For American women, the landscape of care during pregnancy is complex. There is little government support and a lack of education about options available, and unfortunately, that means many women don’t get the care they need. A study in 2016 found that 24% of American women started care late or received fewer than medically recommended number of visits to a pregnancy healthcare provider.
It’s important to be informed and seek out pregnancy care as early as eight weeks into your pregnancy to allow for early detection of issues and ensure both you and baby are healthy and well throughout.
But first things first: it's so important that you get educated about your options so you can advocate for yourself, and remember that it’s YOUR choice which route you take.
Some people in your life may have very specific ideas about pregnancy care, and you may feel overwhelmed or confused by the options out there - but it’s totally normal to feel that way, there are a lot of decisions to make during pregnancy!
You might find some peace of mind in deciding on your pregnancy care earlier on in your pregnancy, so you can have that consistency of care and build a relationship with your carer from the beginning.
In America, there are typically four options for care during pregnancy, so if you’re already pregnant or planning a pregnancy, here’s a top level overview.
OBSTETRICIANS/GYNECOLOGIST, OR OB/GYNs
OB/GYNs specialize in both obstetrics and gynecology, offering comprehensive expertise in women's health. Obstetrics focuses on pregnancy and childbirth, while gynecology addresses a wide range of women’s health concerns. With their surgical training, OB/GYNs are also qualified to perform procedures like cesarean sections.
You may choose OB/GYNs for pregnancy care because they offer a high level of medical expertise, especially for those who may have complications or want the option of a hospital birth. Their ability to manage both routine and high-risk pregnancies, combined with access to advanced medical technology, makes them a preferred choice for women seeking a balance of personalized care and medical intervention.
FAMILY PHYSICIANS
Family medicine providers offer comprehensive care for every member of the family, from newborns to seniors, and can diagnose and treat a variety of health conditions. Over time, they develop a deep understanding of your overall health, which can create a greater sense of comfort and trust during pregnancy.
You might choose to have your family physician provide pregnancy care because they provide continuity—caring for both the mother throughout pregnancy and the baby after birth. This ongoing relationship can enhance the feeling of personalized care. It's important to confirm that your family medicine provider offers prenatal services and can assist with delivery.
MIDWIVES
Midwives provide a holistic approach to women's health, emphasizing education and empowering patients to make informed decisions about their care. They typically care for women with low-risk pregnancies, focusing on natural, personalized experiences.
Women often choose midwives for pregnancy care because of their patient-centered philosophy, which encourages active participation in the birth process. In addition to prenatal care, midwives offer a wide range of women’s health services, including gynecologic care, pap tests and family planning, making them a versatile and supportive option for ongoing care.
DOULAS
Doulas provide emotional, physical, and informational support during pregnancy, labor, and postpartum. Unlike medical professionals, doulas focus on comfort, advocacy, and continuous care throughout the birthing process.
Many women choose doulas because they offer personalized, hands-on support that helps reduce anxiety and stress, especially during labor. Doulas work alongside midwives or OB/GYNs, ensuring that the birthing experience aligns with the mother’s preferences.
Women often appreciate the continuous presence and reassurance a doula provides, which can lead to a more positive and empowered birth experience. Doulas also assist with postpartum care, helping new mothers navigate recovery and early parenthood.
HOW DO I DECIDE WHICH CARE OPTION TO CHOOSE?
Here are some things to consider if you’re still unsure about your pregnancy care.
Risk level
+ If you have a low-risk pregnancy, you may consider a midwife or a doula for more personalized, holistic care.
+ If you have a high-risk pregnancy, or medical conditions like diabetes, hypertension or a history of pregnancy complications, it may be best to choose an OB/GYN.
Birth experience + philosophy
+ If you’re hoping to have a natural birth with minimal intervention, a midwife or doula tend to focus on this type of birth.
+ For those who prefer a home-like environment, midwives often support home births or births at birthing centers. This may appeal to women who want a more intimate and non-hospital setting.
+ If you prefer the option of pain relief (e.g. epidural) or want to be in a hospital setting in case of emergency, an OB/GYN is often the preferred choice.
Support
+ Doulas provide non-medical support throughout pregnancy and labor, focusing on comfort, education, and advocacy. They can complement care from OB/GYNs or midwives.
+ OB/GYNs are trained to manage both routine and high-risk pregnancies and are equipped to perform surgeries like cesarean sections if needed. If you feel more comfortable having a medical expert present, an OB/GYN might be the best fit.
