Any woman who is pregnant, should ask herself, “Was I truly empowered with my first birth? With my first/second provider”? If not, then this piece should be a game changer — the prospect of changing birth care providers. This piece will make the process empowering and exciting, and introduce women to the midwifery model of care. Once they find the right provider, they will never look back! Each birth is opportunity for growth – and when women have felt ‘something was off’ with my birth – it is a sign that it is time to find someone to guide them into new motherhood.
Pregnant women are like sponges, absorbing everything and anything they can get their hands on that’s pregnancy related – which is why picking the right birth care provider is so crucial. Providers have far reaching influence and power by transmitting messages about birth while impacting outcomes. Trust between a pregnant woman and her provider is essential to ensure optimal outcomes. Here’s some great tips to help you pick a Great Birth Care Provider!
1. Decide which qualities you would like to see in your provider. Qualities topping the list: Skilled, knowledgeable, compassionate, reassuring. Speaks your language of birth. You feel heard and supported, not challenged when expressing your heartfelt ideas. Finds windows of opportunity to teach you something new and inspiring. Prompts ongoing discussions about nutrition, healthy lifestyle choices, modification of work and activities, and pregnancy safety protocols. Makes appropriate wellness referrals for a team approach (i.e., chiropractic, PT, therapist). Doesn’t rush the prenatal visit.
2. What kind of practice do you prefer? Solo or group? Do you prefer to give birth in a hospital, a birthing center in a hospital, a free standing birthing center, or have a home birth? The smaller the practice, the closer the relationship you build. The larger the group, the less apt you are to get to know each provider as they rotate you through the practice. The goal is to be philosophically like-minded with each provider. Find a birth location where you feel safe. Each person has a different perspective and there is no right or wrong place to give birth.
3. This is my first baby. Should I work with a doctor or a midwife? What’s the difference? Midwives work with healthy women and obstetricians care for both low and high risk women with medical conditions such as diabetes, heart or liver disease, and auto immune disorders. Midwives are independent health care providers with expertise in pregnancy, childbirth, the postpartum period, care of the newborn, common primary care issues, family planning, and annual gynecologic well-woman care. Midwives screen their clients carefully and make medically indicated referrals to their collaborating and consulting obstetrician, perinatologist, (maternal fetal medicine), genetic counselor, or doctors in other specialties. Midwives consult, collaborate and co-manage with these practitioners. Some midwives co-manage VBAC (vaginal birth after cesarean section,) or twin pregnancies with obstetricians. Midwives do not perform cesarean sections, although some are certified to first assist. While obstetricians are trained in medicine, disease, and abnormality – midwives are trained to recognize variations in normal pregnancies and refer accordingly. Obstetricians are trained surgeons and take care of women with disease states that require initiation and adjustment of medications, and perform surgical procedures including c-sections. Perinatologists are experts in their specialty field when a woman or fetus encounters a high risk medical problem requiring fetal surveillance, procedures, and medications. While OB’s graduate from medical school programs and practice in accordance with the American College of Obstetricians and Gynecologists, (ACOG), midwives graduate from accredited midwifery schools and receive their master’s degree, and some go on for their PhDs. A certified nurse-midwife is educated in two disciplines – nursing and midwifery. Midwives practice in accordance with the Standards for the Practice of Midwifery as defined by the American College of Nurse-Midwives (ACNM). They are licensed by their individual states, and have prescription privileges. You can give birth with a midwife either at home, in a birthing center, or on labor and delivery floor hospital setting. Midwifery care is reimbursed by most health insurance companies, as is obstetrical care with a doctor. Whether you work with a midwife in a solo practice such as mine, or a group practice, the midwifery model of care has a more holistic view of childbirth than the traditional obstetrical medical model of care. Midwives do not see birth as an illness. If your own heath history or your baby’s medical situation requires only the skills of an obstetrician, find a compassionate good listener.
4. A doula is a godsend. Research confirms the many proven benefits to hiring a doula. Women seem to pick their doula quite carefully, and from speaking to many doulas, I get the feeling that pregnant women are asking many more questions of a prospective doula than they do of their prospective providers. The reality is that doulas are not medically trained and should not be depended upon in this capacity. Regardless of how much loving care, massage, and emotional support a doula provides, they can’t make medical decisions. If a woman doesn’t like her provider, suspicion, doubt, and blame can arise when interventions are needed, even in the wake of true fetal distress. The stakes are high for mother, baby, bonding, and breastfeeding – when trust is missing. Then positive birth memories become at an all-time low. Many doulas are mothers, (I was) committed to creating a harmonious energy in the birthing room. If you are not in sync philosophically with your provider from the onset, doulas will often find themselves in an adversarial role. Liza Maltz, Certified Lactation Counselor and Birth Doula at birthyourownway.com, is on a mission, “Women should not be afraid to speak to their doctors about their concerns and question their answers. I give my clients the courage to ask questions, I address their issues, so they feel comfortable enough to seek another provider late in pregnancy if necessary.” Maltz observes, “When a woman feels uncomfortable with her provider, I can see her labor slow down when they walk into the room. It’s a set up to fail.”
5. Meet your backup doctor or midwife. When I showed up nine centimeters dilated on September 29, 1989, my back up doctor was waiting. He looked at his watch often, barely making eye contact with me. I felt an emotional distance. While ‘distance’ may be acceptable while waiting on a check out line at a supermarket, (however some cashiers are quite friendly,) birth is up front, close and personal. Busy and distracted providers are like having strangers at your birth. They illicit shyness, modesty and closed legs from their patients making it difficult to open. With basically a stranger between her legs, a laboring women will be kept on guard and labor naturally slows down to ‘protect’ the baby. That is what happened to me until I focused on motherhood and delivered.
6. Explore your motivation. Is the provider you chose your mother’s OB/GYN from 20 years ago who delivered you? If a friend recommended your provider, how was their own birth experience? Worth emulating? Women often pick providers who unconsciously remind them of a significant role model such as a parent or grandparent who was either nurturing or absentee. Selection should not be based on fear or convenience. I believe the c-section rate would drop dramatically in our country if women were mindful of the reasons they choose their providers to begin with. Pick your provider and birth location from your heart, as this woman did, who picked me!
“I need a provider who will work with me (not on me), who will take the time to establish mutual trust and respect (rather than demanding them based on his/her credentials), who understands the holistic nature of pregnancy and childbirth (instead of compartmentalizing mother and child and creating an unnatural disconnect between the two), who is incredibly skilled, and respects and believes in the natural process, understanding that it is truly the safest way to birth (while at the same time recognizing that technology and “medical intervention” may become necessary for the continued health of mother and/or child). After a long day and an even longer 5 months of searching, I finally collapsed. Tears of relief uncontrollably streaming down my face, I knew that I had finally found someone who will help me, teach me, push me, challenge me and most of all who I can trust will take care of me during what I now know will be the most exhilarating, exasperating, and enjoyable time of my life. I must have you as my midwife. Angelique.”
If you are becoming alarmed about your waning comfort level with your provider, transfer practices. ‘Better late than never,’ is right on time when finding the best fit for yourself and your baby.
Risa Klein CNM, OB/GYN NP, M.S., has been working with pregnant women for 25 years. She is a graduate of the midwifery program at the Columbia University School of Nursing, where she received her Master of Science degree in Nursing with a specialty in Midwifery. Risa offers a home birth approach on Labor & Delivery at Mount Sinai West in New York City. Her office is located on Manhattan’s upper east side. She was the “birth consultant” for the feature films Baby Mama and Maze. To learn more about her midwifery practice, click here.
This blog has been repurposed from Risa Klein CNM.