Parenting: Pregnancy

How do you choose an obstetrician? Most people open the yellow pages and scan through the physician section or they ask their insurance provider for a list of physicians that are included in their plans.

What most women don't realize is they may be overlooking another category of professionals who can provide excellent, holistic, integrated primary health care: family nurse practitioners.

A Need for Nurse Practitioners
Tracy Boland of Eagle Point, Ore., works for a pharmaceutical company and has chosen a nurse practitioner as her primary care professional. "From a patient's standpoint, nurse practitioners offer good, old-fashioned 'bedside manners' in tandem with high quality, comprehensive health care," she says.

Nurse practitioners (NPs) have been around for more than 30 years and have traditionally worked in a variety of settings, including hospitals, clinics, schools, nursing homes and alongside doctors in private practices.

Yet as doctors have become more overburdened and medicine more specialized, nurse practitioner scope of practice policies have expanded to fill the gaps in family health care. Many states now allow NPs to practice under their own licenses (10 percent of NPs now have their own practices) and to serve as patients' primary care professionals, including during pregnancy. Most states allow NPs to prescribe medications, order and evaluate diagnostic labs and call for other diagnostic tests, and diagnose and treat acute health problems and chronic issues. In addition, most health and insurance plans recognize family NPs as primary care providers (PCPs).

More Time for Care
Patients, many of whom are more and more frustrated with what sometimes feels like rushed care from traditional medical environments, are responding. In increasing numbers, patients are turning to NPs for primary care – and not just because they get the same care as they would under a doctor, but because many feel they get better care with an NP.

In a 2002 British Medical Journal study comparing care between NPs and doctors (Horrocks, Anderson and Salisbury), "all analyses suggested that clients experienced greater satisfaction with NPs," say the study's authors. Additionally, no differences were identified between health outcomes for clients who saw NPs or doctors. Further, the study showed that NPs "identified physical abnormalities more frequently than doctors, gave clients more information, had more detailed records, scored higher on communication and gave more advice on management and self-care," say the study's authors.

The study affirmed what NPs already knew: "Nurse practitioners are ideal at helping a patient maintain and improve their health," says Karyn Anderson, a family nurse practitioner in Bend, Ore. "We promote self-care and preventative care."

A Personalized Approach
Nurse practitioners cite the nursing model that they are trained under as a primary factor behind the personal way they approach patient care. This model concentrates on caring for the whole person with focus on primary care, preventative medicine and patient education. To enter a nurse practitioner program, one must already possess a bachelor's degree in nursing.

"Nurses see people in context," says Laura Cheshire, a family nurse practitioner who has been practicing for 23 years. "We are a little bit like the old-time, small-town doctor. We know a patient's family, financial and work situation. We know how they fit into the community and the history of their health and personal lives."

The desire for a greater familiarity with patients is often what draws NPs into private practice. Patricia Newman, a family nurse practitioner, opened her own practice in Bend, Ore., five years ago, "because I wanted more control over how much time I spent with a patient, and I wanted more flexibility and the ability to form a deeper connection with my patients," she says.

The time factor, many NPs feel, is paramount to complete health care. "Getting to know your patient takes a lot of time, and we are willing to take that time," says Helen Wylie Poindexter, also a family nurse practitioner in Bend, Ore. "It's a different model of care than many people are used to."

Being willing to take more time means that NPs ask more questions and therefore receive more information about a patient's overall health situation, especially during pregnancy and during the postpartum months. "Listening and hearing in a non-intimidating manner encourages patients to tell us the little details that might make a big difference for their health," says Poindexter.

Growing Numbers
There are approximately 80,000 NPs in the United States (95 percent of whom are female), and the field is growing steadily, according to the American Academy of Nurse Practitioners.

Becoming a nurse practitioner requires a master's degree in nursing with a special certificate and state licensure. Nurse practitioners can choose to specialize in pediatrics, women's health, geriatrics or any other number of specialties besides family health, but generally only family nurse practitioners can serve as a patient's primary care provider – a real plus to women and their children.

"To become a family nurse practitioner you have to know something about every family member," says Cheshire. "We know a little bit about a whole lot. We aren't specialists and we don't plan to be, but we can give a patient excellent overall care." When more specialized experience is needed, nurse practitioners turn to doctors who they trust for consultation or referral.

Benefits for Pregnancy, Birth and Baby The broad knowledge base that is often the hallmark of family nurse practitioners benefits women in terms of receiving both comprehensive and holistic care. "From a professional standpoint, I am amazed at the amount of information that the nurse practitioners I see every day are responsible for," says Tracy Boland of Eagle Point, Ore., who has chosen a nurse practitioner (NP) for her primary care. "They literally have to treat everything from stomachaches to cancer." With one person to consult on all of a patient's health concerns – before, during and after pregnancy – problems that might otherwise be overlooked or mistreated are more likely to be addressed. Many health ailments are lifestyle problems: issues that can be attributed to diet, activity level, environmental factors or a combination thereof, according to Laura Cheshire, who has been a nurse practitioner in Bend, Ore., for 23 years. "The nursing model addresses a patient's entire lifestyle," she says. Education is a key component for NPs – not only educating patients about good health choices and preventative self-care, but also educating them about their health care options. "I feel passionate about educating people about their right to choose a nurse practitioner," says Cheshire. "It's a role that needs to exist within medical practice because it works for the patient."

Finding a Nurse Practitioner Seeing a nurse practitioner for health care may be the right choice for you and your family members. If you are thinking of choosing a nurse practitioner for your primary care provider, consult your insurance company for a list of eligible professionals. Even if your state doesn't allow NPs to practice solo, you may choose to see an NP who works in collaboration with a doctor in private practice or who works at a hospital or clinic. As you have the right to do when choosing any medical professional, ask your NP about his or her education, license, specialty training and years in practice. For more information, consult the American Academy of Nurse Practitioners Web site.