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Choosing Pregnancy and Childbirth Care

This post continues the Middle Path Mother series on first Fridays of the month.

As I mentioned in last month's MPM post, I am more of a plotter than a pantser--in writing and life, too. But I'm also an opportunist who makes choices quickly.

Before I conceived, I was already talking with my primary care physician about pregnancy wellness. And as soon as I saw that little blue line on a home pregnancy test, I scheduled a doctor's visit to make it "official."

I trust my doctor very much, and she recommended the most well-regarded Ob-Gyn practice in town, so I simply took her advice and had her transfer my care right away. It worked out great for me, but many women want to know more about their options before placing their pregnancy and birth in the hands of a caregiver.

There are many different people--and different sorts of professionals--you may prefer to deliver or "catch" your baby. Think about your ideal birth scenario, and also consider a backup--birth rarely goes according to plan. I say this with the experience of a mother who has spoken to a large number of other moms. Across the board, every birth I've ever heard of involved some surprises (not necessarily huge ones or negative ones) and unexpected twists. One very common snag is going into labor only to find out that the favored birth practitioner is not available! That is why it's important to build a highly trusted support network of several people to guide, nurture, and support you through this very special journey.

First, it is very important to find an obstetrician or Ob-Gyn practice with whom you feel comfortable. Here is a comprehensive guide for choosing an obstetrician or other medical caregiver. All pregnant women should connect with an obstetrician, even if your ideal birth is attended by a midwife. While most women do not encounter life-threatening complications during most of their births, pregnancy and childbirth are much riskier times to our health than when we are not pregnant. Issues small and severe can pop up suddenly or arise without our knowledge if we are not monitored by a medical professional who knows how to find and treat those problems. It is most convenient if you can find a practice with several Ob-Gyns on staff that you trust, in case "your" doctor is unavailable when you go into labor.

Midwives are experts in "normal" pregnancy. If they happen to notice something out of the ordinary, the standard response is to transfer care to an obstetrician. I used an obstetric practice (with a midwifey flair and a crunchy texture) as my only professional care during pregnancy; other women may want to be cared for primarily by a midwife, with an Ob-Gyn on hand "just in case."

The midwifery model of care supports wellness in pregnancy and birth with minimal medical interventions. There is also a higher focus on the processes and positive experiences of pregnancy and childbirth and a higher focus on the well being of the mother. Midwives serve women in hospitals, at freestanding birth centers, and in private homes. Births attended by midwives have a slightly reduced risk of maternal complications compared to hospital birth; however, out-of-hospital birth poses increased risks to the baby.

I know several women who have had amazing, wondrous, life-changing experiences giving birth with midwives outside of a hospital, but it is vital to proceed with caution when choosing to give birth with a midwife or outside of a medical facility. I suppose most of you reading this post don't need this word of advice, but celebrities like Jenny McCarthy and Ricki Lake are not medical professionals, scientists, or journalists. I was one of those new moms who had well-meaning and kind friends shoving all kinds of articles, books, and "documentaries" at me that were hyped by very nice-seeming famous mamas, and I went through pregnancy and childbirth sorely misinformed about many things. Luckily, nothing bad happened to me or my child as a result--but I know other women, smart women, who bought into some misleading ideas about childbirth who were not so lucky.

The midwifery model of care is a lovely philosophy and can be marvelous in practice. But please note that it is much more complicated to make sure you are choosing a safe, ethical midwife than a safe, ethical doctor because midwives are not regulated, insured, or held legally accountable in the same ways doctors are. I am sad to say that there are women in my city who have been harmed or even lost their perfectly healthy babies after receiving negligent midwife care, not realizing until it was too late that their chosen caregivers were not properly trained professionals with good track records. This is a terrible thing, but the inspiring part of the story is that some of those families banded together to form a group called Safer Midwifery for Michigan to help other families choose a safe midwife. Their blog contains links to similar organizations and activists in other states. With the proper tools and cross-checks, a woman can find a trustworthy midwife just about anywhere--and, of course, with complementary Ob-Gyn care, obvious missteps during pregnancy and childbirth will be safely avoided.

Happily, we don't have to decide between health care and natural wellness. As I mentioned, I was able to find an obstetric practice that believed in the midwifery model of care and even had a nurse-midwife on staff. And the best of both worlds can be found in many leading hospitals with collaborative care that integrates midwifery and obstetrics. Hospitals with collaborative care might have a homelike birth center, set up for intervention-free childbirth, attached to the building. (This is something else that Safer Midwifery is helping to develop in my city!) Low-risk mothers can enjoy many of the comforts of a home setting, plus non-narcotic pain relief methods such as birthing pools. At the same time, in the (fairly common) event of a complication or desire for medical pain relief, no dramatic and dangerous ambulance ride is necessary. There is no additional paperwork to fill out, and there are no abrupt transfers into the hands of strangers; care is seamless, holistic, convenient, and as safe as possible. And there is additional peace of mind when the hospital also contains a NICU onsite in case of emergency. An all-in-one facility combines comfort and freedom with peace of mind.

Regardless of your main caregiver or ideal birth location, you may wish to hire a doula. A doula is a sort of birth coach, whose purpose is to guide you through pregnancy, childbirth, and the postpartum period with nurturing comfort. A doula can also advocate for you while you are in labor; there will probably be some time during labor and delivery when you will not be able to speak and make your wishes known. A doula is someone who can get to know you and build positive, affirming emotions throughout the childbearing process. I have only heard wonderful reviews from friends who have used doulas--especially for first births. Supportive partners and family members can be wonderful during childbirth, but it can be especially comforting to have someone with you who has seen countless labors and deliveries and is more familiar with what you are feeling and experiencing. DONA International offers resources on finding a good doula.

And if you're more of a pantser and you don't like making all these complex choices and writing up elaborate birth plans and building a whole staff of birth attendants? That is fine, too--Jezebel says so! It's just important to do the initial work of picking, at the very least, an obstetric practice that you can trust--not just with your safety but with your personal needs and wishes--so you can relax and enjoy your pregnancy and childbearing experience without obsessively Googling every sensation.

After choosing your care provider (or team) with confidence, you can move on to browsing prenatal yoga classes, stuffing your face with chocolate ice cream and pickles, shopping for sexy new bras in various sizes, and all the other fun things you get to do at this magical time in your life. So enjoy the ride!

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  1. Very informative post. I hope you're feeling great. :)

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