The most important decision you will make during your pregnancy is where and with whom you will seek your prenatal care and give birth. Birth caregivers include physicians (obstetricians, family practice physicians, osteopathic physicians) and midwives (certified nurse midwives, certified professional midwives, direct-entry midwives). The paradigms and training of each philosophy of care can be widely divergent. Although it is generally assumed that doctors practice the “medical model of care” (technology-centered) and midwives practice the “midwifery model of care” (woman-centered), individual caregivers may practice according to their own personal belief system which is based on their experiences and philosophies, not necessarily rigidly adhering to their education and training discipline. It is best to first decide which philosophy of care you are most aligned with and then begin to interview caregivers to find those with whom you are most comfortable.
Seek a caregiver that appeals to you philosophically from your available options. Talk to your friends and family members. Ask them about their relationships with their birth caregivers. Did they feel they were treated with respect and dignity during their pregnancies and birth experiences? Would they recommend them to you? Why or why not? Other good sources for recommendations are your childbirth educator, doula, nurses and other medical practitioners, alternative healthcare practitioners (chiropractors, naturopaths, massage therapists), mothering support groups (La Leche League, International Cesarean Awareness Network), midwifery organizations, and, of course, your medical insurance plan.
An obstetrician/gynecologist (OB/GYN) is a medical doctor and surgeon who specializes in pregnancy and childbirth, with training focusing on the possible pathological (disease related) complications that may develop and has very little formal training in the psychosocial aspects of pregnancy. The expertise of an OB/GYN may be important if medical problems are present or if complications develop. OB/GYNs typically employ a more technological approach to pregnancy and birth management and, as surgeons, are qualified to perform cesarean section.
The word midwife means “with woman.” Midwives have been caring for childbearing women from the beginning of time. Midwives still care for the majority of birthing women around the world and boast the lowest infant mortality rates. A healthy pregnant woman can feel confident in choosing a midwife as her birth caregiver. Midwives strive to identify the unique physical, social and emotional needs of each woman and her family to individualize her care. Midwives are trained in the “Midwives Model of Care,” which is based on the fact that pregnancy and birth are normal, physiological life processes. This woman-centered model of care has proven to reduce the incidence of birth injury, trauma and cesarean section. Infant mortality rates are lowest in countries where midwives principally attend birth. While midwives practice in homes, birth centers and hospitals, it is rare to get the full benefit of the Midwives Model of Care in a hospital setting because of restrictions, rules and standard practices. An informed consumer would be wise to ask their prospective midwife about her philosophy of care and any limitations placed on her practice.
Ask questions! Communication is a key element of good care, and you must take responsibility for obtaining the information you need to make decisions you will ultimately feel good about. Have confidence in yourself and the importance of your needs and questions. Phrase your comments and questions in a way that communicates your intention to be an active participant in your baby’s birth. For example, a woman who is interviewing a physician and says, “I am planning a natural birth. Are you willing to assist me?” presents a different image than the woman who asks, “Is it alright to try to go unmedicated?” The type of response she receives will be a reflection of her confidence and determination.
Your initial conversations with a caregiver will establish whether you wish to pursue his services and may be accomplished with a few basic questions over the phone. More in-depth questioning can occur at your first prenatal consultation. Once you have chosen a caregiver, detailed conversations will unfold over a period of time at your prenatal appointments. It is your responsibility to determine what you believe and want for your birth experience – you and your partner are the only ones who can make the decisions that will be right for you. Trust your instincts and intuition. The way a caregiver answers your questions can be more indicative of his true meaning than what he actually says. If you are having negative feelings about the information and attitudes you hear from your caregiver, do not hesitate to honestly express your concerns. Approach your caregiver respectfully with your questions or concerns. Take care to avoid causing defensiveness, which will not be conducive to effective negotiation. Evaluate whether comfortable compromises can be reached or if you and that caregiver are too far apart philosophically to work together in a positive way. Do not be afraid to seek another caregiver or place of birth at any time during your pregnancy, if it feels appropriate.
Once you choose the caregiver that is best suited to your particularly needs, you can take pride in your efforts and feel confident in your love for yourself and your baby as you journey into parenthood!