Location
+ If you have chosen a midwife or plan on a home birth, make sure the distance to the nearest hospital is manageable in case of emergency.
+ Consider how easy it is to access the care provider you want. Some midwives and OB/GYNs may have limited availability, so you’ll want to choose someone who can meet your schedule for prenatal visits.
Continued care + support
+ Some women prefer family medicine providers because they offer care before, during, and after pregnancy, including for the baby. This creates a long-term relationship and continuity of care.
+ If you’re comfortable changing providers after delivery, an OB/GYN or midwife might work for the pregnancy, while a pediatrician can take over for the baby.
+ Consider what type of postpartum support you need. Some women prefer midwives who offer extensive postpartum care, including home visits. OB/GYNs generally provide standard medical follow-ups but less personalized postpartum support.
+ Midwives and doulas often provide additional breastfeeding and postpartum care, while OB/GYNs typically refer patients to lactation consultants.
Most importantly, ensure that you feel comfortable with your care provider - trust is essential for a positive pregnancy and birth experience.
WHAT QUESTIONS DO I NEED TO ASK TO DECIDE ON THE RIGHT CARER?
+ Will you be the person that cares for me throughout?
+ What happens if you’re not available at any point?
+ How many visits can I expect during my pregnancy?
+ How many scans/ultrasounds will I receive?
+ What support do you provide after I deliver?
+ What happens if I need advice or support in between appointments?
+ Where will our appointments be?
+ Are there any additional costs I need to prepare for?
+ What is your philosophy of care?
+ What are your ideas about intervention during birth?
+ Are you open to me having a birth plan?
WHAT ABOUT INSURANCE?
Health insurance plays an important part in accessing prenatal care and your options will vary based on your employment, income and your location.
Here are the main types of insurance available for pregnancy care.
Employer-sponsored health insurance
Employer health insurance plans typically cover maternity care, prenatal visits, labor, delivery and postpartum care, under the Affordable Care Act (ACA).
Coverage depends on your plan, so be sure to familiarize yourself with what deductibles, copayments and out-of-pocket costs you might be liable for.
Marketplace insurance (ACA plans)
The Health Insurance Marketplace (Healthcare.gov or state exchanges) provides private health plans for individuals and families. All plans under the ACA are required to cover maternity and newborn care. It should cover comprehensive prenatal care, labor and delivery, postpartum care, and newborn health services. Preventive services like screenings and vaccinations are often covered at no cost.
Premiums, deductibles, and out-of-pocket expenses depend on income, the chosen plan, and eligibility for subsidies or tax credits. Low-income families may qualify for reduced rates.
Medicaid
Medicaid is a government-funded program offering low-cost or free health coverage for low-income individuals and families, including pregnant women. Each state sets its eligibility rules, but pregnant women generally qualify with higher income thresholds.
It covers full prenatal care, labor and delivery, and postpartum care, including newborn services. Medicaid may also cover midwifery and birth center services in some states.
For those who qualify, Medicaid provides comprehensive care with little to no out-of-pocket costs.
Private health insurance
Individuals can purchase private health insurance outside the marketplace. These plans also must cover maternity care due to ACA requirements.
This will cover prenatal visits, hospital deliveries, and postpartum care. Options like midwifery and birth centers may be available, depending on the plan.
Premiums and out-of-pocket costs are higher compared to Medicaid, but comprehensive coverage is typically provided. Plans and costs vary depending on the insurer.
Note: Not all insurance plans, especially private ones, cover midwives or birthing centers, so it’s important to check with your insurer if you plan to use these options.
If you’re still unsure about next steps, have a chat with your regular physician or ask your friends and family about their experiences to help you decide.
Remember, there’s no right or wrong when it comes to choosing the care that suits you and your unique circumstances best. The most important thing is that you and baby are getting the medical care and support you need to be healthy and well throughout your pregnancy and beyond.
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RESOURCES TO EXPLORE
If you're looking for more information or exploring which care option is best for you, check out the following:
+ American College of Obstetricians and Gynecologists (ACOG) – acog.org: A resource for learning more about OB/GYN care and high-risk pregnancy management.
+ Midwives Alliance of North America (MANA) – mana.org: Explore midwifery care and how to find a midwife near you.
+ DoulaMatch.net – doulamatch.net: A directory to help you find a certified doula in your area.
+ The American Academy of Family Physicians (AAFP) – aafp.org: Learn about family physicians and their role in pregnancy care.