Choosing Your Birth Attendant

 
If your desire is to create a positive birth experience for yourself, and a gentle birth for your baby, finding the right birth attendant for you is essential.  Your birth attendant, whether you find a doctor, midwife, or a group of doctors and midwives, are the people you choose for your birth team who will monitor the medical wellbeing of you and your baby in pregnancy and birth.  When seeking out the right practitioner for your team, it is key to ask good questions.   Hearing responses that feel compatible with your preferences, and having clarity in your understanding of your chosen practice’s style of care will ensure that you are working with a well-chosen birth attendant.  This will contribute significantly to your feeling safe and secure at the time of your birth, and will support your ability to trust and be open to the process of labor.  It is of the utmost importance to know that you have chosen a practitioner in whom you are comfortable placing your trust.  You will find security in knowing that your birth attendant is respectful of your wishes, and willing to include you in the decisions necessary for yourself and your baby.  Following are some sample questions that may help you make your decision in choosing the right doctor or midwife. 
 
At what facilities do you have privileges?
Some doctors and midwives practice at more than one facility, and where you are to deliver may depend on where the person on call is at the time you go into labor.  Be sure to interview each facility as thoroughly as you do your doctor or midwife, as birthplace policies may vary widely.  Some homebirth or birth center midwives also have hospital privileges in the event of an emergency, some may work alongside doctor practices that are willing to provide hospital services when necessary, and some do not, making it necessary for you to make your own contingency plan. 
 
 
 What will happen during a typical appointment?  What tests or procedures do you normally recommend in pregnancy?


Every practice has different guidelines and recommendations for standard procedures during routine prenatal care. It is important that you know what will happen in typical appointments.   Regardless of what testing your practice may recommend, it is important that your practitioner is willing to thoroughly explain each test to you, discuss with you the risks and benefits of each, and explain which tests are considered optional.  Now is the time to feel out what your practitioner’s response may be should you choose to decline testing or seek alternatives. 
 
How much time do you allow for each prenatal visit, and how long is a typical wait in the waiting room?


This may not be a question you even need to bring to your practitioner. Look around the waiting room and ask women who are well into pregnancy how long they usually wait. If your stress level rises at every visit because the wait is making you late for the next part of your day, your pregnancy will not be enhanced by this experience.  Knowing also that you have adequate time to ask questions and understand what is going on with your body and your baby will increase your satisfaction with how you feel about your pregnancy and your provider.  Office schedules vary widely, with some docs allowing seven minutes for each visit, and others allowing as much as an hour.  Find out what your practitioner’s policies are. 
 
 
What pregnancy books or websites do you recommend I read?


Educating yourself about your birth options is a necessary step in creating an empowered birth. Practitioner’s styles may vary widely when it comes to advocating that his or her patients educate themselves. Some have lending libraries in office, while others may believe that a mother is best off doing as she is told.  Your doctor might have a recommended reading list that is readily available.  If so, look it over and see if he suggests any books or websites that you have already found and like. 
 
 Do you recommend any specific childbirth classes?


There are a myriad of choices available to consumers when it comes to childbirth class options.  Some doctors and midwives insist on only one method, and if so, it is important that this is one that one that feels right to you.  Some practices advocate hospital-based classes only.  Some hospital or birth center classes are supportive and informative, taught by certified childbirth educators,  and others are classes taught by hospital staff on “how to be a good patient”.  Others may suggest out-of-hospital classes that they consider good, and may even know instructors in particular that they recommend.  Knowing that your practitioner speaks the language of whatever method you choose will help ensure that everyone is on the same page at your time of birth.
 
 
How regularly do you attend births with doulas?  Which doulas have you worked with? Who would you recommend?
 
