The Educated Parent: Choosing a birth attendant
By Amy V. Haas, BCCE
It’s exciting to find out you or your partner are expecting a baby. One of the first choices a woman has to make is who will care for her during the pregnancy, and attends her during the birth. Many women simply continue going to the Gynecologist/Obstetrician that they have previously been seeing. However, this may not be the best choice when it comes to the birth of their baby.
Choosing a Doctor or Midwife to care for you during pregnancy can be one of the most difficult decisions a family can make. We are all told we need proper prenatal care during pregnancy. In fact it seems to be looked at as yet another of those “magic pills”. Get good prenatal care, and all will be well. Unfortunately, prenatal care is not magic, and can be very limited. It is up to us to be proactive in our health care and that of our babies.
“Trust Me!”
“I trust my Doctor to do what is best for me”, says the average pregnant woman. As well you should be able to! However, you must all be aware of your doctor’s training biases, focus & limitations. Most women blindly trust their doctors to do what is best because they feel their doctor would not recommend a medical intervention unless it was medically necessary and safe. Conversely, if a woman requests medication for the pain, she trusts that her doctor will tell her if it is not safe. What most women do not think about is that obstetricians are highly trained surgeons who specialize in medically managed labor and delivery. They believe it is their job to accept the risk for the patient. Research done in 2018 shows that even a doctors attitude toward vaginal births can raise your chances of having a medically unnecessary cesarean .
It can become a cascade of medical interventions with serious risks that were probably not necessary to begin with. What most women don’t realize is that, if they are healthy, they rarely need medical interventions during birth, and that the interventions themselves can create additional pain and risk. Even women who do not want medications will usually end up with them because that is what doctors and hospitals do.
[Note: The American Congress of Obstetricians and Gynecologists recently issued a statement regarding patients right to refuse interventions. You can find a copy here.]
So how should a woman choose her care- provider?
First, find out which care-providers best fit your birth philosophy. Get recommendations, and interview them. Contact your local birth network or childbirth educator. Studies show that Midwives are the experts in normal natural birth. Just be aware that they may also be medically oriented if that is the only experience and training they have. However, the countries that have the lowest infant, & maternal morbidity and mortality statistics are those where the Midwifery model of care is practiced. You can also investigate the option of using a Family Physician who attends births.
Schedule a get acquainted visit with each care-provider you are considering. Take the time to do your research and create a list of questions. Or just use the one from the Coalition for Improving Maternity Services (CIMS), called “10 Questions to Ask”. A copy can be found on the CIMS website: http://www.motherfriendly.org/downloads
Be aware of your legal rights, but take steps to prevent situations that place you in an antagonistic position with your care provider. No one can force a procedure or medication on you if you do not want it. Interventions are only medically necessary about 20% of the time for low risk moms, but are administered more than 80% of the time. They must have your consent to even touch you. They also can not threaten to kick you out of the hospital if you refuse their recommendations. Choosing the right care provider to begin with – one who respects you – and making sure you are well educated about each test, procedure, or medication, can help to prevent an adversarial relationship. Be sure you are truly informed before signing consent forms.
And last, but not least, if you find that you feel your care-provider is not on the same page as you, then you have the right to change care-providers. They are not God, or dictators. They are your employee, and you need to choose one that respects you and your choices. Just be sure to be well educated so that you can have intelligent and informative discussions that help you make the decisions that are right for you and your family.
Recommend reading:
Born in the USA by Dr. Marsden Wagner
Creating your Birth Plan by Dr. Marsden Wagner
Local Resource: Rochester Area Birth Network www.rabn.org
Amy Haas has been a childbirth educator, writer, consultant & lecturer in the field of pregnancy and birth for almost 20 years. She often writes for Midwifery Today, and is the Education Chair for Rochester Area Birth Network. Visit her at www.healthybirth.net
References:
Wagner, M.; Born in the USA Univerysity of California Press, Berkley & Los Angeles California; 2006.
Wagner, M., Gunning, S.; Creating Your Birth Plan: The Definitive Guide to a Safe and Empowering Birth; Berkley Publishing Group, NY, NY; 2006.
Having a baby? 10 Questions to Ask – CIMS (Coalition for Improving Maternity services) – http://www.motherfriendly.org/downloads, 2000
White-VanGompel, et al; “Do provider attitudes influence cesarean delivery rate: a cross-sectional study” BMC Pregnancy and Childbirth 2018; https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1756-7#Sec13
[As seen in the May 2015 issue of Natural Awakenings]
[This is an excerpt from a future publication: Haas, AV; Healthy Babies! Healthy Moms! A Practical Guide to Preventing Problems during Pregnancy, Labor, and Birth , 2016]
Amy V. Haas© 2015
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