April 11, 2008

How to choose: Midwife or OB?

In America, most mom's don't even ask that question since the norm is to go see an OB (either private or group practice) and deliver in a hospital with all technology at hand. However, more and more women today are educating themselves on their birthing options and the previously normal trend of midwife attended birth is rising. Though still less than 1% of births take place at home, more women are opting for a nurse-midwife (a midwife who has RN training also called a Certified Nurse Midwife or CNM) for delivery in a hospital or birthing center.

Though the ideal place for normal, low-risk pregnancy and birth is home, having a midwife and birthing in a birth center will greatly help a woman achieve a less interventionist birth.

"Why would this be important to the outcome of birth? Isn't this just more a matter of preference?" many may ask. Well, technically, yes, either way you birth is ultimately a choice you have the free will to make. But, it DOES matter and it DOES play a large role in how your birthing experience can and will go. For many women, they want a natural birth simply to feel more connected to their body, more empowered. After all, there is nothing more womanly than birth and breast-feeding. But for some women, it's more than that. It is about the child, and they learn through research and thought just how negatively unnecessary intervention can be to their precious baby. It always makes me laugh to see women watch so carefully what they eat and drink during pregnancy just to pump themselves full of drugs hours before their baby is born.

For the women looking to achieve natural childbirth, the environment in which they deliver is very important. Not only the location, but who is there with them in attendance of their birth. When looking for a prenatal care provider there is a list of things you'll want to make sure are met.

  • You want to look for someone who takes the time to listen and answer your questions and concerns without making you feel rushed or degraded. Don't forget, whether you're meeting with a midwife or OB, they work for YOU. You are paying them for their services and though they are there to offer their advice and suggestions, it is all up to YOU what happens.
  • You want to hire a provider that connects with you. This is probably the most important thing you will do in your life (giving birth) and you don't want to share it with someone who looks at you as another number or as a meal-ticket. You want someone who is genuinely concerned with yours (and your child's) well-being, someone who understands that your wishes for a natural birth aren't silly and shouldn't be undermined.
  • You will probably want a care provider who shares your similar views and interests regarding the area of birth. Perhaps your midwife or doctor has had natural births themselves and feels strongly about it, in turn, leading to more support for you. But, don't forget, midwives and doctors are people, and if you are delivering in the hospital, you get the hospital ride, meaning they could be one way during pregnancy, and another way in labor. Always be prepared. This is also why the previous "rule" is important.
  • You'll want to ask for the provider's stats. And, if they are associated with a group or specific hospital, ask for those stats as well. It is important to know the trend your provider has. If you're planning a birth center birth, it may not be a good idea to do so with a midwife who's got a transfer rate of 45%. Likewise, if looking for a natural hospital birth, you don't want to hire an OB who has a high cesarean rate (anything over 10-15%). This information is important AND you are damned welcome to it. Any provider that won't disclose this information freely and gladly should make you nervous.
  • You'll want to share early in pregnancy what your wishes and goals for your birth are. Don't wait until you are 35 weeks pregnant to say "Oh, by the way, I wanted to go natural.". At that time, your doctor has already built trust with you and probably has their own plans for the birth. Aside from that, it's sort of rude to tell your provider just weeks before birth that you want "this, this and that with no if's and's or but's". Just, be straight forward. When you first meet and share this information, you can also use their reaction and answers to it as a deciding factor in whether or not they are right for you.
  • You should question any routine testing/intervention/practices your provider has. Some OB's will hand out a sheet of "what to expect" at different points in your pregnancy (for ex: when certain blood tests are done). Don't be afraid to question or deny a test or procedure, but if your doctor has a pre-printed list for patients, expect that they will probably fight you on your choice to refuse. This may mean that provider is not a good match for you, and you should keep searching. No matter the procedure, you have a legal right to refuse it. Also, your provider cannot legally drop you within 30 days without finding another one to take you on. Gestational Diabetes testing, ultrasounds, amniocentesis, quad-testing, and other procedures are not required, only suggested and ONLY on a case by case basis and if the mother is willing.
  • You will also want to start saving, preferably before you get pregnant, but if it doesn't happen that way (for ex: if the pregnancy is a surprise) then you can start saving and budgeting early on in your pregnancy. The reason you want to save is not only for the purchases you'll make for baby, but also for your birth. You never know what may happen. Many women discover in the end of their pregnancy that they provider wasn't who they thought (this goes for OB's AND midwives). Women may go from planning a birth center birth to home, some go from home to unassisted, and sometimes late pregnancy complications arise and you could go from out of hospital birth plans to in hospital. Life is full of surprises, so it's no wonder that the journey to bring life into the world is full of surprises as well. Save enough money as you can comfortably, but try to shoot for a figure of a couple thousand.
If you follow some of these simple guidelines, not only should you end up with your desired birth, but you should have the confidence to know you made a good choice in care. Remember: your birth is important, and the provider you choose to attend it is a big part of your birthing experience.