Thoughtful Thursday: Choosing the right doctor or midwife for you

Are all care providers create equal? No.

At the beginning of a pregnancy we tend to choose a care provider based on distance from our homes or work place or on the recommendation of a family member or friend.  Many assume that all care providers are pretty much the same because for many women pregnancy is the first time we’ve sought out a specialist.

This was definitely the case for me when I was pregnant with my daughter. I already knew I wanted a midwife and so I opened up my insurance booklet and chose a group pretty much at random.

As my pregnancy went on I learned that not all care providers used the same protocols or even had the same philosophies. That was a real eye opener! It turns out that doctors and midwives are as human as the rest of us. Products of their training, experience, and even their upbringings. Some are more laid back and let the birth process unfold on its own – others choose to manage the process with multiple procedures from start to finish.  And on top of that, I had my own thoughts and feelings about the birth process. I finally realized that I needed to find someone who could balance being the guardian of the process while sharing my birth philosophy and respecting my autonomy. It is totally possible! Make a list of the things that are most important to you and prioritize them. Discuss these things with your care provider. If you find that you are having to give up or compromise more than you want, then find another care provider!  Every birth is important and special – you don’t have to settle. I changed care providers twice before I found the one that was right for me. And I had a wonderful birth experience!

Here are some questions to help get you started. These are excerpted from our Intuitive Birth Guidebook. The Intuitive Birth  class is filled with comprehensive information about birth to help you navigate the current system. We go into great detail about choosing the right care provider for you. Carefully choosing a care provider is not limited to people seeking an unmedicated birth. Providers and women are completely individual so it’s important for every woman to find a doctor or midwife she is comfortable with.

How often do you attend unmedicated births?

Ask for a percentage of total births.  80-90% of women opt for an epidural in labor, so many doctors have very little experience with natural birth. Unmedicated births are very different from medicated births and require different skills.

Natural birth, in this case, means no Pitocin, no pain medication, and no unnecessary interventions.

Minimum requirements for an average birth?

Do they insist on an IV or hep lock?

If they require the electronic fetal monitor, how often and for how long?

Do they allow eating and drinking during labor?

Vaginal exams:

There is rarely a medical reason to have these at all during pregnancy and labor.

At what point does your birth team start doing exams during pregnancy, and how often during labor?  How do they feel about your declining them?

Induction/augmentation rates & reasons:

How often (%) do they induce or augment labor?

For what reasons do they usually induce?

How long will they “allow” a pregnancy to continue?

At what point do they usually augment during a long labor?

How do you manage long labors with ruptured membranes (broken bag of water)?

At what point do they recommend Pitocin?  Antibiotics?

How long can a woman labor with ruptured membranes before a cesarean is recommended?

What is your cesarean section rate?

The World Health Organization recommends a maximum of 10% for low-risk populations, and 15% when high-risk populations are included.

Nationally, the cesarean rate was 32.3% in 2008.

Your practice’s cesarean rate is your risk of having a cesarean, whether you truly need one or not.

What is your episiotomy rate?

The recommendation for episiotomy (a cut to the perineum to enlarge the birth canal) is that they should be done only in emergencies.

They cause many problems for women and shorten second stage only slightly.

The rate of episiotomies should be very low.  They are more common in first time moms, so if this is your first baby ask the rate for first time moms.

Find out more about Intuitive Birth here:

Intuitive Birth

Baby Steps offers natural and prepared childbirth classes, breastfeeding classes and support, and doula services in the metro Atlanta area.  Current locations include East Point, Douglasville, Marietta, Kennesaw, Buckhead, Sandy Springs, Lawrenceville, and Decatur.  If these locations are not convenient for you we also offer private, in-home classes on your schedule.  Contact us for more information.  babysteps@babystepsonline.net