Using the services of a professional labor doula has been shown to significantly reduce the likelihood of a mother having a cesarean birth. Women who use doulas report experiencing less pain in labor, and typically express greater satisfaction with their birth, regardless of the use of necessary interventions. A good doula is an asset to your support team, and if you are choosing to birth with a doula, then finding a doula-friendly practice is essential.  If your doctor or midwife has a doula that they work with often, or even have a doula on staff with their practice or their hospital, this is even better! You may wish to avoid practices that discourage doula care.  Some practitioners have been known to say that doulas are unnecessary, or that your doctors and nurses will provide the same services as any doula would. This is not possible.  A doula’s training and expertise is specifically in the non-medical support of the physical and emotional experience of labor and birth. She is trained to work alongside – not in conflict – with the medical care providers on your team.  Find a practitioner who will support your right to have excellent labor support.  You might consider asking your doula who she recommends. 
 
 How will you encourage me to manage and cope with the intensity and discomfort of labor?
 
 Doctors and midwives can offer a host of options for pain relief including medication such as narcotics and  epidural anesthesia.  Some may be very supportive of keeping you up and moving to ease birth, and are willing and able to provide access to a shower or tub.  Others may advocate partner and doula support for massage, encouraging words, and effective non-medical relaxation techniques. (As a doula,I have a fond birth memory of a doctor who sat on the bed next to a laboring mama and said, “I’m your doctor. I know medicine. If you’re asking me what to do for pain, I’m going to talk to you about what I know. I’m happy to do that, but you’ve told me that you don’t want that, and that’s ok with me. You have a doula and your partner here who can get you through this without medication, and I think I’m going to step away now and let you have this conversation with them.”)
 
 
What role will my birth partner play?


It is standard now for a father or partner to remain with the laboring woman throughout labor and delivery, although the amount of participation varies. Ask if he or she is welcome at prenatal visits and whether he or she can stay with the mother in the event of a cesarean, or if they may stay with the baby in the event that nursery care is needed. Some hospitals consider doulas to be visitors, and others may not, allowing your doula to remain with you in addition to your partner. Find out what the boundaries are at your birth facility for having your doula remain with you. 
 
What do you recommend for normal pregnancy aches and pains?


There are many common discomforts associated with pregnancy, and many can be relieved with simple non-medical remedies.  Perhaps  you have found a practitioner who is willing to talk about these comfort measures.  She may recommend chiropractic care, homeopathic remedies, and common-sense solutions, or her answer may be written on a prescription pad. If limited medication is important to you, it is significant to learn where your practitioner’s style of care falls, as well. 
 
 Will you be my attendant at the time of my birth? If not, who will be there with me? Who are your back up practitioners? Will I meet them before my birth?


It is important to know who will be in the room with you at the time of your birth. Even if the possibility of another practitioner is remote, you may be more at ease knowing who might be there during your birthing time.  Some practices share on-call schedules with all doctors in the practice, some have one-on-one relationships between doctor and client, and others share their responsibilities with other practices.  Some hospitals have laborists who attend all births, regardless of what practice you have seen during pregnancy. If you should choose to hire this practice, will you know who will be at your birth? 
 
 
What interventions do you routinely recommend in labor?


There are no routine interventions that have been proven to be necessary in every labor or birth scenario.  There are practitioners who may have preferences for some interventions to be used routinely, and it is important to learn this long before having this conversation in your birthing room.  (I once heard a doctor exclaim to a mama, “But hardly anybody’s water ever just breaks on its own.”  This was hardly a surprise, given that rupture of membranes is typically the first thing she does routinely at the time of admission into the hospital.) Informed consent is a must in any birth situation, with each intervention being considered on an as-needed basis.  By having these conversations in advance, you may be sure that you have found a practitioner who will involve you in your own care.
 
 At what point do we talk about the artificial induction of my labor?

Induction of labor may be necessary when the medical facts show that your baby would now be safer on the outside than on the inside.  However, induction for a myriad of reasons may vary widely from one practice to another. Some doctors will recommend induction if you are one day past your due date, while others are willing to wait a full two weeks past that point as long as mother and baby are healthy and well. Some will suggest induction after one minor concern, while others will insist first upon further testing to confirm that all is well before going the induction route. Your doctor or midwife should also be willing to discuss their recommended method of labor induction, taking the time to explain the options you have and the reasons for each step along the way. 
 
