You’re pregnant with your first and checking out all your options. Or it’s your second or third baby, and you’re wanting a different experience than the last time around. Maybe no epidural, definitely not that awful Pitocin.
Where do you start, and how do you get the experience you’re looking for?
A lot of things about birth are out of our control, but one very important thing is not – your choice of provider. My number one piece of advice is to find a provider whom you trust implicitly and who is on the same page.
Based on your insurance situation and your state regulations (ex: Certified Nurse Midwives, CNMs, are illegal in my home state), you may be limited. Regardless, I encourage you to interview prospective providers. If you are a low-risk pregnant woman, here are some questions to ask and, maybe more importantly, answers to look for.
1. What is your policy for induction in regards to late-term pregnancy (after 41 weeks), macrosomia (big baby), and PROM (premature rupture of membranes, or water breaking before contractions start)?
In my experience, this is the most important question. Why?
Evidence. We have evidence that says that “big” babies are not helped by being born early (and ACOG now says the same!), and we have evidence that says that induction is not necessarily helpful immediately after water breaks. And we the evidence we have for induction in the 41st week is so thin that the risks of inductions need to be weighed against the “risk” of waiting.
If your provider does these things routinely, absent of other indications, she/he is not practicing based on evidence. Over and over again, I have seen women scared into unnecessary inductions. If you really want a natural birth, find a provider whose induction protocol matches evidence.
The key is to really listen to the provider’s answer. Does she skirt the question? Does he just say, “Well, it all depends on your baby. After all, we want a healthy baby, health mom.” Honestly, this answer is insulting. Obviously, you want your baby to born healthy and safe.
When you’re asking your provider these questions, you’re looking for evidenced-based, information-filled answers. You want your provider to act as a member of the team (of which you are captain!) and welcome you into the process of informed-decision making. For any intervention, the provider should use evidence to describe to you the risks, the benefits, and the alternatives. If he shames you for asking such questions, move on to the next interview.
2. Can you describe your philosophy of birth?
This is an open-ended question that might catch the provider off-guard, but the answer will be informing. Does he think that birth is a natural, physiological process, and he is a helper, almost a guide or a safe-keeper? Or does he think that birth is an accident waiting to happen? Something to be managed, almost like an illness. Listen carefully.
3. Do the other providers in your group share your philosophies and practice?
I’ve mentioned this before, but your provider’s group matters as much as the primary doctor or midwife herself. You never know who will show up when you’re in labor. Do the other doctors or midwives have the same philosophy of birth?’
4. How do you help women laboring without medications achieve their goals?
A provider comfortable and experienced with natural birth should be able to describe the ways the staff and hospital are equipped to help you labor. Listen for the provider to feel totally comfortable and glad to offer you these options – things like walking around, using the shower and tub, eating and drinking as you want, being monitored intermittently, etc. If she seems hesitant or talks about “allowing” you to do these things, it’s probably a sign that it’s not the norm in her practice.
Bottom line – look for someone you can trust without reservation. You know that they believe in normal, physiological birth and are on your team, keeping watch over you as you experience one of life’s toughest and most transforming moments.
Ladies, would you add anything to this list?
Lindsey lives on and loves the west side of Chicago with her husband Mike and her kids – Caleb, 4 and Lily, 3. She works part time as a doula and childbirth educator and is fascinated by birth. In winter she likes to bake with sourdough, and in summer she likes everything. In all things, she is covered with God’s grace.
