The gray area comes into play when I listen to a mom tell me her deepest and most strongly held desires for her birth and then tell me about her care provider. No, it is not my job to choose a care provider for my client. BUT. but. What is my responsibility when I have previous experience with that provider and I have not seen them to be supportive of the type of birth my client desires? Should care providers be given the benefit of the doubt when this mama has only one chance to experience THIS pregnancy, HER birth?
Generally, I start with this question- Why have you chosen this provider?
Health insurance is often a factor and I do understand the financial limitations. Though, even with some of the most stringent health care coverage there are usually options.
Often times I hear moms tell me that this is where they have always gone for gynecological care and they thought it would be easier or they don't want to hurt their care providers feelings. This is indicative of how women have been molded in our culture.
Please, hear me.
Your care provider wants you to have a healthy baby but this is not the same as them wanting you to have the birth you desire. The two do not have to be mutually exclusive! You can have respectful, thoughtful and evidence based care AND a healthy baby. Their practice will go on with one less mother. I promise. Birth is a once (or twice or three times) in a lifetime experience for most moms but for care providers it is a day in and day out career. They will see a birth right before yours and they will attend a birth right after. Your care provider will not live with the emotional or physical repercussions of your birth, you will.
I also ask if they feel supported when they talk about their desires for birth.
If the provider is not on board mom almost always senses this from the beginning. If you cannot get your care provider to give you straight answers to your questions in pregnancy it is not a good sign for how you will be treated in labor.
So, here are a few tips for deciding if your care provider is a good fit for your family. This is by no means an exhaustive list, but rather a starting point for a conversation that is important to have.
*Let your care provider tell you their philosophy on normal birth.
Instead of handing over a list of things you desire and waiting for them to give you approval and then feeling disappointed that they won't "let you" do something have them tell you how they see birth. So much can be learned here. Are interventions brought up as a routine procedure or are they spoken of as last options. What does your care provider consider to be "over due" and why? What is their course of action if you are past your estimated due date? How do they feel about unmedicated birth?
*What is their cesarean rate?
Sometimes you might have to follow up on this question because, hard as it is to believe, the care provider may not know off the top of their head. Please, follow up. The WHO (World Health Organization) recommends a rate of 10-15%. In our country the rate is closer to 30-35% on average and in some hospitals it is over 40%. That means nationally almost a third of women are having major surgery in order to meet their children. There is no evidence based reason for this number to be so high. Your best bet for avoiding a cesarean is to make sure you know your care provider's stance on cesareans and their actual statistics, as well as those of the hospital where you may plan to give birth. If your care provider doesn't know their statistics you could also ask how many of their last 10 births were cesarean births.
*How on board are they with your decision making power?
Make no mistakes, growing a baby does not mean you forfeit your decision making abilities. In fact, parenting forces you to make big, life altering decisions and those begin while your baby is still in the womb. If you express a concern your care provider should fully address it. (This means more than telling you not to worry and patting you on the hand) If you ask for alternatives they should be provided. If you voice a desire for your birth it should be fully fleshed out during pregnancy. If your care provider dismisses you with a, "We will see how it goes..." or "I guess you can try..." then there is a further conversation to be had.
*How do they feel about birth plans?
I have heard all the snarky comments about birth plans. I have heard nurses mock them and care providers dismiss them. I am here to say they are wrong. Forming a birth plan forces you to educate yourself about birth. It allows you to go into your birth with knowledge about your body and your options. It means when your care provider brings up something during transition and you are exhausted it will not be the first time you are hearing the words. Care providers should WANT their patients to have birth plans, because it means the patient is taking an active role in their pregnancy and that makes their job easier. Does having a birth plan guarantee the outcome you desire? No, not anymore than having a Life Plan guarantees you will retire to a beach home at 65. What is does is equip you with knowledge and knowledge is power!
If you feel uncomfortable I encourage you to interview other care providers. It is never too late to change providers.
I also urge you to do the research. Put in the same hours learning about birth and birth practices in the US that you log on researching cribs and car seats. Don't think that not knowing will make it easier, don't think that you don't need to know about birth because your care provider does. Birth is one moment in time, but the way you are treated during labor is something that can leave an indelible mark on your life, whether positively or negatively.
Some great resources:
Evidence Based Birth
Birth Without Fear