Welcoming a new baby is full of happy moments for a family. From birth plans to breastfeeding and everything in between, there is a lot of information parents consume as they prepare for their new addition.
“Caring for an expectant mother during pregnancy and while she gives birth is one of the greatest privileges medical providers get to enjoy,” said Amanda Kossak, MD, a family medicine provider at ThedaCare Physicians-Appleton North. “Generally, having a baby is one of the most exciting times in the life of a woman and her family. Being a part of that experience is an honor.”
Dr. Kossak chose family medicine as her medical specialty because of the many options it offers her throughout her career, including the option to do obstetrics care.
“My residency program had a very robust obstetrics program, Dr. Kossak noted. “We trained under obstetrician-gynecologists, and I connected well in working with expectant mothers and wanted to continue that in my practice.”
Dr. Kossak explained women have several options in choosing a medical provider to assist them during pregnancy and the birth of their child.
“There’s a continuum of options for women – from a midwife to a nurse midwife to a family medicine practitioner who offers obstetrics care to an obstetrician-gynecologist (OB/GYN),” she said. “Depending on the woman’s overall health, she may choose from any of these professionals.”
Dr. Kossak explained that a midwife is a person who may not have previous medical training, but has completed a midwifery course. Typically, these midwives deliver at birthing centers or in private homes. Generally they don’t have hospital privileges and have limited ability to offer medications.
A nurse midwife is often a former nurse or nurse practitioner who had previous medical experience and then completed a nurse midwifery program, Dr. Kossak said. She added that they often have hospital privileges and noted that many OB/GYN practices in the Fox Valley employ nurse midwives to provide care to expectant moms.
“It’s important for expectant moms to thoroughly understand the training a midwife has,” Dr. Kossak said. “Your primary care provider can assist you in looking at the midwife’s credentials and, because they know your overall health situation, they can help you make an informed choice about what is best for you and your baby.”
Another option expectant moms have is to choose a family medicine provider who provides obstetrics care. Not all family medicine providers offer that care. She added there is a one-year fellowship program that family medicine providers may take after their residency to become trained to do C-sections, which gives them greater privileges.
“I do lower-risk OB/GYN care,” said Dr. Kossak. “Most of my patients are women who have had previous uncomplicated pregnancies or are first-time moms with few underlying health conditions. Such women are good candidates to have their delivery monitored by a family medicine provider.”
Expectant moms with more significant health concerns, those who have had previous high-risk pregnancies, previous C-sections or those expecting multiples should generally be cared for by an OB/GYN, Dr. Kossak suggested.
“OB-GYNS are thoroughly trained to care for all levels of pregnancy and all women’s reproductive health issues,” she said. “A woman should feel empowered to choose whatever type of care she feels will meet her needs. Having a child is a very personal experience, and different women have different wishes.”
Dr. Kossak observed that family medicine providers live somewhere between nurse midwives and OB/GYNs.
“We do use medications in the process of labor and delivery, and at times, will use operative delivery procedures if necessary,” she explained. “Birth is a very natural process. We only intervene when it’s necessary to ensure that mom and baby are healthy.”
She noted that OB/GYNs, family medicine providers and nurse midwives all follow the American College of Obstetrics and Gynecology Standard of Care Guidelines in providing care to expectant moms.
Dr. Kossak noted some families may choose to receive care from a family medicine provider during pregnancy because that same provider can continue to care for your baby after birth.
“If an OB/GYN delivers your baby, the baby then will be seen by a pediatrician or a family medicine provider after birth,” she said. “Having the family medicine provider deliver provides a continuity of care for mom and baby. After having gone through prenatal care and delivery together, you generally have developed a good relationship and have good trust. There’s a lot to be said for having a good relationship with your health care provider.”
Pregnancy during the COVID-19 Pandemic
Pregnant women are not at a greater risk of contracting COVID-19, Dr. Kossak said.
“According to the Centers for Disease Control and Prevention (CDC), there is no data showing that COVID-19 affects pregnant people differently than others,” she said. “As long as expectant mothers follow the recommended protocol of wearing a face mask when in public, maintaining social distancing and frequent hand washing, their risk is no greater than anyone else.”
The COVID-19 pandemic is changing how prenatal care and delivery are managed.
“The biggest change is that at this time, typically only one support person is allowed to join an expectant mom for prenatal visits, ultrasounds and during delivery,” said Dr. Kossak. “That’s being done to reduce the risk of an asymptomatic person bringing COVID-19 into a medical facility and/or infecting mom or baby.”
Another change is that after the baby is born, grandparents, siblings or other family and friends are not permitted to visit.
“We understand it can be difficult for families who want to share those happy moments,” said Dr. Kossak. “I’ve noticed a lot more texting, sending of photos, and other online interactions to let people meet the new baby.”
Dr. Kossak said COVID-19 testing is administered for patients prior to labor/C-section. If a woman does test positive, the medical professionals caring for her will be gowned in full personal protective gear. The support person the woman chooses to be with her will also be required to wear personal protective gear while in the hospital.
Then, after delivery, there are recommended protocols about the interaction between mom and baby to prevent the baby from possibly contracting the virus.
“Preliminary studies indicate there is not a risk that mom can pass the virus along to baby while in utero,” she said. “There is a risk once the baby is born and mom begins caring for her baby. That risk is minimized with proper handwashing, masking and appropriate distancing.”
ThedaCare birth center teams have been working closely with each family to make decisions based on the clinical condition of each patient, ensuring safety for all after birth.
Dr. Kossak noted that pandemic or no pandemic, giving birth doesn’t really change, it just might look slightly different.
“Medicine is a field of continuous learning and discovery; as we learn new information we make changes in prenatal care, delivery and neonatal care,” she said. “That’s why it’s important that expectant moms have confidence in whomever they choose to care for them during this special time in their lives. They need to be assured they are getting the best, most up-to-date care possible.”
ThedaCare and Go Valley Kids are teaming up in 2020 to help families be healthier, more active and enjoy Northeast and Central Wisconsin.
About the Author – Dr. Amanda Kossak
Forming strong patient relationships is extremely important to me. Doing so allows me to care for each individual in a unique way that best fits his or her needs.
I was drawn to family medicine because I enjoy caring for entire families, from the oldest to the youngest. I especially like women’s health and obstetrics, and love delivering babies. I also have an interest in transgender medicine, contraceptive management, and small in-office procedures.
I’m originally from Superior, Wisconsin, but grew up traveling and seeing the world. I still love to travel but also enjoy spending summers back in Superior with family at our lake cabin.
For more than 110 years, ThedaCare® has been committed to improving the health of the communities it serves in Northeast and Central Wisconsin. The organization delivers care to a community of more than 600,000 residents in 18 counties and employs more than 7,000 health care professionals. ThedaCare has 180 locations including seven hospitals located in Appleton, Neenah, Berlin, New London, Shawano, Waupaca and Wild Rose. ThedaCare is the first in Wisconsin to be a Mayo Clinic Care Network Member, giving our specialists the ability to consult with Mayo Clinic experts on a patient’s care. ThedaCare is a not-for-profit health care organization with a level II trauma center, comprehensive cancer treatment, stroke and cardiac programs as well as a foundation dedicated to community service.