How Did You Choose Your Birth Attendant?
Updated: May 3, 2021
If you are wanting a natural childbirth, are you wondering how you are going to make this happen? When I read Natural Childbirth the Bradley Way two decades ago, the idea of a natural birth just resonated with me. It felt right. A natural birth was what I wanted for my beloved baby.
My gynecologist didn’t deliver babies, so when I realized I was pregnant I needed to choose a health care provider for the birth. Ideally this would have been done before I got pregnant, but my first little love bug was my I-didn’t-realize-I could-actually-get-pregnant-on-my honeymoon child. A friend of mine, who had recently given birth to twins, gave me the name of her OB. Another friend (who didn’t have children yet) had a cousin who was an OB. I didn’t even consider a midwife (sadly) because I was thoroughly unfamiliar with the concept of midwifery. That seemed way out there. Only one of my friends had children - my friend with twins, and she had a cesarean delivery.
I grew up with the cultural conditioning that doctors were the best providers of all health services. Certainly, obstetricians are the most common provider of care for maternity services in the U.S. My decision to go with an OB was based on cultural conditioning, what felt familiar, my perceptions of the “best” care, and naiveté.
Based on what I learned from Natural Childbirth the Bradley Way, I did have the where-with-all to interview those two OB’s. OB#1 was my friend’s cousin. My newly pregnant self and my husband walked into his office – my husband was completely unprepared, but I had a list of questions. That interview was scary – this doctor was the model of being affronted when asked certain questions. I think the one that really ticked him off was my inquiry about not using an IV – oh, man – seriously, his energy totally changed with him putting on his sternest “I am the doctor and no one questions how I do birth” attitude.
I found him frightening. He tried to be all charming at the end, like for sure he was going to be my doctor because my friend was his cousin. I left that interview literally and physically shaking. My husband thought maybe I shouldn’t ask too many questions - which, frankly, is poppycock. Any provider you interview should be doing all in their power to make you feel comfortable and to not try to scare any pregnant mama. All-in-all I was lucky he showed his true colors.
For Doctor#2, I still asked questions. He was very affable. A kind man. In retrospect, I don’t think he actually thought a natural birth was really possible (in terms of not using pain relief) but he seemed supportive and we all got along. We chose him.
Choosing an OB for my first birth made sense. It was what “everyone” did and I had not yet been exposed on a deep level to any other possibilities, beyond reading about midwives in one book. I did have a natural and spontaneous birth. I do feel I chose the right doctor. If I had chosen my friend’s cousin, I am sure I would have ended up with an unnecessary cesarean.
If I could redo my first birth and I had the knowledge I have now, I would have used hospital-based midwives. Certainly I was not psychologically ready for a home birth (way too out there!), but using midwives would have most likely prevented some of the negative events that happened at the birth of my first daughter. I think my doctor did a good enough job, but the potholes that are systemic with obstetric care in the hospital did leave gaps that had a negative impact that were potentially preventable.
For my second birth, I was searching for a different birth experience (and overcoming some residual trauma from the first time around). La Leche League was a big part of my life and I was exposed there to women who used midwives as their birth attendants. This type of exposure made it possible to envision different possibilities.
I interviewed several midwives, but I also interviewed OB’s (all of whom were women, which now makes sense to me in terms that I must have been searching for a midwifery experience – which actually has less to do with gender and more with philosophy – but I think that was what was unconsciously motivating my choices for interviews). Right when I got pregnant again, I was interviewing another OB. She seemed really great and the labor and delivery nurse had recommended her. I hadn’t yet found a midwife that I felt comfortable with, so I began that pregnancy with an OB again.
This all changed a couple of months down the road, when the OB and I were chatting about breastfeeding and she said something that really bothered me. Our philosophies did not line up and I felt like this extended down the line to birth on a deep level. I really wanted the health care provider I worked with to be more aligned with what I believed and valued, in addition to having the clinical skills.
