The next topic on our "11 Ways to Prepare for Your Best Birth" series is:
#3: Create your dream birth team
Here are the team members for your consideration:
Care Provider - Midwife or OB
Nurse(s) (in a hospital setting)
Another wise consideration at this point would also be equipping yourself with postpartum resources such as getting names and contact info for at least one lactation consultant and postpartum doula (some birth & postpartum doulas are also lactation consultants). We'll talk more about those in a future post.
Care Provider - Midwife or OB
There are several general differences between the midwifery and the OB models of care. Keep in mind these are generalities, and there will of course be exceptions to these general trends.
Expert in natural, normal, low-risk birth (important to note they do work in conjunction with an OB should the need for surgical birth arise)
Holistic focus on health, wellness, prevention
Labor/birth as normal physiological processes
Lower rates of using interventions
Midwives tend to spend more time with their patients, helping their patients feel at ease, feel cared for, and feel heard
Depending on your insurance, it might take some calling around to find a midwife who is covered by your insurance. In NYC, it's often easier to get full coverage when a midwife is under the umbrella of an OB's practice instead of in a midwifery-only practice. However, you may also want to inquire about the possibility of a reimbursement scenario. Much of the time independent midwifery practices tend to be worth the less-than-ideal insurance logistics with the thought of avoiding unnecessary interventions -- that is, a midwife working within an OB practice can often present certain pressures for practicing a more medicalized model of care, making it sometimes a less than ideal scenario. In most cases, though, still a better route for a healthy, low-risk expectant parent.
Primary expertise/training is in surgical birth -- many OBs go through med school and never see an unmedicated, vaginal birth
Focus on managing problems & complications
Often see labor/birth as dependent on technology
Higher rates of using interventions
Due to problems in the U.S. healthcare system, many patients tend to have extremely brief appointments with long wait times and often walk away feeling like they have unanswered questions
I also want to mention that there's a common misconception among low-risk pregnant parents that working with a high-risk OB is the safest way to have a good birth. This is certainly the way to go for high-risk pregnant parents. However, for low-risk parents, it's better not to go with a high-risk care provider as they are more accustomed to using medical interventions readily, putting a low-risk, healthy woman and baby at an increased risk of unnecessary intervention.
As you interview potential providers (or try to determine if your current OB/GYN is the right one for you in this new scenario of giving birth), check out these smart questions to ask from NYC's own Choices in Childbirth. Ask yourself, as you talk with your care provider or potential candidates, "Do I feel heard and respected with this care provider?" Surveys show that feeling respected and heard in birth is one of the key factors in a satisfying and positive birth experience.
Moving on to others on your support team, and as you consider how many people and who to have on your support team beyond your clinical care provider, it's important to know hospital policies. Many traditional Labor & Delivery rooms (at least in NYC) only allow 2 non-hospital staff support people in the room, where birthing centers tend to be larger and may allow for 3. Another thing to consider is that, from a hormonal and physiological perspective, women tend to labor best with few people around...yet we almost always do need a couple of carefully selected people to be very hands on to help with pain management as labor sensations intensify. Therefore, think about your best strategy for "minimum people/maximum support". This most often will mean partner (if applicable) and a doula.
A doula (from the Greek word meaning "a woman who serves") is a trained, non-clinical professional who provides continuous emotional, physical, and informational support in the weeks leading up to and throughout labor as well as in the immediate postpartum. She helps to bring a sense of calm to the labor, which can be indispensably helpful and strategic, particularly for first-time, nervous parents. Having someone there to tell you, at every unnerving turn, "This is normal," can help everyone breathe easier, help to labor at home longer (thereby avoiding the all-to-common unnecessary interventions), and help labor progress more readily with wise strategies. Having someone who has a vast toolkit of massage techniques, labor positions, pain management techniques up her sleeve to help you along the way is truly priceless. Even childbirth classes can't replace the power of a doula as a strategic tool -- they very much complement each other.
