When a woman becomes pregnant and begins to think about the birth, she quickly realizes there are many choices ahead to make. “Do I want to use medication? Do I want a natural birth? Do I need a cesarean? What’s an episiotomy? What will this cost? What does insurance cover?” Pregnancy can seem like a daunting time of research and self-evaluation. And I’m not here to tell you it shouldn’t be. It’s in our maternal nature to begin thinking through these options to find out what kind of mother we want to be and what kind of children we want to raise. But I would like to offer what I believe to be the two most important decisions you’ll make when planning your birth: care provider and location.
When choosing care providers in America, the most common first step is to look at your health insurance plan to see which doctors are covered in your plan. Then you look at those who are closest to your home and maybe ask trusted friends for referrals. The problem with this approach, in my opinion, is that you may not be giving yourself the best chance at a satisfying birth experience. Not all OBGYNs and midwives are the same. Their methods of practice differ greatly depending on varying factors, such as where they were educated, how long ago they were in residency, and the group practice that they are connected to.
For instance, if your baby is breech (meaning not in a head-down position), you may have a hard time convincing a doctor who was never trained in how to deliver breech babies to help you with a vaginal delivery. Or if you would like to avoid an episiotomy (a surgical cut to your perineum during the pushing phase), you don’t need to see a doctor who routinely gives women episiotomies without discussing the procedure with them beforehand. If you find yourself with an obstetrician or midwife who does not align with your desires for birth, you can most certainly switch care providers. Even at the very end of your pregnancy, a switch can be made if you feel strongly against your provider. Having someone in the birth room whom you trust is vital in regards to your birth experience. If you do not feel safe, your pain will be maximized and you are more likely to experience trauma.
Your choice of location is equally as important. Do you want to birth at home, a birth center, or in a hospital? In America, the most common choice is hospital; but you can and should still consider which hospital in your area you want to birth in. Hospital policies absolutely affect the type of care you will encounter during your birth. Hospital protocols are strongly adhered to by nurses and doctors to avoid liability concerns. If the hospital has a rule, it will probably not be broken. Rules regarding eating and drinking, mobility of patients, types of monitoring, and timelines all work together to form the birth experience you are given.
I heard it once said, “Don’t go to a Chinese restaurant if you want barbecue.” You can’t expect anything other than what you’ve signed up for. If you are intent on any decision during your birth, you must ensure that you do everything you can to find a place and people who will support you in that decision and champion for you. Above all the many decisions you’ll make, your choice of care provider and location will most greatly affect the outcome of your birth. A trusted doula can help you to wade through the decisions and can give you referrals based on their insider’s view. Doulas are unique in that we see these doctors, midwives, and nurses in action. We get to study the hospital protocols and we (hopefully...I do, at least) make notes about everything during our time there. We can tell you more information than you will probably get during a prenatal visit.
Ultimately, I hope that you see that the choices you make are YOURS. You have autonomy over yourself and your birth. Claim your birth choices and go after the most satisfying experience you can. The birth of a child only happens once and is a powerful memory that transforms the rest of your life. You deserve to provide yourself, to the best of your ability, a safe place to birth and a trusted provider who will champion for your desires.