I was also feeling uncomfortable about the idea of delivering in the hospital again (this was for a number of reasons which I won’t go into in this post.) A friend gave me another name of a midwife who delivered at home. My husband was really reticent to do a home delivery, but agreed to meet this midwife (and her partner) with me. When we met, I literally had this intense energy enter my heart – it was like falling in love. The safety issue was a big issue for my husband, and he was reassured by both midwives' no-nonsense attitude and their training for emergencies. I felt completely reassured by their ability and aligned as far as philosophy for both birth and breastfeeding. This was a much better partnership for us.
So, that was how we ended up with a planned home birth with midwives for our second child. This was a wonderful birth experience that I would want every family to have. I feel extremely thankful for it.
I don’t think everyone needs to have a home birth in order to have a good birth experience. That was just part of my journey. However, I do want you to realize that as a parent who you choose as your birth attendant and where you give birth are two of the most critical decisions you will make regarding your child’s birth.
Important concepts I've learned as a teacher, doula, and as a parent about choosing a birth attendant:
Your choice of birth attendant is most often influenced by your culture and the environment around you (like your friends and family.)
Studies show that in societies with the best birth outcomes (and that happens to not be the U.S.), midwifery care is the dominant model of maternity care. In these societies, the health care system will not cover the services of an OB for a healthy, low-risk pregnancy.
My class statistics as well as experiences in the birth room echo what is known about maternity care outcomes and choice of a maternity care provider. Using midwifery care greatly increases the likelihood of a natural delivery and more satisfaction with the birth experience. A number of my student's births with midwives would have likely been cesareans if they had chosen an OB.
We make our decisions about maternity care providers on what feels familiar to us – what seems the safest. As human beings we rarely make decisions based on facts – we are emotional creatures by nature.
Sometimes, our choices are limited by life circumstances – sometimes this is financial, some times this is mindset.
It is crucial that your trust your provider and you feel safe with this person(s).
To do what you can to have a supported and integrated birth experience and to minimize the potential for a traumatic experience, it is important that you (and your partner) really take a good look at how you came to choose your maternity care provider and delve into what your options really are. Many people put less effort into the search for their maternity care provider than they do when they need to buy a new gadget. However, this decision is so much more important. It has a life long impact for your family. Ask yourself these questions:
How did I come to choose my maternity care provider?
What am I basing this choice on?
What do I really know about the different choices that are available to me?
What is it about my provider that makes me feel safe?
How is it that my provider is giving me individualized care?
How does my provider view the birth process?
What training/skills does my provider have that will help me have a natural delivery and a good birth experience? Is this their area of expertise?
How often does a natural delivery happen under my provider’s care?
What does my provider believe about what a baby experiences during the birth process?
What happens in my appointments with my provider that will help me have the best pregnancy and birth experience? Do I feel satisfied with these appointments and our relationship?
What am I willing to do to help create the conditions for optimal support and the best outcome for my child’s birth?
Keep an open mind about what you need to do to have an optimal start to your new family life. Be willing to question your belief system and figure out what will be best for you – not your mother, your sister, your best friend, your neighbor down the block, or the last blogger you read on the internet. Don't be afraid to make a change if circumstances do not feel right. Your body is your barometer of felt safety - it never lies to you about how you are feeling about your provider.
If your options are truly limited as far as provider – well, this is a really common scenario. A lot of the time people don’t realize they have choices, but there are situations where circumstances truly limit some of our choices. If this is so, there are still some choices you can make about other aspects of your preparations for the birth of your child.
No matter the situation, your education and preparation are paramount. You don't live in a society where natural, supported birth is the norm. So, you must ask yourself what you can do to create the supports you need for a good birth experience - one that closely aligns with the natural processes and that will help you to succeed at breastfeeding. Deeply and thoroughly educate both yourself and your partner. If you are in a less supportive environment or with a provider that statistically lessens your chance for a natural delivery, then making sure your partner is trained to help you is essential. I cannot over state this. Preparation needs to be done on a physical, mental, and emotional level. I think spiritual, too – if this applies to your belief system. If your partner is not willing to do this, then please consider hiring a doula - for your sake and for your baby's. Both preparation and support are the keys for an optimal birth, no matter who your provider is.
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