Choosing a caregiver for your prenatal care, labor, & delivery is an important decision - one that will undoubtedly shape your entire birth experience. It's certainly not a matter that should be taken lightly.
The first thing to remember is that Midwives, OBs, and Family Practitioners are people. That's not rocket science, right? But it's sometimes easy to forget.
What this implies is two things:
1. Every caregiver comes to the table with a unique personality, perspective, and worldview. Every caregiver has had different experiences and types of education. As such, it isn't fair to say that "all midwives do such-and-such..." or "all OBs respond in such-and-such a way." It's not quite as simple as that. Certainly, there are generalizations about each group (that are largely true...), but each individual person is still going to have their own philosophy of birth.
2. Medical caregivers are not superhuman. They do not know everything about everything. They sometimes unknowingly give bad advice. They sometimes make mistakes. As such, it is wise to think critically about any information that they dispense. It is also wise to treat them with grace and respect (and to expect the same thing in return).
Now that we have those two points out-in-the-clear, here is some basic information about choosing a caregiver for your pregnancy.
Some pregnancy books will advise that you interview the doctor detective-style and ask about induction rates, percentage of C-sections, etc. While it's certainly acceptable (and it can be helpful) to ask these kind of questions, I don't think they are the best way to decide which caregiver to choose. Besides, (a) many doctors won't willingly offer up those stats (I'm uncertain if that is because the information is unknown, inaccessible, or they just don't want to share...) and (b) stats alone can be falsely reassuring.
Here's what I advise that you do over the course of your first few appointments:
After all those observations have been made and the questions have been asked, take some time to reflect on how you FEEL about that particular caregiver and his/her office staff. Often, your "gut" is right. If you feel small, silly, dismissed, or rushed when you go to your prenatal appointments or if something just doesn't seem right, it is 100% okay to switch caregivers. Even if you're already halfway through your pregnancy...or more.
If you're newly pregnant and looking for a caregiver, I recommend that you ask other new mothers in your circle. Start by asking about their birth experience. Find someone who had a beautiful birth - someone whose birth story you admire - and then ask who was there when they had their baby. That's a good place to start.
Or you could always have an unassisted childbirth...
YOUR TURN: How did you decide on your caregiver?
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* Image of pregnant woman from Lee Hansen Graphics
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I knew since I was 19 that I would never have a hospital birth by choice. A midwife was a guest speaker in a college course I was taking and her talk convinced me in less than 40 minutes.
For my first child, I had just moved to an area in California where there were too many homebirth midwives to interview. So we asked a student in my husband's grad program which midwives he and his wife used. We interviewed them and felt fine with them. The birth was amazing.
For our second birth, we were living in an area of New York State where there weren't any conventional options for homebirth. The choices were either underground midwives who mainly worked with the amish community or a doctor who we were friends with who attended homebirths of the "hippy" population. He was very hands off and was perfect for us. I did all my own prenatal care by reading Ina May Gaskin's books. I was a little concerned about having a male as an attendant, but although the birth was very different from my first, it was amazing as well.
Currently I live in New Mexico where there are tons of homebirth midwives. I happen to be friends with many of them, so I don't know how I would choose should I become pregnant.
REALLY great tips Stephanie- most first time moms are lost about this, I really liked the suggestions you gave. I did what you said at the end, found a woman (my sister :)) that had a birth experience I wanted, and then I went to her midwife (with my husband), and we really liked her. So- we went with her!
I picked the best OB I found. I didn't consider going any other way. She was definitely kind and took plenty of time with me. She is known for being an excellent doctor and person. Unfortunately, it never dawned on me to really ask questions about the actual labor and delivery. I just thought babies get delivered every day. This really can't be rocket science. Boy, do I wish I had known more then. But, what I really wish I had known is that you can take all the care in the world over who your OB is, but the people who are actually most involved in the delivery (the nurses)you don't get to pick them. My OB showed up after I'd been in labor for 10 hours. The nurse taking care of me didn't realize that I was even in labor...not sure what she thought I was doing screaming so much. By the time the doctor got there the nurse had already messed up quite a bit...not doing some things and overdoing others. It wasn't long before I was told that I had to have a c-section.
