Perinatal Providers: Scopes of Practice

Heidi Creston returns today for her monthly blog post. Today, she covers a very important topic: scope of practice for different obstetrical providers. Scope of practice dictates what a medical provider can and cannot do so it is important to know a particular providers limitations. For instance, as a registered nurse, I cannot diagnose illness though most nurses are very good at this very thing and we may indicate to a family what we think is going on. However, only a physician, nurse practitioner, or physician's assistant can diagnose.

Now, I'll turn it over to Heidi.

It is especially challenging for the perinatal patient to understand the scopes of practice that different providers offer. As authors, we must remember that our audiences are impressionable, and may believe your fictional story as the Gospel truth. If your character is a perinatal provider it is imperative, that you keep them working within the means that their occupation allows.

The providers:  Obstetrician-Gynecologist, Perinatologist, Family practitioner, Certified Nurse Midwives, and Doula's.

Obstetrician-Gynecologist (OB/GYN) is a medical doctor who provides both clinical and surgical care for their patients. The OBGYN serves not only the perinatal patient but all women's medical issues from puberty to post hysterectomy.

Perinatologist is an obstetrician who specializes in the care management of high-risk pregnancies. Patients assigned to a perinatologist are referred out by their OBGYN or family practitioner due to the extensive or specialized care that is required maternally and or for the fetus. Patients with cardiac issues, diabetes, Eclampsia or HELLP, and multiple gestations are prime examples of patients referred to perinatologists. Fetuses with severe abnormalities such as gastrocentisis or Tetralogy of Fallot are also referred.

Family practitioner is a medical doctor who specializes in the health care of all family members. They are prepared to provide normal OB/GYN care, but usually refer pregnancies and other women’s health issues to an OB/GYN. All family practitioners are trained to perform Cesarean births in an emergency and also to assist other specialists in doing the procedure.

Certified Nurse Midwives are registered nurses who have earned their master's degree in nursing, with a strong emphasis on clinical training in midwifery. Midwives work with obstetricians who are always available to assist if complications occur during pregnancy, labor, or delivery. CMW’S can assist with cesarean sections but can not perform them independently.

Doulas are not licensed or certified personnel. Doulas are support liaisons hired by the patient, to assist them through the pregnancy, and offer support during the labor process. There currently are no mandatory qualifications, regulations or requirements necessary in order for someone to become a doula.

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Adelheideh Creston lives in New York. She is former military and married military as well. Her grandmother was a WAVE and inspired her to become a nurse. Heidi spent some time as a certified nursing assistant, then an LPN, working in geriatrics, med surge, psych, telemetry and orthopedics. She’s been an RN several years with a specialty in labor and delivery and neonatology. Her experience has primarily been with military medicine, but she has also worked in the civilian sector.

Heidi is an avid reader. She loves Christian fiction mysteries and suspense. Though, don’t recommend the gory graphic stuff to her… please. She enjoys writing her own stories and is yet unpublished.