Birth Providers & Facilities (pt. 1): Choosing a Provider

The moment has arrived: you suspect that you’re pregnant. Now what?

First, you’ll want to confirm that you are, indeed, pregnant. If you haven’t already bought a test from the store, schedule an appointment with your primary care doctor so that an official pregnancy test can be taken.

Now you’ve determined that there is definitely a baby (or two, or three…) in there. First things first, breathe. Relax. Celebrate the fact in knowing that there is new life growing inside of you. Accept the fact that you are about to become a parent and are now tasked with shaping the life of this new being that will soon be entering the world. Feeling anxious? It’s okay.

One of the most crucial steps you can take is deciding on who your provider will be. Maybe you’ve always known the perfect doctor or you’ve heard great reviews from friends and family members. You want to be sure to do your research as this is someone who you will be having an up close and personal relationship with for the next nine-ish months or so. This is not a decision to be made carelessly; finding a provider for your pregnancy means finding someone whose childbirth philosophy you respect and who will also respect your own. You went through a process of elimination based on certain traits that you found more or less desirable. You also want to make sure that as your pregnancy progresses, you will be able to ask all the questions you need and have the answers explained to you thoroughly.

There are a couple of options you have in terms of type: OB/GYN, certified nurse midwives (CNMs), certified midwives (CMs), or certified professional midwives (CPMs). When you look a little more into each one’s qualifications, you can the training each must undergo. Furthermore, some providers may adapt the midwifery model of care while others may choose a medical model of care. For more information on those differences, click here. https://birthlink.com/midwife-vs-medical-models-of-care/

When you are ready to start looking, make a list of qualities that you think you might like. Think about the process you went through in choosing your own doctors, dentists, therapists, and the like. If you have given birth before, this gives you a slight advantage because you are able to think of situations that you did not particularly care for and would like to change. Make sure to be specific in listing your preferences. Believe it or not, there are a lot of ways in which individuals’ choices can be whitewashed. Taking the time to put things down on paper will help you develop your autonomy for your birth story. There is nothing wrong with taking the time to feel out a doctor or midwife to make sure he/she is the best fit for you. Having a personalized list will help you guide the conversations with your practitioner.

Some examples of questions to ask:

· What is his/her birth philosophy?

o A birth philosophy is someone’s beliefs about childbirth and practices for delivery. If you have ever given any specific thought to how you want to deliver, whether or not you would like medical or surgical interventions, this is where you would begin that part of the discussion.

· Does the provider deliver multiples? Breech babies?

· What are the provider’s hours?

· Will the provider be at your birth? If not, are you able to choose and meet other providers before labor?

o If someone else is on call, you do not want your first meeting to be the delivery room. It will be less nerve-rattling if you are able to meet beforehand and have a conversation.

· Does he/she work with doulas?

o If you have chosen to work with a doula, it would be nice for the provider to know before delivery-time. This could prevent potential tension in the delivery room/birthing area and also allow the birth team to compile a client-centered strategy for your birth.

· Credentials?

· Does he/she listen to you and explain things?

o Throughout your pregnancy, you will want to feel listened to and acknowledged. Especially when it comes to your health and that of your baby’s. If this is your first pregnancy, there will be a lot of questions you will have – new sensations, physical changes. Even if this isn’t your first, you may be experiencing something new this time around or you didn’t get all your questions answered the last time.

· Induction rate?

o How long does the provider allow before inducing labor? Commonly, the reason for inducing labor is going beyond a due date of 40 weeks. However, induction can also lead to an increased likelihood of a C-section. Nevertheless, talking about induction can also lead to follow-up questions such as methods (https://babytalk.life/inductions/).

· C-section rate?

o Is the doctor prone to operating? This may not be a big deal to you, but if having a C-section is completely off the table, you don’t necessarily want to work with someone who favors them.

· What supplies are brought to labor?

o If you are working with a midwife, chances are they have some handy birth tools to help with pain relief. Examples include birth and/or peanut balls, birth stools, essential oils, etc. Often times, they will encourage you to bring your own personal tools as well.

