Personalized pregnancy and childbirth experiences are a relic from the days when medical practices had only a few providers who shared call. Small practices can still be found in rural areas, but most Twin Cities clinics have become very large, both to meet the demands of the population and to survive in the HMO-dominated marketplace. Besides the difficulty with call coverage that small practices entail, they are not as attractive to payers like HMOs and insurance companies. "Across the country there are numerous groups of three or four midwives," says Hangsleben. "And we've heard of some of them being dropped by insurance companies because they don't bring in enough business. So there is a marketplace issue that we have to be sensitive to. . . . By the same token, the HMOs in Minnesota are very good to us. Around the country, HMOs often mean the nurse midwives are cut out of the market. Here, nurse midwives are part of the care-provider system. It's an interesting balance."
Despite all the constraints on the system, every pregnant woman should know that she has some control over how her prenatal care and delivery will go. It often takes persistence, though, to get what you want. Most clinics will honor a prenatal patient's request to see only certain providers, but she may have to adjust her schedule accordingly to make that happen. It is more difficult to control who will be present for the delivery, but a woman who feels strongly about a certain provider, either negatively or positively, should at least make her desires known. All the clinics in the Twin Cities want return and word-of-mouth business, and they will do what they can to keep their customers happy.
Diana Kenney is a Minneapolis writer specializing in health and medicine. When she became pregnant last spring, she was working as editor ofMinnesota Physician newspaper. This is her first contribution to Minnesota Parent. A bibliography for this article is available: send your request and SASE to Minnesota Parent, 401 N. Third Street, Suite 550, Minneapolis, MN, 55401.