© 2010, Carol Peterson, ICCE, CD(DONA) Erie, PA

Birth Journeys

Carol Peterson, ICCE, HCHI, CD(DONA)

Instilling Confidence in Birth Since 2004

814-899-7722  * cbecarol@yahoo.com

 

Where Do You Pitch Your Tent?  Selecting a Doc or Midwife For Your Birth

written by Carol Peterson, ICCE, CD(DONA).  September 2008 Newsletter.

 

Perhaps the most important decision you will make as you prepare for the birth of your baby is who will provide medical care during your pregnancy and birth.  Most first time moms underestimate the influence that a doctor or midwife has on a labor.  Asking questions is key to making sure that you have selected someone that supports and agrees with your view of birth.

Before jumping into questions to ask, it is important to determine in which camp you pitch your tent.  There are two camps: (1) medical management and (2) expectant management.

 

Medical management is based on the theory that labor and birth are medical events that are best managed from the very beginning.  These types of labors tend to have more intervention, with lots of monitoring, more frequent use of labor stimulating drugs (Pitocin), and usually a higher cesarean rate. 

 

Expectant management is based on the theory that labor and birth are natural processes best left alone, unless a medical problem arises.  As one would expect, these births are more "natural" with less intervention, monitoring, and a lower cesarean rate.

 

In which camp you pitch your tent is personal preference.  

 

If you lean towards birth as normal, then you need to find a caregiver that has the same viewpoint.  In most cases, as long as you are experiencing a low-risk pregnancy, a midwife may provide you with your best hopes for a birth with minimum intervention.  You may even find that a homebirth with a midwife best suits your needs. 

 

If you are more of a medical-management girl, or if you are experiencing a high-risk pregnancy, then an obstetrician may be your preference.

 

However, the choice isn't black and white.  There are some OBs that practice like midwives: slow to intervene, low cesarean rates, and low use of drugs to stimulate labors.  On the flip-side, there are some midwives that use interventions on a regular basis.

 

So, how do you choose, or how do you make sure that you've made a good decision?  The bottom line is that you need to ask open-ended questions, and listen very carefully.  Then, go with your gut.  If your gut is telling you that your chosen caregiver is not likely to support your birth, then you MUST make a change.  Don't ignore your gut instinct for fear of hurting someone's feelings.  Believe me, if you are with a large practice your departure will probably go unnoticed. 

 

I tell those in my class to ask three questions: (1) How often do you see unmedicated birth?; (2) Under what circumstances do you recommend using Pitocin to either start a labor or speed up a labor?; and (3) At what point during a labor would you recommend a cesarean?

 

The answer to these questions will give you a good idea as to which camp your OB or midwife pitches his or her tent.

 

Beyond asking direct questions to your OB or midwife, ask other girls about their birth experience.  This will often give you more valuable information than asking your OB or midwife.

Remember, your first birth will often dictate what happens with future births.  You owe it to yourself, and to your baby, to give him or her the best birth as possible.  This will often depend on your caregiver.