· What tests do you require during pregnancy?

o Not all are required. For now, I won’t go into detail about the different pregnancy tests and which ones are absolutely necessary. I will also encourage you to do your own research and to make your own informed decisions.

· What happens if I go past my due date?

· Are any childbirth classes offered? Or, does the provider have any recommendations?

· Any experience with natural medicine?

o Again, this is more for anyone who is considering a natural birth, without medical interventions. If you are uncertain, you can work with your birth team to develop a plan for you to labor as long as possible without medical intervention.

· How are high-risk situations handled?

· Does he/she attend water births?

· Hospital transfer rate?

o If you are not giving birth in a traditional hospital setting, you will want to know how often births end up transferring to the hospital in the event that there is an emergency situation.

· When does the provider arrive?

o As your pregnancy progresses, your provider will discuss with you the procedure for when you go into labor and when he/she will typically join you. Chances are, it won’t be immediately.

· Cord-clamping policy?

o Does the facility permit delayed cord clamping? For more information, watch Penny Simkin’s video here: https://www.youtube.com/watch?v=W3RywNup2CM&index=22&list=PL7HywWmLzaZv7h9ANX5ss35qdfQcjuRl0&t=0s

· How is baby monitored? (Fetal scope or Doppler)

o Also, how frequently is baby monitored?

· Are episiotomies first resort?

· Frequency of vaginal exams

o This is something that you can control. Talk with your doctor about how often internal exams are necessary to ensure that they aren’t being done excessively.

· Is any help offered with breastfeeding?

· Is neonatal resuscitation offered?

· What procedures are required after baby is born?

o Once the baby is out of the womb, you will feel more at ease if you have an idea of what’s going on while he/she is being poked, prodded, cleaned, and measured. However, check to see if all of these things need to be done immediately or if you they can wait while you have bonding time.

· Are there any factors that limit the scope of the doctor’s practice?

o For example, are there any setting where the doctors are unable to practice? Not all OB/GYNs can attend homebirths and not all hospitals permit midwives to attend. If you are delivering in a birth center, sometimes they do not accept high-risk or multiple pregnancies.

Below, you will find a checklist from Homebirth in the Hospital that helps you locate providers with a blend of midwifery and medical models of care. You can adapt this checklist to reflect your personal preferences.

Checklist for Evaluating Integrative Childbirth Providers

(adapted from Homebirth in the Hospital, © 2008)

꙱ Who performs the intake interviews, gathers the initial patient/client information, and does the first thorough physical exam?

꙱ How much time does the initial visit take?

꙱ Who will you see for your subsequent prenatal visits?

꙱ Does each visit include a blood pressure check, weight check, urine check, belly measurement, and a fetal heartbeat check? Do you get to hear the heartbeat, too?

꙱ Can you eat and drink while you’re in labor?

꙱ How often does the provider cut an episiotomy?

꙱ Do you have to be moved from a labor room to a delivery room to have your baby?

꙱ Assuming a normal birth, is your baby given to you immediately?

꙱ What is the Cesarean-section rate in the provider’s practice?

꙱ Do they have automatic protocols, such as:

꙱ Checking your cervix weekly after a certain date?

꙱ Sonograms at a regular intervals?

꙱ Induction by a certain date or immediately when your water breaks?

꙱ Who will deliver your baby when you go into labor?

꙱ If there is a call group, are the other members supportive of integrative childbirth?

꙱ Can you meet the other providers before you go into labor?

꙱ Where does the provider deliver babies?

꙱ If in a hospital:

꙱ Is the hospital staff supportive of integrative childbirth?

꙱ What is the hospital’s C-section rate?

꙱ Are protocols negotiable?

꙱ Do they take your insurance for payment?

꙱ If it’s in a birth center:

꙱ How far are they from the hospital?

꙱ What are the criteria for transfer to a hospital?

꙱ Do they have a good working relationship with the hospital staff?

꙱ Do they take your insurance for payment? Does their backup hospital take your insurance?

꙱ Does the provider’s style of care reasonably match your needs?

꙱ Are you able to clearly communicate with the provider?

꙱ Do you trust the provider?