How to Choose a Health Provider for Your Birth
So often we pick a healthcare provider based on who we happen to find first. But that’s not necessarily the ideal way to plan the birth you really want. All healthcare providers can be wonderful and well-trained, but not all healthcare providers are a great fit for every birthing woman.
Everyone has different personalities, worldviews, skill emphases, and preferences. This includes doctors and midwives. Some healthcare providers are very skilled at high-risk birth and managing emergencies, and that is where they shine. Others are amazing at supporting physiological (“natural”) birth, and that is where they excel.
Knowing what you want for your birth, how you want to be supported, whether you want access to medication pain management or not, and the environment you prefer to be in… these are the clues that will help you find the healthcare provider that is perfect for you.
What Are My Options?
Just about everyone knows that doctors catch babies. But not everyone is aware that more kinds of providers can also be there for your birth. So here’s a quick overview of the types of skilled practitioners that can support you through your pregnancy, birth, and postpartum experience.
DOCTOR/OBGYN
These medical professionals typically support births in a hospital or a private practice clinic that’s associated with a hospital. They are trained in normal birth and surgical birth, as well as gynecological care of women through the lifespan. Typically, doctors focus on either OB care or GYN care. OBs can perform cesarean sections in addition to supporting “natural” or medication-managed births.
DOCTOR/PERINATOLOGIST
These are highly specialized OB/GYN doctors that focus on high-risk pregnancies. They are a great choice for people with health conditions that need careful management during pregnancy, such as diabetes, HIV, and hypertension.
FAMILY PRACTITIONER
These providers are typically doctors that provide care to the whole family and sometimes also catch babies. They can work at a hospital or be in private practice with hospital privileges. They typically only accept low-risk pregnancies and refer to specialized practitioners for high-risk pregnancies.
CERTIFIED NURSE MIDWIFE
A nurse midwife is an RN that has advanced training in the obstetrical and gynecological care of women. They usually have a master’s degree and are board certified. They typically work in hospitals, caring for clients with low-risk pregnancies. CNMs can also work in birth centers, and less commonly also can deliver babies at home.
CERTIFIED PROFESSIONAL MIDWIFE
A CPM has been trained through a midwifery school and/or an apprenticeship. They specialize in the care of low-risk birth at home or in a freestanding birth center. They typically cannot catch babies in the hospital. They have to pass a certification exam through the North American Registry of Midwives (NARM) in order to claim the CPM credential. Many of them are licensed through their state and often carry a limited selection of emergency medical supplies and medications. In some states they can bill insurance.
Traditional MIDWIFE
These midwives are trained through midwifery schools and/or apprenticeships. They only catch babies at home births and are trained to handle low-risk pregnancies and births. They are skilled practitioners that focus on out-of-hospital births only. Often traditional midwives have a specific philosophy around birth and caring for women, especially when it comes to holistic and hands-off care. They don’t traditionally carry medication and typically manage emergencies through prevention and holistic means. They aren’t able to bill insurance, but they often have flexible payment plans and other financially supportive options.
DOULA
A doula is not a medical support person and cannot replace your healthcare provider. However, they can be an excellent addition to your birthing team, offering the kind of support that a busy healthcare provider often doesn’t have the time or resources to offer. Doulas can help you plan your birth and decide on your preferences. They can be there to answer questions and help you track down resources. Once you go into labor, often they can come to your house to support you and help you get to the hospital or birth center. During labor and birth, they stay by your side to support your process and needs. After birth, they can help with breastfeeding and answer questions.
How Should I Find the Right Provider?
Figure out where you prefer to give birth and what makes you feel more comfortable. Does the idea of giving birth in a hospital make you feel safe and supported? Or restricted and nervous? Are you interested in exploring the idea of birth center birth or home birth? Or does that feel unappealing?
You can explore more than one option to help you decide which place feels the best to you, too. Interview a couple of OB/GYNs, a couple of midwives, and pick a couple of places that you’d like to tour and consider.
You might be surprised by what you feel in each place or the experiences might validate what you already knew felt right.
Once you’ve found the place you prefer, you can start to narrow down provider options. If you really liked one that you’ve already interviewed, great! If not, get some recommendations from friends, family, or your community and do a few more interviews.
You’ll probably find someone that has the kind of philosophy that you love and that has the personality you feel connected to. Once you've found this person, you’ll know that you’ll be supported well throughout your pregnancy and birth.
What Kinds of Questions Should I Ask?
You can create a document of questions to bring with you, as well as a birth preference worksheet to go over with the doctor or midwife. Make some notes of their responses so you can keep track and think about it all more at home. Here are some questions you could consider asking at your interview.
What is your philosophy of pregnancy, labor, and birth?
How does this impact the way you practice?
When and where were you trained and what is your certification?
How long have you been practicing?
What inspired you to become an OB/GYN, midwife, etc.?
How many babies do you deliver every week or month?
Can you provide references for me to contact?
What is your cesarean rate?
What is your hospital transfer rate? (for birth center/homebirth practitioners)
Who will be at my prenatal appointments?
Will you for sure be available during the time around my due date?
Who is your backup practitioner if for some reason you can’t make it? Can I meet them?
What are your rules around inducing labor?
What are your policies for how many weeks a pregnancy is allowed to go over 40 weeks?
Who do I call with questions or concerns and how can I get a hold of you personally?
Tell me what a typical prenatal appointment will be like and how long it will be.
How do you handle the end of pregnancy and how do you structure prenatal appointments at that point?
Tell me what a typical birth is like for you and how you like things to go.
How do you handle a long labor?
Do you trend toward trusting the body to birth the baby? Or do you prefer to “help” labor along more often than not?
What kinds of induction options do you offer and how often do you use them?
What kinds of pain management options do you offer?
Do you allow laboring and/or birthing in water? What facilities are available?
What will happen if my pregnancy becomes high-risk? Can you still care for me or do you have a specific practitioner you would refer me to?
Do you allow birth plans and what is your general attitude about them?
Will you allow me to have a doula and/or birth photographer at my birth?
After my baby is born, how will you care for my baby and me?
Will you allow things like skin-to-skin right after birth, delayed cord clamping, and testing baby right next to me?
Will you allow my baby to stay with me unless there is a medical emergency?
If I have concerns about my baby, will you be available to help during the first few weeks?
Do you have a wide network of resources and referrals to offer if I need additional support?
Making the Choice
Sometimes our preferences don’t fit with our needs, and that’s okay. You can have an incredible birth full of compassionate support no matter where you choose to give birth. Interviewing healthcare providers can help you to make sure you’re choosing someone who cares about what you want, will ensure they do everything they can to make that happen, and is dedicated to your birthing experience.
The more educated and informed you feel about your options during birth, the more likely you’ll feel empowered, and the more likely you’ll know how to choose the support you need to have a positive experience.
If you’d like more nourished and embodied support throughout your pregnancy and postpartum journey, I work with women who want more autonomy, powerful, and self-trust in their childbearing experiences. You can explore sessions with me here.