Many couples say that the doula is just as much there for an involved partner as for the laboring woman -- she alleviates a good deal of the enormous pressure and stress off. Hear me, however, when I say that she does not in any way replace a partner who wants to be involved (and whom the laboring woman wants to be hands-on support). She strategizes with the woman/couple before the labor on how they would like her to support them, and this is different for every family. If you end up having the day-long or days-long first labor, too, it's indispensable to be able to tag team with labor support as needed, or double up as things get so intense that she desperately needs several (all) hands on deck. Check out what most doulas include in their services here. I recommend interviewing more than one doula to find the right one for you -- one you'll feel entirely at ease with. Think of yourself (ie laboring parent) at your most vulnerable and in a highly suggestible state as you make this choice. I've never met a woman/couple who didn't, after all is said and done, swear by hiring a doula as the best decision they could have possibly made toward a better birth. Check out some interview questions from Choices in Childbirth.
Be sure, too, to ask your care provider (once you've found the right one for you) if they are supportive of hiring a doula, since you want your team to work well together. Hopefully their answer will be yes; most natural-friendly care providers should be very supportive of a doula's role. To my thinking it could be red flag should your care provider not be doula-friendly, but again, you'd want to probe and understand their reasoning before coming to this conclusion.
When the partner is able to be at ease (often with a doula's help), a loving, involved, supportive partner is the most important person in the room to aid in the laboring woman's labor progress in a healthy way. He is the one who best can help elevate the most critical hormone in labor, the "love hormone" -- oxytocin. Through partner's touch, eye contact, perhaps making out, even sex (until membranes have ruptured and if both are in the mood), that oxytocin can be boosted, thereby strengthening the power of the uterine contractions and helping baby down and out.
I want to point out, however, that not every pregnant woman wants her partner/spouse to be her labor support. Every couple's relationship dynamic is different, not all optimal for this particular task. I want to put this out there because we're living in a day and age in which dads/partners are often expected to be labor support. For many couples this is ideal, but not all. For a woman who is in this camp, it's very important to intentionally assemble a support team who she feels will help her labor well.
You might opt to have a parent, sibling, other close family member, or friend support you through your labor. Ask yourself the following questions to help make a smart decision:
Do they have experience with birth? If yes, is it positive or negative? -- best to have someone knowledgeable and with an overall positive view
Do they view birth as a healthy, natural, normal process or are they fearful of it? -- you only want someone in the room who sees it as the former and will not bring any fear or anxiety in the room, as this dynamic will not help your labor to progress in a healthy way
Are they healthy, strong, have stamina for the long haul of labor? -- this is essential for the kind of support a laboring woman often needs
Do they know when to speak and when to be silent? -- both referring to being quiet during contractions as well as being respectful and not combative with anyone in the room, including the laboring woman, her partner (if applicable), or the hospital staff
While we're on the family/friends topic, also think carefully about who you tell you are in labor. Will those people come to the hospital immediately and -- even if only by their mere presence in the waiting room -- cause you to feel pressured, to feel like the "watched pot that never boils"? Will they constantly text or call? This can certainly impede progress. One smart strategy you could use is to assign a family/friend who will not be in the laboring space to be the point person whom everyone can bug, but no one in the laboring room should have that unhelpful distraction. Once you're where you're going to give birth, I actually recommend just silencing or, better yet, turning off phones altogether if possible. You'll need to have it on while laboring at home to interface with your care provider and perhaps to occasionally time contractions if it's a smartphone, but once you're with them, ask yourself if you really need it on as a potential distraction.
Another person you won't really get to choose per se but that is there throughout your time in a hospital setting is one or more nurses. A couple of recommendations here:
One of my recent students had the wise idea to request a nurse (upon arriving at the hospital) who is experienced with/supportive of natural birth -- smart for anyone aiming for a natural, unmedicated birth.
Bring treats for them (home-baked or store-bought cookies can be nice, or a baby's birthday ceremonial cake, donuts...no healthy crudité here, please, many nurses say! Doesn't have to be food; some of my doula clients have made little thank you gifts. If you do this, be sure to take enough for several rounds of nurses, as you never know how many will be helping you.
Labor support partners, learn nurses' names and be kind to them, working to create an amicable atmosphere while standing your ground and speaking up for mom if/as needed.
Spend time considering and discussing with your partner (if applicable) what your ideal birth team will look like, and then find and secure your optimal partners for a better birth. It's worth the time, I promise!
Your Birth Team (Choices in Childbirth)
The Doula Book (Klaus, Kennell & Klaus)
Doulas of North America International (DONA) - learn more about doulas, find a doula in your area
Doula interview questions (Choices in Childbirth)
Questions to Ask Your Care Provider (Choices in Childbirth)
Midwives Model of Care (Citizens for Midwifery)