Choosing a Care Provider

Before you make a decision about where to give birth, it is important to look at all your options, and think about which one is best suited to help you achieve the experience you desire and the safest outcome for you and your baby. Your range of choices include:

Your care provider options may also include a Doula, who can work in conjunction with any of the above. A Doula is a person who provides support, during pregnancy, especially during you labor and birth. In addition, postpartum Doulas provide after-birth care. During the delivery, the Doula is there purely to support you and your family. Doulas do not function as medical professionals, and they will not interfere with your midwife or doctor. They will support you and your healthcare providers to help you achieve the most wonderful, satisfying possible birth experience. Eden Fromberg, an Obgyn in New York City says, “The only way I know of to have a gentle natural birth in a NYC hospital, is to bring your doula!”

In conjunction with the decision about who to utilize as your primary care provider, also comes the decision of where to give birth. Again there is a range of choices which include:

  • A Hospital
  • A Birth Center
  • A Home Birth

Ultimately each woman should follow her heart and give birth wherever she feels the most comfortable. You owe it to yourself and your baby to make sure these are informed decisions.

Choosing a care provider becomes especially challenging if you desire a natural delivery. So often, medical professionals who have received their training through medical schools and work out of a facility like a hospital are immersed in the Western style of practice. They simply do not have the same commitment to natural childbirth as those who practice at birthing centers or do home births.

Hospitals also frequently have a system of protocols that they must follow that put constraints on the natural birth process.

The Western medical model of the birth process, from labor inducing drugs to drugs for pain relief, often sets in motion a series of events which reduces the mother’s ability to give birth vaginally, leading to a cesarean birth.

  • Labor inducing drugs such as Pitocin may be used to force the uterus to begin contractions before it is truly ready. The extra stimulus of the drugs can produce contractions that are stronger than normal, creating additional pain for the mother.
  • This creates the need for pain relieving medical procedures, such as an epidural.
  • The numbness from the epidural allows the dosage of drugs like Pitocin to be increased, resulting in even stronger contractions.
  • The stronger contractions may cause a constriction in blood vessels and a reduced blood supply to the baby, putting it under stress, indicated by  an abnormal heartbeat.
  • Once it is determined that the baby is under stress, the doctor will declare the need for an emergency cesarean birth.
  • While this may not happen with every induction, it is one of the reasons why hospitals have a higher cesarean rate than birth centers and home births.

Before you choose to have a natural birth in a hospital setting, ask these questions:

  • What is the hospital’s cesarean rate?
    Many hospitals in the U.S. today have a cesarean rate of 30 to 40%. It can be even higher in other countries. In contrast, a birth center or home birth midwife may have cesarean rates as low as 2%.
  • What is your doctor’s cesarean rate?
    Again, certain doctors and obstetricians may have startlingly high cesarean rates.

What setting will make you feel the most comfortable?

  • The assurance of technological intervention when necessary?
  • The relaxing atmosphere of a birth center?
  • Or even more personal, your home?

Questions to Ask When Choosing a Hospital, Doctor, Birth Center or Midwife: http://www.socalbirth.org/resource/question.htm

Evidence Regarding The Practice of Certified Professional Midwifery and Home and Birth Center Settings for Birth. http://nacpm.org/about-cpms/evidence/

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