Next go round I'm looking for a midwife.
We really really want to do a homebirth for my second baby, but I am very discouraged by the prices. I wish that we lived in a country where home birth was covered by insurance, but the thought of $2000 for a midwife versus the $35 co-pay for a hospital birth is a big deterrent for me. Obviously, this is only my situation and my insurance. We are currently researching hiring a midwife in training (if anyone knows anyone servicing Northern California who'd be interested, contact me!). I had a great experience with my first birth in a hospital. It was attended by a midwife only, no doctor, and we had no medication and no real intervention (except for an annoying IV because I was dehydrated from throwing up). It's discouraging to believe in home birth and natural childbirth so much, and to be burdened by the lack of money to make those things happen.
I had both of my children delivered at the hospital with our family physician. All turned out well and I wouldn't change a thing.
For this pregnancy I'm going with a midwife. I'm fortunate to have a friend who is a midwife and asked her for recommendations. Happily there was a group nearby and I'm going through them. So far so good!
Great post Stephanie.
I went with a Family Practitioner that specialized in OB and I'm really happy with her. She's now my daughter's ped as well. She respects my decisions even if she doesn't agree with all of them.
A few of the main reasons we decided to use this doctor were...
She included my husband in all of our discussions (as he was at all of my appointments) which meant a lot to us.
Also she respected our decision not to vaccinate. We asked her about that early on in our pregnancy so that we would have time to change if need be.
I had assumed for years that I would use a midwife but where we live there aren't many so it was nice to find a doctor that was a good fit for us.
I tried, really tried, to find a midwife for my last pregnancy. One I didn't agree with, one didn't return my calls and another was moving. I ran out of time trying to find a midwife and decided to just stay with my OB.
I initially wanted a homebirth, but I was very uncomfortable with the main practice in my area that does homebirths and I was unable to find an independent midwife whose schedule was not full already. I instead found an amazing group of midwives who were extremely pro natural birth--but who only do hospital deliveries. I loved their demeanor, their philosophy, and their statistics on c-sections (practially zero). Looking back I am glad I was in the hospital, although it's not what I initially would have chosen. I feel I had the best of both worlds--I had a midwife and nurse with me my entire labor who could not have been more supportive of natural pain management and birth. I never once had to lie on my back in bed, but chose the positions I wanted to labor and birth in. I never once had a monitor hooked up to me or an iv, and I was free to eat and drink. I feel very blessed that way. The room had dim lighting, my choice of music, a laboring tub, and a shower. I honestly felt more relaxed knowing I was in the hospital and that there was medical help available if I did need it (which I didn't). This group of midwives has since disbanded (to my dismay) and I may consider a homebirth in the future. My hospital experience was not typical, and I fear that if I have a hospital birth again, I won't have it so easy the second time with my choices of pain managament, labor positions, etc. I was very fortunate to have midwives at the time who were on staff at a hospital. I never once saw a doctor for anything pregnancy or birth related. If I have a hospital birth again, I will still work with a midwife and I will hire a doula as well, just for the extra support.
I had an OBGYN with all three. It is just the thing to do, right? Most people don't even think about it, they just go to one. I was the same. Though last pregnancy I wanted to do a natural birth, with a doula and all that jazz... my health was so bad, I was sick, and weak and knew my body wasn't up for it. However, now that I'm getting healthy should it ever happen again I'd want to do a home birth.
My last experience in the hospital was just plain terrible. They took my baby from me and placed him in the NICU for jaundice, that wasn't that bad, and introduced a bottle to him. I'll never forget how the hosp. ruined my first few days with him.
Totally great post - and even then, you're not always prepared! my sister had what she thought was the perfect OB/GYN, who ended up making her have a caesarian (*for which she was completely unprepared) and her spinal tap (?) STILL hasn't healed up! so sometimes there are crazy "bumps" along the way!