Choosing a maternity care provider is a more significant decision than you might think! In fact, who you choose can greatly influence the course of your pregnancy, birth, and postpartum experience. For so many reasons, a provider's philosophy directs the options that they give you, right down to how they handle variations of normal during pregnancy to what position they want you in to have your baby. Doctors and midwives carry their own expectations for birth. A provider’s idea of what an “ideal birth experience” looks like may not match yours.
Choosing the right maternity care provider is especially important these days, given the limitations, changes, and unknowns that pregnant people are facing due to the COVID-19 pandemic. Across the nation, pregnant people are adjusting to Telemedicine prenatal visits, online childbirth education courses, and virtual doula support on FaceTime. For those giving birth in the hospital, the COVID-19 related restrictions in place that limit the number of support people allowed in a birthing room can cause a lot of anxiety & disappointment. It’s a tough time to be pregnant, but you’ve still got options! Continue reading to find out more….
What are my choices? What kinds of maternity care providers are there?
Many pregnant people feel their only choice in a maternity care provider is a hospital-based OB/GYN (Obstetrician/Gynecologist). However, this is not the case for those with low risk pregnancies! OB/GYNs do offer services for low risk pregnancies, but they actually are trained surgeons who specialize in more complicated, or higher risk cases (they are the specialists who perform Cesarean section births and other complex surgeries). The services provided by an OB/GYN are not necessarily the best option for someone with a low risk, healthy pregnancy.
If you’re someone with a low risk, healthy pregnancy, you may want to consider working with a midwife. Midwives are trained in normal, physiologic birth and they tend to view health care as a collaborative process. In the United States, we have two primary “types” of midwives: Licensed Midwives (LMs) and Certified Nurse Midwives (CNMs). Licensed Midwives provide home birth and birth center services. Certified Nurse Midwives typically work in hospitals, but they can also serve those desiring to birth at home or in a birth center. Working with a midwife lessens your chance of having an episiotomy, vacuum/forceps delivery, and Cesarean section birth while increasing your likelihood of successfully breastfeeding and being satisfied with your birth experience.
One option for out-of-hospital birth is the Santa Fe Birth Center. During an interview with SFBC’s Clinical Director Rebecca Palak, she explained that the midwives at Santa Fe Birth Center value support people and doulas throughout the birthing process and encourage their clients to have both. They follow the midwifery model of care, which includes hour-long prenatal and postpartum visits, in order to foster a relationship and for clients to feel comfortable in the birthing space. Once your baby is born, they offer the one-day postpartum visit at home. They also promise inclusive, individualized care from pre-conception through birth, postpartum, and well-person visits. They offer regular tours and welcome questions.
Another option for low risk pregnancies is home birth. Wildwood Midwifery is one of several home birth midwifery practices in Santa Fe. Wildwood Midwifery offers comprehensive prenatal, labor, birth, and postpartum care. Appointments are hour-long, and take place in the comfort of your home. Lucy French, owner & primary midwife at Wildwood Midwifery, finds that families tend to birth and parent with more confidence when they understand their choice and make informed decisions. Her goal is to facilitate this process by providing thoughtful, un-rushed prenatal and postpartum care. Lucy offers free consultations for anyone interested in home birth and midwifery care. Like the Santa Fe Birth Center, she values and encourages families to have support people and/or doulas during the birthing process.
Sometimes we don't have the luxury to choose our providers, whether for financial, medical, or other reasons. If you find yourself in a scenario where you desire a home birth, but your health insurance doesn’t cover that option, then your choices may become more limited. If your pregnancy is complicated and requires medical intervention, you may need to be seen by a specialist who you didn’t originally choose to work with. However, if your pregnancy is healthy and low risk, you certainly have options to choose from.
How do I choose my provider? How do I make the best choice for myself?
The process of choosing your maternity care provider can begin with figuring out your desired place of birth. Do you want to have your baby in the hospital? At home? In a birth center? Once you’ve selected your preferred birth setting, your provider options are automatically narrowed down to choosing someone within that scope. Ask trusted members of your community for recommendations, and be sure and come up with a list of questions to ask during a consultation or initial visit. Set up interviews with midwives and schedule a tour of your local birth center! Be thoughtful about who you choose, and pick someone who resonates with your preferences and philosophy.
What about the COVID-19 pandemic? How does that impact my choices or decision making?
As you consider who you want your provider to be and where you want to give birth, you may be wondering how the COVID-19 pandemic will alter the course of your pregnancy, birth, and postpartum experience. Many pregnant people across the country are choosing to give birth at home or in birth centers because of hospital restrictions and the potential increase in exposure to the virus in a hospital setting. Others are continuing with hospital care because that is where they feel safest. All reasons are valid - just remember that most of the time, you have options. Many home birth and birth center midwifery practices are open to working with families who decide to switch from hospital care quite close to their expected due date, for example. The best course of action is to ask questions and do your research.
Here’s a preliminary list of questions to ask a provider at an initial visit or consultation. Keep in mind that this information may change throughout your pregnancy.
- What kind of protocols does your practice have in place to help minimize the spread of coronavirus?
- What can I expect for prenatal visits? Do you offer in-person visits, or will they primarily be virtual through a Telemedicine app?
- How many support people will I be allowed to have in labor?
- Do you offer rapid coronavirus testing when I go into labor? What happens if I test positive? What happens if I test negative?
- What kinds of requirements do you have regarding mask-wearing in labor? Will I have to wear a mask when I’m in labor? Will my partner have to wear a mask?
- What kinds of protocols or requirements do you have in place once my baby is born? Will I be restricted from holding him/her for any reason?
- What is your policy on skin-to-skin contact and breastfeeding given the COVID-19 pandemic?
We know there is a LOT to think about right now and a LOT of information out there. Always remember that it's your body, your baby, and your birth experience. Where and with whom you give birth matters. Take time to consider who will offer you the best choices for you and your growing family.
Please let us know if we can support you in anyway during your pregnancy.
*This post is co-written by Licensed Midwife Lucy French and Nurse-Midwife Shabd Simran Adeniji. Thank you for understanding that this guidance is based on professional experience and should not be considered fact.