Having a baby. It is an experience filled with so many different feelings. If you are expecting a baby, you are likely searching for information, advice and support that will make the journey through pregnancy and birth an easier one. So what makes labor and birth a more positive experience? This seems to be the question on almost every expectant mother's mind. I have spent countless hours trying to figure out what makes some births more positive, while others leave the childbearing person feeling anything but joyous. While some of the reasons for a more taxing birth may be physiologic and often out of our control, like positioning of the baby, levels of exhaustion, or emergency situations, there are some other factors that we do have some control over. Today I will share with you the top 3 of my 10 Keys to Your Best Birth Experience.
Key 1- Your Choice of Provider
This may be the most important choice you make as an expecting parent. Just as important as whether or not a provider is on your insurance plan, is whether or not they share your philosophy of birth. So what is a "birth philosophy"? The philosophy of your midwife or doctor will determine what type of care they provide. This philosophy stems from a combination of their training, experience, and personal beliefs regarding pregnancy and birth. There are generally two models of care that lie along a spectrum. At one end you have the medical model and at the other you have the midwifery model, with providers of all types that lie somewhere along this spectrum.
The medical model tends to see birth as a potentially pathological process that requires constant oversight and intervention to create the safest experience. The main goal is live mother, live baby. Mother and baby are seen as two separate patients, and may have competing interests. Some women feel safer with this model where the expertise of a surgical specialist is the foundation, decisions are made for them, there is less autonomy, and they are surrounded by technology. For these women an obstetrician might be the best choice. The most conservative of the providers in this model often have the highest cesarean section rates. If you have to have a cesarean, having a surgeon who performs large numbers of them may feel like a safe choice.
The midwifery model sees birth as a natural, normal process with a more holistic view of care, using a shared decision-making foundation where in the mother shares her expertise regarding her own body and the provider shares their expertise in normal pregnancy and birth. Together they make decisions regarding care. The goal of this model is healthy mother (emotionally, physically and spiritually) and a healthy baby, while honoring the ability of the woman to make decisions. Mother and baby are seen as an intricately connected dyad, whose interests are inseparable. Some women feel safer when they have more autonomy and are involved in making the majority of the decisions in a labor and birth that remains normal. A midwife who is trained in the normal processes of birth and sees normal birth as her area of expertise and utilizes minimal interventions may feel like a safe choice for a low-risk, healthy pregnancy. Providers fall along a spectrum of these two models. There may be a more conservative and medical midwife as well as a more progressive and holistic obstetrician.
There are a number options when choosing a maternity care provider. There are several types of midwives as well as several types of physicians who can care for you during pregnancy and attend your birth. Your choice may be dictated by where you choose to have your baby- at home, in a birth center, or in a hospital. In general there are 3 types of midwives:
TBA- Traditional birth attendant- a birth attendant recognized by her community of origin who provides care based an ancestral knowledge learned through hands-on experience usually from another experienced TBA. These attendants usually carry with them honored cultural knowledge regarding birth highly revered by those they serve. These attendants usually practice solo.
CPM- Certified Professional Midwife- have a wide range of educational backgrounds. From a master's to no formal education through an apprenticeship only model. They have passed a national certification exam and many are licensed in their state, should licensing be offered. Some states have optional licensure. Their training is in normal, low-risk birth with the ability to recognize and handle some complications. Depending on the state, they attend births in the home and in birth centers. They transfer/transport to a higher level of care, should it become necessary. May be in a solo practice or a small call group.
CNM/CM- Certified Nurse Midwife/Certified Midwife- most often trained in and work in a hospital setting but depending on state regulations may attend births in birth centers and at home. These providers are trained as nurses first and then go on to receive graduate level degrees in midwifery. They hold a license different from that of CPMs. CNMs are nurses before they become midwives, CMs are trained similarly but are not nurses before beginning their midwifery program. They are educated in normal birth but are not required to have experience in birth center or home birth before being licensed to practice. Only hospital experience is required. They have the ability to care for women with some slightly higher risk sitiations, as well as those choosing medication for pain relief. They usually work in conjunction with Obstetricians, so that care can be transferred, should the need arise. They may or may not practice in large call groups.
Family Practice Physician or DO -osteopathic physician- These are doctors who are not Obstetricians, yet have training to provide maternity care. They are not trained as surgeons, and so would be required to transfer care should a surgical birth be required. Usually practice in smaller call groups or solo practices.
OB/Gyn- surgical specialists, have training in high risk pregnancy and birth. Far less training in normal, intervention free birth than midwives. Most often practice in large call groups.
Another consideration when hiring a provider i s the size of their practice/ call group. Being on-call 24/7 can be extremely difficult. Some providers choose to practice together to provide some time off call. Obstetrician groups tend to have high numbers of providers with much less time on call. Midwives tend to be in smaller practice groups or in solo practices with more time on call. What this means is that if your provider is in a large call group, you are much less likely to have your provider on the day of your birth. Many obstetric practices have providers with extremely varied birth philosophies. This may affect your birth experience.
A quick quiz to help determine your birth philosophy:
Choose one from each group of two.
A. Do you feel birth is a potential emergency waiting to happen?
B. Do you feel birth is a natural normal process?
A. Being hooked up to monitors that can tell me how my baby is doing makes me feel safer.
B. Being able to tune into my body without being tied to monitors makes me feel safer.
A. Having the option of medication for pain relief available immediately makes me feel safer.
B. Not having the option of medical pain relief immediately available makes me feel safer/more comfortable.
A. Having decisions made for me about my care makes me feel safer
B. Having the ability to discuss, get information, and share decision-making regarding my care makes me feel safer.
A. I prefer to go with what my provider feels is best in the moment rather than plan.
B. I have things I want during labor and birth, like delayed cord clamping, immediate skin-to-skin contact, intermittent monitoring.
If most of your answers are A answers, you tend more towards a philosophy in line with the medical model. If you answered B more often, you tend more towards the midwifery model of care. The likelihood is that you will fall somewhere in the middle of the two models. This can help you formulate questions to determine your providers philosophy and determine whether or not it aligns with yours. Neither model is considered better than the other. What is most important for your feelings of satisfaction following your birth, is that your provider shared a similar philosophy and you felt cared for throughout the process. As you move towards hiring a provider, some of the questions to ask yourself are:
How do I feel when I sit with this person? Do I feel heard? Do I feel respected? Do I feel comfortable when I think about or am in the presence of my provider? Do I feel cared for? Do I want to be in one of the most intimate and vulnerable experiences of my life with this person? Does my body feel at ease when I am around them? When they discuss the specifics of how they will care for me, do I feel safe and comfortable? When you ask questions, are you placated or does your provider listen to and answer all of your questions? Do they encourage questions? What are the chances that the provider that you are developing trust with will be present to attend your birth?
Next week we will be discussing my second key for your best birth experience.