Thought and careful deliberation should go into choosing your birth provider as this is one of the most important decisions you will make for the health of you and your baby. Your environment, and those in it, play a critical role in setting the stage for a positive birth experience and outcome. Many women may choose a provider based on the proximity to their home, whether they are an in-network provider, or a recommendation from family and friends. However these three options are not the only reasons to choose a provider: Your care provider makes continuous decisions and recommendations for the health of you and your baby. Having trust in them is imperative for feeling safe and having a good outcome. You should hire a care provider based on their experience, skill, and most importantly because you like them! It is important to determine what you desire in your birth experience to know which provider to choose. For example; if you are looking for an unmedicated birth, rather than choosing a high-risk obstetrician, it may be best to choose a Midwife. On the contrary, if you have pre-existing conditions such as high blood pressure, diabetes, heart disease, or epilepsy, a high risk fetal medicine doctor may be the best choice for you. But in any case, you have choices! It is best to find a provider that you and your partner connect with. Every provider has their own beliefs regarding birth. Doctors and practitioners have different philosophies on birth which alter their birth practices. It is most important that you are on the same page as your provider. Doctors and midwives have beliefs and ways which they practice that they are most comfortable with. You will not change their beliefs, so it is best to find a provider that is aligned with what you believe.
So where do you start?
First, think about your prenatal and laboring goals. Determine what it is that you want, and then begin to ask the questions to see if the provider and environment will help support your choices and help you achieve the birth that you desire.
Choosing a Birthing Provider:
This task can be daunting with so many providers to choose from. We are here to help assist you in making that decision. There are 4 types of birth providers; an Obstetrician or OBGYN, Maternal Fetal Medicine Specialist, Family Physician, and Midwife.
Obstetrician:
An obstetrician is a medical doctor specialized in pregnancy, labor, and birth who are trained to detect and manage obstetric and gynecological problems. These providers usually work with a partner or within a practice of multiple providers. They provide care within the hospital setting. When choosing this provider, please note that you will spend most of your time laboring with the nurses. Usually, the doctor will only arrive to deliver the baby.
Midwife:
A midwife specializes in normal birth. This is the optimal model of care for most births. Midwives offer complete women's care- prenatal, labor, and postpartum. They may assist in birth in a hospital, birthing center, and some midwives even as home-birthing midwives. Midwives are best at caring for low-risk pregnancies. They have low rates of inductions, continuous fetal monitoring, interventions, and may have a low cesarean section rate. Midwives are well trained in managing complications if they do arise, but they defer high - risk cases and complications to medical doctors. Midwives spend more time with their client rather than relying on nurses and staff. According to midwife Ina May Gaskin, "Good research shows that when midwifery model of care is applied, between eighty-five and ninety-five percent of healthy women will safely give birth without surgery or instruments such as forceps and vacuum - extractors." See Oregon State University’s research on the impact of midwife and home birth here.
Maternal Fetal Medicine Specialist:
A Maternal Fetal Medicine Specialist provides non-routine medical care to women during high risk pregnancies. These providers have a high rate of use of interventions due to the high risk of the birthing person and/ or baby. They are trained in surgery and routinely perform cesarean sections. Many of these providers provide exceptional care to challenging cases with rarer scenarios. It is reassuring to have a provider who has experience and more expertise with the high risk population.
Family Physician:
A family physician is a provider that works with people of all ages. These physicians are going extinct as they are much rarer in large metropolitan areas. A portion of these physicians do deliver babies and may refer out if complications arise. Family Physicians deliver babies in hospitals. The benefit to these doctors is you may already have an established relationship with one and they can continue on with the doctor as the Pediatrician. One of the biggest disservices we currently face in the United States is the continuation of maternal care postpartum. This provider allows for a greater continuum of care. As medical doctors they are trained in administering and managing medical interventions during labor, as well as recommending cesarean sections.
See our list of questions to ask your provider here. Asking these questions will give you insight into your provider's personality.
Choosing your Birthing Place:
Birth can happen anywhere, but I am assuming you are not envisioning giving birth in the back of a cab on the Expressway. Choosing a desired location can assist you in narrowing down practitioners. There are 3 main birthing locations to choose from; a hospital, birthing center, and at home.
Hospital Birth:
A hospital birth can be assisted by an OBGYN, Family Physician, Maternal Fetal Medicine Specialist, and a Midwife. This birthing location offers all types of providers, giving you the most choice. A hospital birth provides close proximity to every intervention if desired and necessary. Unfortunately, there can be many hidden out-of-pocket costs for a hospital birth because the medical model leads to the highest rate of intervention including a cesarean section. It is also important to note that anyone who enters the hospital is given a diagnosis and treatment for care. This is why the birthing person is immediately put into a wheelchair as you enter and leave the facility.
Careful Considerations/ Questions to have answered:
Is this hospital a teaching hospital? What this means for you: This could drastically change your experience. Interns will be performing procedures and many students will be in and out of your room throughout your experience. The list continues, see our list of questions regarding facilities here.
Birthing Center Birth:
A birthing center birth can be attended by both a midwife or a physician. The birthing center provides some of the comforts that you would experience at home, with access to medical technology and intervention if needed. The birthing center offers space and privacy that may not be obtained in urban living or a busy hospital. Some birthing centers have tubs, showers and other amenities that may be desirable during your birth. Birthing centers may offer access to some interventions and allow you to be close to the hospital if transfer is necessary, as many birthing centers are connected to the hospital. Read more on a birthing center birth from the American Association of Birthing Centers here.
Home Birth:
This birthing location gives you the most freedom. Home births are associated with the lowest intervention rate. The home environment encourages a natural birth: giving you the freedom to move, eat, sleep, bathe, and be in control of your familiar environment. This environment is familiar and comfortable, no limitation on visiting hours from family and friends, and no risk of exposure to infection from sick people. The downside to a home birth is that there is no possibility for an epidural and there is the possibility of more out-of-pocket expenses due to the possibility of lower reimbursement from the insurance company.
We hope this helped bring clarity to the birthing options you have and the best way to choose a provider that will support your family’s goals.