Your caregiver is the person you select to provide your prenatal care and to deliver your baby. It is the doctor or midwife that you hire to be your healthcare provider.
The choice of this important person may have a significant effect on the type of birth experience you have. You should consider how to find the best caregiver as soon as your pregnancy is confirmed. Early in pregnancy, you have sufficient time for interviewing and exploring the options. However, even in late pregnancy, women have successfully changed caregivers. If possible, include your support person (husband, other family member, or friend who plans to be with you during labor and birth) in interviews with potential caregivers.
- Make a list of the things that you wish to discuss with your caregiver.
- Start asking questions early in your pregnancy.
- Ask a few questions at each obstetric visit, rather than a long list of questions at one visit.
- Take your partner with you to the visits at which you want to discuss important issues. Your caregiver may be more willing to discuss these issues with both of you present.
According to Dr. Silvia Fledman in her book “Choices in Childbirth” the choice of a caregiver “should be determined by three things: his or her expertise, philosophy, and personality.” When the pregnancy and childbirth are expected to be normal, Dr. Fledman recommends that women interview several caregivers using an organized list of specific needs and wishes. Almost all possible birth options are now available in most areas, so it should not be difficult to locate a caregiver who is willing to go along with any reasonable request. The important factor is communication. It is up to you to communicate your desires and to ask the doctor or midwife to explain any policies that may be unclear. An open exchange of views establishes a good rapport and a feeling of mutual trust and security.
A conscientious, up-to-date doctor or midwife will take the time to discus feelings and will promote careful attention to good nutrition. Such a doctor or midwife will encourage you to educate yourself by reading all you can about pregnancy and childbirth, and by attending classes. You may want to ask the doctors you interview about their cesarean rates, as well as the cesarean rate of the hospitals where they deliver. Find out, too, the reasons they consider non-negotiable for performing a cesarean. You may also want to verify the credentials of all the doctors and midwives you consider selecting. For example, a board certified physician has passed an exam administered by his professional society. A certified nurse-midwife has completed training in midwifery in addition to being a registered nurse. A few states recognize licensed midwives, who have completed training according to the requirements of their states. On the other hand, lay midwives may or may not be registered in their states, so their standards and quality of care will vary.
- Join your mate for interviews of prospective caregivers.
- Discuss the options with your mate prior to her office visits.
- Tour the local hospitals and birth centers.
- Ask labor and deliver nurses for recommendations of supportive doctors and midwives.
- Help your mate make her birth plan, Discuss the plan with her caregiver and have it signed. Make sure that it is placed on her chart when she enters the hospital or birth center in labor.
Many women in the United States prefer to have an obstetrician as their caregiver because of his training in handling the problems that may arise. Family and general practice physicians also deliver babies. A certified nurse-midwife’s experience and training are in handling normal, uncomplicated births. This training, as well as her outlook, makes a midwife less likely to use medical intervention in the course of labor and delivery. In addition, “Midwives are willing to start in early labor and sit with a woman 14 hours” says Charles Mahan, MDB, OBG, dean of the University of South Florida College of Public Health and former State Health Officer for the State of Florida. “I am not willing to do that. Most of my colleagues aren’t either. For low-risk women, they are better off with a midwife.” If a problem arises, however, the nurse-midwife will refer the woman to an obstetrician. Therefore, If you are considering employing a midwife, you should also interview her medical backup.
You may want to take a tour of the facility where you plan to deliver. In addition to hospitals, many areas offer out-of-hospital birth centers. Some of these freestanding birth centers are owned independently by midwives or physicians; others are financed by a hospital, but located outside the main building. Birth centers offer low-risk women the opportunity to deliver using few medical interventions. They usually cost less than the local hospitals, but still provide a high quality of care. A few areas offer the option of home birth. If you are considering a non-hospital delivery, be sure to find out about medical backup and the procedures for transfer to a hospital if complications do arise.