggest challenges postpartum. Newborn Care specialists (formerly referred to as a “Night Nurse”, we no longer use this term because many NCS are not actually nurses) can help with establishing good feeding and sleep habits while also allowing parents to get more shut-eye. Duties include feeding the baby or bringing the baby to the chest-feeding parent, changing diapers, and getting the baby back to sleep. They may also clean bottles and pumps. “An NCS usually stays up to three or four months with the family to help establish feeding and work towards healthy sleep habits."
Things to Ask When Choosing Your NCS:
-What are their credentials?
-Do they know lifesaving skills such as infant CPR & first aid?
-Ask if you can speak with any families they’ve previously worked with
-Ask their schedule and make sure they find time during their day to sleep and take breaks
Assembling a care team can seem daunting but it can make all the difference for a smooth pregnancy. While this guide is certainly not all encompassing, we hope that it will help you to make educated decisions while choosing which providers are right for you. Remember that you have the ultimate say in how much support and what type of support you need during your pregnancy and there is no right or wrong way to go about it. We are happy to provide additional information, guidance & support through our For the Moms program both before and after delivery. Have a question? Ask us in the comments!
Sources:
1. https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/midwives/
3.https://my.clevelandclinic.org/health/articles/22648-midwife
4.https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/having-a-doula/
5.https://www.dona.org/what-is-a-doula/
6. https://www.dona.org/wp-content/uploads/2017/08/COESOP-2020-FINAL-Birth.pdf
7.https://americanpregnancy.org/healthy-pregnancy/breastfeeding/lactation-consultant/
8.https://www.goodhousekeeping.com/life/parenting/a30643551/night-nurse/
By Dr. Sarah Casali, PT of The Pilates Rx.