The national percentages for c-sections, episiotomies and inductions are somewhat relevant to the way your birth will be handled. But far more relevant are your doctor or midwife’s statistics for these things. Even your hospital or birthing center statistics are less significant than the philosophy of your particular care-giver.
Hence the advice: make sure your care-giver’s philosophy matches your own.
But how can you assess the “philosophy” of a care-giver when you’ve only just peed on the stick?
Most of us would like a safe, uncomplicated, wonderful (or at least tolerable) labor. But right out of the gate, how do we know the difference between a doctor who uses a doppler to monitor low risk births and one who insists on continuous monitoring throughout, regardless of what’s happening? Even midway through pregnancy, most women are still adapting to the life of a vessel, not yet able to take on the distant challenge of childbirth.
But choosing the right (or at least not completely *wrong*) care-giver is an important decision. Dawn Meehan explains just why in her great piece up on Babble this week. I recommend reading it if you’re at all unsure about your care-giver or if you’re at all unsure about why it matters so much that you have someone you like and trust.
Here are some tips to help you think about what kind of care you’d like. Without getting too heavily into the birthing wars (home vs. high tech, etc.), I have focused here on things that can be harder to assess by newly pregnant women; things like philosophy or care and mode of communication. (I’ve left out some logistics but be sure to check: insurance, office location and hospital affiliation.)
1. Look for a labor management style that feels right to you.
“Active management” of labor means that technology is used often and with enthusiasm. The M.O. is, we have all this great stuff — let’s use it! “Expectant management” involves only using procedures and medications if something arises that would require them. Under this model of care, birth is normal and works almost all the time. So support it as best as you can, then intervene only if necessary. You can ask your care-giver where they fall on the spectrum between extremely active management and a more “natural” approach. Your ideas about birth may not fit neatly into one or the other category but that’s OK. Though the controversy around birth always seems to pit medical against natural, there are many women and care-providers who can see the benefit of both approaches. The more open your care-provider, the more options you may have come time to deliver.
2. Don’t forget about midwives.
They are an excellent option for many women. Midwives often take insurance, handle all prenatal care and work in conjunction with back-up obstetricians should a c-section be necessary.
3. Get statistics.
Ask about your midwife or doctor about his or her rates for episiotomy, c-section and labor induction. If you are low-risk, ask about their statistics specifically for the low-risk deliveries. Routine episiotomies — the cutting of the perineum to create a larger vaginal opening — are no longer recommended. The c-section rate is over 30% in most of America; it should be closer to 10-15%.
4. Find someone who listens.
Does your care-provider really listen to your concerns? Well, there’s only one way to find this out and that is to express them. Though midwives are generally trained to take a more well-rounded approach to prenatal care by spending more time with women and listening to their particular hopes and fears, this isn’t always the case. They can be as rushed or burned out as a high-risk obstetrician at a busy hospital. Conversely, a conservative doctor at a busy urban hospital may be very good at answering questions and offering important reassurance. The bottom line is that your care-provider makes you feel good and safe. Does your midwife or doctor tell you very clearly the risks, benefits and alternatives to various procedures? You shouldn’t have to fight for this information. Trusting a care-giver can actually help your labor progress!
5. You can always switch care-providers.
Even at the end of pregnancy, this is sometimes possible (though the sooner you decide, the easier it is to find a new provider). It can be hard to “break up” with a doctor. One way to avoid too much anxiety-producing confrontation is to write a thoughtful letter and send it in. You don’t have to explain everything — just let the doctor or midwife know you’re grateful for the care you’ve received but for a few personal reasons, you’ve switched and you need your medical records transferred. Or you can be specific if there was something that really irked you. Whatever you want. The point is: this is your birth. Don’t do it with someone you feel bad about because you’re nervous about confrontation. Speaking up on your own behalf is important now, and very good practice for when you are a mother and will often be speaking up on behalf of someone.
6. Ask who will likely be there for the birth.
You may suddenly find your lovable trustworthy doctor only delvers on Mondays. So, find out how back-up care works and if possible meet the other doctors or midwives and meet them. You may not love all the practitioners equally. But if there are doctors or midwives you really feel horrible about, that’s a concern worth addressing.
7. Think about a doula to help support you in labor.
This is especially important if you intend to go for a non-medicated birth. Ask your care-provider how he or she feels about doula support.
8. Advocate for yourself.
Use this opportunity to practice your own skills at communicating with a care-provider and advocating on your own behalf. If an answer doesn’t make sense to you, ask again. If you get confused in prenatal check-ups, bring someone along or take notes. I have written books and taught classes and STILL sometimes find myself getting dazzled and dazed when my doctor starts talking. I’ve trained myself to say things like, “I’m sorry — can you explain that again? There were a lot of unfamiliar terms and I’m having a hard time keeping up.” It’s up to you to get this info. Doctors and midwives can be intimidating. They are “authority” figures. But you are the one who will be giving birth and doing the work here. Your care-provider is there to help. But it’s your birth.
photo: Matt Carmen/flickr