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Introduction:

After our exciting morning at the Improving Birth – National Rally for Change rally in downtown Augusta, we had a few hours to rest before welcoming most of the rally attendees, as well as some brand new faces, to our evening meeting about Choosing a Care Provider. We had wonderful attendance, considering the fact that it was a holiday, and it was a lovely meeting altogether.

When we showed up at Earth Fare to set up for the meeting, we were surprised to see that they were closing one hour early for the holiday.  Thankfully we are all birth workers and can be very flexible with last-minute changes and our second half of the meeting, mostly mingling and visiting, can just as easily be done outside as inside and the weather was particularly beautiful that night. It all worked out perfectly.

Our speaker on Monday was Ashley – a local birth activist and soon-to-be postpartum doula/Childbirth Educator – who has personally experienced care by three different types of care providers. She planned a home birth and had prenatal care throughout her pregnancy with a Certified Professional Midwife (CPM) who attends home births. She also had backup care from a Certified Nurse-Midwife (CNM) at a local hospital, just in case, and saw an Obstetrician (OB) a couple of times as well. During her labor she had a very necessary transport from home and experienced care during labor from the CPM, the CNM, and from an OB.

Choosing a Health Care Provider in Pregnancy

The first step in choosing a care provider is to know what kinds of providers are available in your area.

  • Obstetricians (OB) are trained surgeons who attend to pregnant women through their pregnancies and births.
  • Family Practice Doctors can also attend women through pregnancies and births and are not trained surgeons so they would need to call in an OB if a c-section was needed at any point.
  • Certified Nurse-Midwives (CNM) are trained nurses with additional studies in midwifery. Most CNMs deliver in hospitals and are affiliated with an OB.
  • Certified Professional Midwives (CPM) undergo rigorous competency testing by the North American Registry of Midwives in order to be certified. CPMs are independent practitioners who mostly catch babies at their clients’ homes and at birthing centers.
  • Direct Entry Midwives (DEM) are independent practitioners who are trained through midwifery studies, apprenticeships, and possibly a midwifery school or a college that is not part of a nursing program.
  • Licensed Midwives (LM) are licensed to practice in a particular area, normally a state. They can be CPMs or DEMs depending on the laws of the state in question.
  • Doulas are non-medical birth assistants who provide informational, physical, and emotional support. A doula can help you know when it’s time to call your midwife or leave to go in to the hospital. Doulas can also help with comfort measures during labor and birth. Doulas do not provide any clinical care and are hired in addition to one of the primary care providers listed above.
  • Pediatricians are physicians who specialize in the care of infants, children, and adolescents. Most primary care providers for pregnant women like their patients/clients to choose a pediatrician for the new baby before the baby is born.

When considering an Obstetrician (OB) – 

Typical questions that are good to ask:

  • What is your c-section rate?
  • What is your episiotomy rate/How many women under your care give birth with intact perineums?
  • What is your epidural percentage?
  • Are you board certified?
  • How much time do you allow for prenatal visits?
  • How many women under your care give birth in a position other than on their backs?
  • How many doctors are in your practice?
  • Are you on rotating call or do you see your own patients?
  • Can I meet the other doctors in your practice before I go into labor?
  • Have you ever seen a natural birth/What do you consider to be a “natural birth?”

Some red flags to watch out for when interviewing an OB are –

  • Using the word “try,” “attempt,” or “we’ll see.”
  • Saying, “I have to be able to get to the baby.” when alternate pushing positions are brought up.
  • Bringing up potential lawsuits or hospital policies/option to deny your wishes.
  • Time limits or restraints on what you can do.

Keep in mind that your OB might only come in at the very end of your labor to catch your baby. Planning to ask for a natural-friendly nurse when you go in and having a birth plan that your OB approved and signed ahead of time can help a great deal during your labor before your OB arrives.

When considering a Certified Nurse-Midwife (CNM) – 

Be sure to ask about:

  • Restrictions by the CNM’s attending OB or hospital – time limits, IV’s, etc.
  • Same questions you would ask an OB about rates and percentages.
  • Insurance coverage.
  • Can they attend the birth themselves? What happens if you need a c-section?
  • Have they ever seen a home or natural birth?

When considering an Out of Hospital Midwife (CPM, LM, DEM) – 

Ask about:

  • Number of births attended.
  • Rate of transfer and typical reasons for transfers.
  • Will she come with you to the hospital in case of transfer?
  • What types of medical issues will risk you out of having a home birth?
  • Has she delivered breech babies or twins?
  • Is she trained in Neonatal resuscitation (NRP)?
  • What emergency equipment does she bring to births?
  • What are her guidelines for a healthy pregnancy?
  • Does she have any references from previous clients?

When considering a Doula – 

  • Make sure your personalities mesh well.
  • Find out what services she provides, how often you meet prenatally, and if she has any backups available if she cannot get to your birth.
  • Is she willing to help facilitate the involvement of the father in the birth?
  • Does she offer postpartum assistance or does she have any suggestions for postpartum doula services?
  • Does she have any references from previous clients?

When considering a Pediatrician – 

  • What are their feelings on circumcision?
  • Do they understand how to care for an intact (not circumcised) boy?
  • How do they feel about vaccinations – are they open to having patients with selective vaccines or no vaccines?
  • How do they feel about breastfeeding and do they recommend an age of weaning or of introducing solids?

*With a pediatrician, just like with any other care provider, it’s most important that their views are consistent with your own so that they can support your choices and work well with you and your family.*

Special Situations: Military – 

We had some very informative side conversations about how things work with doctors in the military. For military mamas be sure to ask your doctor if he/she will come in to catch the baby, otherwise whoever happens to be on call will come in.

Military spouses have a great deal of freedom in choosing their care providers – more than many spouses think they have. If they aren’t happy with the military doctors then they can switch from Tricare Prime to Tricare Standard and then they’re covered to see civilian doctors.

If you are a military spouse, you do not have to agree to or show up for an induction. Just like any other civilian, you can request to have Non-Stress Tests done weekly on the baby from 41 weeks instead of scheduling an induction. If you’re doing well and the baby’s doing well, there’s no reason that you have to be induced.

That wraps up the meeting topic for this month!

Announcements: 

In other news: we have a new location for our first-Monday Birthing Connections meetings starting on the first Monday in November. Family Bible Church – located across from the Martinez Post Office – has graciously agreed to let us meet in their space. We are very excited about this new location because our current location has gotten rather crowded recently! Our Doula Teas will continue to be at Earth Fare on the third Mondays of the month for the time being. We are not affiliated with Family Bible Church or any other religious group.

Our Healing Circle meeting this month will be at the new location and this will be a sort of trial run with a smaller group of people before our big meetings move there.

We are also looking forward to our very first movie screening on September 20th! We will be screening the film Freedom for Birth at Augusta’s First SDA Church and we hope that you will be able to join us! The movie screening is free, but we do ask that you consider making a small donation or becoming a BirthNetwork National member to support our group so that we can continue holding community events like the Rally and the Movie Screening.

Thank you so much for your continued support!

~B.

For more photos from this month’s meeting, please see our Facebook Album.