Choosing a Supportive Provider
Congratulations! It’s definitely not line eyes- you are pregnant… now what?
CHOOSE. A. SUPPORTIVE. PROVIDER.
Here’s a little secret I am going to share with you, that I would not have believed myself in my first pregnancy— IT MIGHT NOT BE YOUR CURRENT OB/GYN.
That’s right. You have a relationship with someone who you started seeing when you were first sexually active, or when you had your first pap smear all those years ago… and they might not be the one who deserves your business for your birth.
Read that part again. You hire them. They do not hire you. The day you give birth should be viewed as the most powerful, transformative experience of your life. Your care should revolve around informed consent. You should be provided options, the biggest one being patience: patience to be pregnant beyond your due date, patience to make decisions that feel right to you- when they feel right to you, and the option to navigate any risks that arise in a case by case individualized basis- not a one size fits all approach.
So how do you go about finding the one that is right for you? Figure out what your birth philosophies are.
What does the space you give birth to your child look like?
Are you seeing a midwife or an OB?
What kind of language from your providers would make you feel safe and nurtured?
Do you feel birth itself is Safe? Sacred? Scary?
Do you fear labor is potentially dangerous? Where do your fears stem from?
How do you reconcile the normal, natural process of birth turning into an emergent event?
Do you want to give birth in the most natural, uninterrupted way possible? Or, do you know you will be tapping into resources for pain management?
Do you fall somewhere in between, believing birth can be and is usually safe, but feel you want a higher level of medical expertise on hand, just in case?
As you identify your birth philosophy and desires, keep in mind that it is just as important to stay flexible as it is to consciously prepare for your birth.
Talk to like minded folks who have given birth recently.
If you are planning a hands off, low intervention, unmedicated birth experience, it would not make sense to speak to someone who planned an elective 39 week induction, who used an epidural. The experiences could not be more day and night, and choosing a provider who is great at one, probably sucks at the other— there I said it.
Additionally, if anything is higher risk in your pregnancy or for your baby, you STILL HAVE OPTIONS. You still have agency, risks and benefits should still be spoken on, and your provider should still practice evidence based care.
Gather names of providers who come highly recommended, and meet with them.
This might mean a couple of extra appointments- but I promise you, it is worth it to avoid an uphill battle during your pregnancy and on the day you have your baby.
Important questions to ask that will help you identify red flags:
How long do you support me staying pregnant?
Do you offer outpatient Cervical Ripening Balloons closer to 42 weeks of pregnancy?
What is your induction rate? Your c section rate? Your VBAC rate?
How many of your clients have successful unmedicated birth experiences, if that is what they desire?
Do I have to have an IV during labor? How about continuous fetal monitoring?
How do you handle breech birth? Do you do ECV’s? What is your success rate for vaginal breech birth and ECVs?
Do you routinely utilize pitocin for augmentation? Can I decline pitocin for the 3rd stage of labor?
Are you open to holistic options for labor encouragement such as acupuncture, nipple stimulation,
intercourse, castor oil?
Things to dicuss with Home Birth Midwives.
What meds or supplements they carry for comfort and coping or labor progress
How they resolve shoulder dystocias
What they do for surprise breech or known breech presentations
Clear next steps for babies who have no muscle tone or respiratory effort at the time of birth
How they manage postpartum hemorrhage - what drugs do they carry/when, and how they are used
Roles of team. members in emergencies. Who starts IVs. Who pushes meds. Who massages uterus and monitors bleeding. Who evaluates baby.
What level of perineal tearing can they repair.
What requires a hospital transfer for me? For baby?
Make sure the providers in the practice are similarly minded.
This is super hard to achieve in large practices- what one provider holds as a gold standard of care might be laughed at by another— IN THE SAME PRACTICE. Avoid at all costs.
Check the stats of the hospital or birth center you chose to give birth at- if you are going that route.
C-Section rate? Induction Rate? VBAC Rate? Epidural use? Are tubs available? Is water birth an option? Must I give birth in bed? Can I be in the shower? Nitrous Oxide? Am I encouraged to eat and drink in labor? (And not just clear liquids). Do you have a NICU? If not- what level of care requires a transfer for baby or myself?
Have a back up plan.
Know where you would go for a late transfer. Consider dual care with an OB+Midwife team if risks start to arise for someone planning a home birth.
Hire a doula.
Seasoned doulas can vet for locations, midwives, and OB’s. Many provider groups work on a call rotation, which means you may not have a deep connection to who is on call the day your baby is born. Nurses also take care of more than one patient at a time, have lunch breaks, shift changes, etc. Your doula will be the one person who will remain constant should your care team change… especially if you are giving birth in the hospital.
Build a team who will surround you with the values that you value, who believes in what you believe in, and is prepared to show up for you in the ways that you promise!