Choosing Your Care Provider

Your care provider and place of birth are two of the most important decisions you can make prenatally. Birth is an intimate and vulnerable time and choosing a provider you feel uncomfortable with can disrupt your birth process. Finding a care provider who is in line with your birthing values stacks the deck in your favor for a positive birth experience.

Learn to spot the warning signs of care providers that aren’t in line with your beliefs and preferences. Discover the difference between the Medical Model and the Patient-Centered Model and choose which options are best for you.

 

Place of Birth

First and foremost, birth where you feel the most comfortable and safe.

  • Home - Where you birth in the comfort of your own home with a midwife who oversees the safety of you and your baby, and brings along necessary life-saving equipment should an emergency come up. This is appropriate for healthy, low-risk people.

  • Freestanding Birth Center - A "maxi home," not a "mini hospital," these locations are buildings outside of the hospital that are usually run by midwives. They also have life-saving equipment and serve healthy, low-risk people.

  • Hospital - A good choice if you or your baby have health concerns that need a doctor's attention or if you will likely need medical procedures after birth. Also a good choice if you desire IV pain medication or an epidural. A hospital would be a great choice for you if you prefer having all that modern medicine has to offer quickly available.

 

Choosing Your Birth Team

The birth of your child can be one of the most amazing, challenging, intimate, and vulnerable experiences of your life. You will literally and figuratively be in the process of unfolding, opening, and falling apart in the most beautiful way. Choosing who will be present is a personal decision, and not one to be taken lightly!

Some people feel most comfortable surrounded by all their closest friends and family, while some want it to be just them and their partner. There is no right or wrong answer. Some people also hire birth professionals called doulas who can guide you through labor, birth, and life with your new baby.

If you choose a doula to help guide you through this important and special time, be sure you "click" and feel comfortable with that person as well.

 

Induction

Induction refers to using medicines and/or tools to start labor before it starts naturally on its own. While induction can be medically necessary for the health of you and your baby, some care providers promote "elective" (aka "not medically necessary") inductions. Like any other tool, inductions can be overused or used inappropriately, and it's important to weigh the pros and cons.

 

Cervical / Vaginal Exams

Internally, your cervix is the gateway to your baby between the vagina and the uterus. Using fingers, midwives and doctors can assess baby’s station (how high or low baby is), dilation (how open cervix is), effacement (how thin cervix is), and other markers.

This has no bearing on when you will have your baby or how fast baby will come! Cervixes can change quickly or slowly. Also, remember that it is your body and you have the right to accept or refuse any vaginal exams.

 

IV Fluids

Sometimes intravenous (IV) fluids are given during labor to hydrate you and/or administer medications such as pitocin, antibiotics, and pain relief. This flexible tube is inserted into a vein in your arm or wrist and can either be "capped" with a saline lock or attached to a bag of fluids.

 

Monitoring

Fetal monitoring tracks your baby’s heart rate in relationship to stimulus like contractions, tickling baby’s head, pressing on your belly, etc. This can be a (sometimes unreliable) way to assess how your baby is tolerating labor and their overall well-being.

There are several ways you can monitor your baby: Intermittently with a handheld dopper, or continuously with an external fetal monitor or internal fetal monitors. There are also intrauterine pressure catheters (IUPCs) that monitor the strength of your body’s contractions. Each one of these options comes with it’s own benefits/risks.

 

Eating and Drinking

The uterus is a muscle, and like all muscles it needs fuel to work efficiently. If you are dehydrated or starved, you may have a longer, more dysfunctional labor. Some hospitals restrict your diet to clear liquids once you start labor, but there are some risks involved. Weigh your options below.

 

Freedom of Movement

Being able to move during labor can ease the intensity of contractions, make contractions more efficient using gravity, and help baby wiggle down into the pelvis, making labor more effective.

If you are trying to remove a ring from your finger you don’t just pull it straight off, you wiggle it back and forth. It’s the same with birth. Using movement and gravity during labor can shorten and ease labor by giving baby lots of opportunities to move into the best positions for birth.

Head down is only the first step, learn more below!

 

Comfort Management

While your body produces natural chemicals to ease discomfort in labor (endorphins and hormones, some people opt for medical pain relief during their birth.

There are three main medical options for pain relief during labor:

  • IV pain medication

  • Nitrous oxide

  • Epidurals

IV pain meds are narcotics injected through the IV and into the bloodstream. Nitrous oxide is a gas commonly used during dental procedures that is administered by a face mask or a tube held in the mouth. It metabolizes quickly and leaves your body rapidly. Epidurals are catheters placed into the lower spine with a needle, administering narcotics locally, numbing from the waist down (but you remain clear-headed).

 

Hydrotherapy and Water Birth

Hydrotherapy is often called “the midwife’s epidural” due to the relief it gives. Essentially, hydrotherapy uses water for pain relief, either in the shower or the tub. Many providers offer and encourage hydrotherapy during labor. Birth centers, home births, and even some hospitals are comfortable with allowing babies to be born in the water itself, called a “water birth.”

 

Speeding Up Labor

When labor is “stalled” and progress is slow, care providers may request to “speed up” or “augment” labor. This is done with an IV medication called pitocin, a synthetic version of your body’s naturally occurring hormone called oxytocin. Sometimes a pill called cytotec/misoprostol (prostaglandins) is also used, although this is not as common in the US. While it can make contractions stronger and closer together, there are still risks and benefits to be weighed.

 

Breaking the Waters

Your baby is surrounded by amniotic fluid encased in a strong bag (amniotic sac) that protects them from infection and cushions their umbilical cord to keep blood flow from getting compressed. Most bags break on their own at some point during labor, but some providers offer to break the bag to “help things along” with mixed results.

 

GBS+ and Antibiotics

Group B Streptococcus (or GBS) is a bacteria sometimes found in the vagina that can make babies sick if they are exposed to it during birth. Typically you are tested for GBS a few weeks before birth since the bacteria can come and go without symptoms. You may be positive one week and negative the next.

There are different protocols and recommendations. Learn which one is right for you.