You’re pregnant! Now what?
The important process of choosing the care provider for one’s pregnancy and birth is often passed over by just going with whoever their mother or friends had. Someone’s glowing review of a provider is encouraging and great to hear, however just because they were right for them won’t necessarily mean they are right for you.
So why is it so important? You can birth however you want, right?
True, you can (and should) advocate for yourself in any birthing situation, but if you can set up an environment where you could avoid or reduce the chances of even having to, why would you not?
Many believe that finding a provider that prefers and encourages your wants and needs for birth is one of the best ways to build the foundation to have a positive birthing experience.
STEP 1: Decide what is right for you.
What type of birth do you want?
Are you wanting a natural birth? Or maybe looking forward to the comfort an epidural will provide? Do you know you will be scheduling a repeat cesarean? Once you figure out this foundation for your birth, you can begin to plan the environment that is just right for your family.
What setting would you be most comfortable in?
Birthing at a hospital, a free standing birth center or having a home birth all have their pros and cons. If you would feel more comfortable in a hospital where the operating room and medical equipment is just down the hall in case of a true emergency, that is where you should birth. If you know that the beeping of monitors, hospital policies and uncertainty of staff will give you more stress than comfort, than perhaps an out of hospital birth is right for you. Many enjoy the comfort and settled pace of a home birth. Others choose free standing birth centers because they designed for birth. They hold big soaking tubs, comfy surfaces, and are often close to the hospital; all things one may not have at their home if they had chosen to birth there.
Once you have found your birth location you can narrow down your options to who those providers who deliver there.
How important to you is the personal connection with who delivers your baby?
The most common and widely available system for maternity care is the group practice with care under an OB/GYN. OB/GYNs have the most training and experience as they care for large numbers of women yearly. Many feel comfort in the medical and surgical expertise they provide. You will meet with different OB/GYNs throughout your prenatal care at a group practice. They all share an on-call schedule for deliveries at the hospital. Many are unable to spend much time with you prenatally, only 10-30 minutes at each appointment. This model can be hard on the birthing woman if a doctor she doesn’t mesh well with is on call the day she does in. However if a emergency cesarean is needed having an OB will allow for continuity of care throughout your birth.
Also some group practices have Nurse Midwives in the rotation or even a separate rotation with only the Nurse Midwives. This is a nice option for those who prefer the Midwifery Model of Care but want to birth in a hospital. Keep in mind that a Nurse Midwife will not be able to perform a c-section even if they deliver in the hospital. You will transfer to the care of an OB if complications arise.
If you are birthing at a hospital and want to be sure who will be your care provider, some Primary Care Physicians (aka doctors in a family practice) have extra training that allows them to provide prenatal care and deliver babies. You will have your prenatal appointments with them and they will be on call for your labor and birth. You can also continue on with them and have them be your baby’s pediatrician. This option is wonderful choice wanting more personalized OB/GYN care but may be harder to find in your area and typically they do not perform c-sections.
If you are birthing out of hospital you will have a Midwife. If you are planning a natural birth, being out of hospital with a Midwife is can be the most advantageous environment to achieve that. The Midwifery Model of Care is more personalized and hands on. While you may only see an OB at a prenatal appointment for a portion of the visit, you spend the entirety of your appointments with your midwife(s). Most take the time to educate you on the birth process and tend to your emotional and physical health. They have extensive medical training, some medications and basic equipment in case of an emergency.
However they are unable to take on high-risk patients, multiples, and often VBACs (vaginal birth after cesarean). If you develop certain complications during your pregnancy, pre-eclampsia for example, you will have to switch to an OB/GYN. During labor they will transfer you to care in the hospital if signs of concern begin to arise. Midwives do not offer pharmaceutical pain relief out of the hospital (with the rare exception of laughing gas in some free standing birth centers). If you are sure you want those available, look into Nurse Midwives who work in a hospital.
Midwives are a safe and intimate option for low risk mothers. They follow a strict scope of practice to make sure you are in a safe, responsible environment.
What aspects of birth hold the most weight to you?
Now that you have explored your birth and care preferences, it is up to you to decide which of these factors is most important and to focus on the options surrounding it. There is no universal perfect environment for birth. Find what is right for you and go from there.
Step 2: Explore the logistics of your options.
- Which of my options is covered by my insurance? (If not, could you afford them out of pocket?)
- Who is available for my estimated due date?
- Do they deliver where I plan to give birth?
Step 3: Meet them and ask specific questions.
- How much time will you spend with me at my prenatal appointments?
- What if I have questions or concerns in between appointments? Who will I speak to?
- How do you view the birth process? (unpredictable, a natural process, risky etc.)
- In labor, what does your role look like?
- What do you recommend I do to prepare for this type of birth?
- In what cases will you induce labor?
- What are your routine prenatal procedures?
- What are your routine labor & birth procedures?
- In what circumstances would you be unable to be my care provider?
- Will I be able/encouraged to walk & move freely in labor?
- Will I be able to eat and drink in labor? What are your restrictions for eating?
- Will I be able to push in positions I feel comfortable in?
- What positions do you feel comfortable delivering a baby in? Can I deliver in other positions?
- In the case of a cesarean, what can you do to make it more family centered?
- What will my care look like after I have my baby? The first 10 minutes? The first hour? The first week? etc.
- For even more questions and ones that are VBAC or high risk specific, take a look at BabyCenter’s checklist here: http://assets.babycenter.com/ims/Content/ob_gyn_interview_May_2010.pdf
Step 4: Make a choice you trust.
- Which providers treated and talked to you respectfully? Were they patient as you asked your questions?
- Which provider or practice routinely supports women in labor as you wish to be supported?
- If they or your birth place have policies or routine care that you hope to avoid, are they open and flexible to make accommodations?
- Who did you truly feel the most comfortable with?
If at any point in your pregnancy you feel that your care provider or birth facility is not supportive, you have the right to switch to one who is. It may take some phone calls and paper work, but it is worth it to insure you are being cared for by a provider you trust in a place that systematically cares for women in the way you wish to be cared for.
Thankfully it is never too late in a pregnancy to switch providers.
The same goes for when you are in labor. If you are feeling disrespected by your doctor or nurse, you can request to be cared by for someone else.
Consider hiring a Doula. The earlier in your pregnancy the better. Find one who is familiar with the Doctors and Midwives in the area and they can help you navigate this process with experienced insight. A doula on your birth team would be especially pertinent if you are unable to find a provider you are completely comfortable with.
Even with a perfect provider, a doula is a valuable addition to the birth team.
Doulas offer total continuity of care. You get you know your doula over prenatal planning and preparation appointments. Your doula is by your side throughout your labor and birth and you have a familiar face even though the nurses and doctors may switch at shift changes.
Be intentional about your birth. No matter how you want it to look- intimate home birth or empowered scheduled cesarean- take steps to build a superb foundation for your birth.