 What are your vaginal birth rates? At what point do you recommend a cesarean birth? For first time moms? For moms who have had previous cesarean births?

Let your doctor know that you are committed to having a normal birth, and ask questions about the likelihood of this happening.  Be sure to ask specifically about Vaginal Birth After Cesarean (VBAC) if you have previously had a cesarean birth. This is another area where standards of care vary widely. Some practices are willing to allow for a trial of labor only if labor occurs spontaneously before a specific date, such as “before 39 weeks.”  Some doctors advocate for a c-section if labor progress seems to have paused for an hour or two, where others are willing to allow more time as long as mother and baby are fine.  Some practices or birth centers or hospitals have specific time limits for pushing, allowing “two hours for a first baby, one hour for a second baby” before a cesarean is ordered, whereas others are willing to continue as long as mother and baby are doing well. It is important to know in advance what your practitioner’s guidelines are. If you are planning a home birth or a birthing center birth, knowing at what point transfer to a hospital would be considered necessary is also important. 
 
What is your rate of episiotomy?  Forceps birth? Use of drugs and anesthesia? What percentage of births in your practice are unmedicated?


 Many practices keep their own statistics on these aspects of birth. These statistics can help you in comparing practices by indicating the amount of intervention during a typical childbirth with this midwife or doctor. Some may avoid answering these questions directly, by saying that they do the procedures only as necessary – the definition of necessity, however, can vary widely. There’s no harm in asking for specific numbers or a “best guesstimate”. Remember, you are the consumer choosing to pay for these services, and you have the responsibility of knowing what to expect. What are your chances of beating the odds if half of their births are cesarean, or if most births “require” episiotomies? On the other hand, there are many practices who no longer use routine episiotomy at all, and perhaps you have found one. Don’t wait until your baby is emerging to find this out – ask now. 
 
 
 If  I have a question, who do I call?


Some practices have a dedicated “warm line” that their mamas may call any time of day or night.  Some have nurses in the office who will return calls during the day, and some doctors and midwives have a “phone hour” planned into their daily schedule. It is important to know what you can expect your experience with your practice to be. 
 
Are there any special risks that I should be aware of with this pregnancy? Do you recommend that  I change my diet?  Are there other lifestyle changes that I need to be making?


Your doctor or midwife can be a treasure trove of information that will assist you in having the happiest and healthiest pregnancy that you can.  The more you ask, the more she can offer. Don’t just ask the internet – ask your doctor!
 

 It is unlikely that all of the above will be answered in one fell swoop on your first visit.  I encourage you to ask the questions that are most important to you at your first appointment, and if you are reasonably comfortable choosing this practice for your care, continue asking more questions at each appointment. If you feel rushed or intimidated asking questions, or if you get the sense that asking questions is unwelcome, it would be unwise to think it will be any different several weeks down the road when you want to know about concerns regarding your pregnancy or wish to discuss your hopes for your birth. Remember that you deserve to be treated with respect as an active participant in your own pregnancy and birth.  A good practitioner will welcome and encourage this.  Even if you are just now learning this later in your pregnancy, there are many good practices who are willing to take on a new patient, even if you are quite far along. Find one! Ask your friends, your doula, your childbirth class teacher,  and your community members who are happy with their births who they chose and why.
On the other hand, if you find yourself getting more excited about the pregnancy as you speak with your midwife, and if your doctor inspires your confidence and trust more at every visit, congratulations! This will be an excellent care provider for you! With this step, you can have the confidence of knowing that you are well on your way to creating a positive birth experience.

One thought on “Choosing Your Birth Attendant

  1. I had no idea that using a doula has been shown to reduce the likelihood of a c-section. My wife is about 3 months pregnant, and we had heard that using a doula could be beneficial, but I didn’t think much of it. Someone else mentioned using a professional labor doula helping reduce c-sections like you did, and I think that would be something both my wife and I would love! Thanks for the info!

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