Archive for the ‘Care Providers’ Category

Do’s and Don’ts in Labor & Delivery (a.k.a. Getting What You Want, Kindly)

Monday, April 20th, 2015
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Birth plans. Epidurals. Natural Childbirth. Doulas. Induction. Cesareans. And more…

The list of decisions about birth goes on and on…

More women are becoming dissatisfied with the status quo in American maternity care, and are asking for something outside the norm for the hospital where they plan give birth. Naturally, this might make for some conflict between a birthing mother and her care provider and nursing staff.

Conflict.

There. I said it. Right out loud.

There might be conflict in the labor and delivery room when a mother is giving birth. I am not writing this post to tell anyone how to avoid conflict, but how to manage it in a healthy way, so that the birth experience is not characterized by the conflicts that arise, but by the solutions everyone involved is able to come to.

Here are some do’s and don’ts that may help you in the labor and delivery room to self-advocate effectively, while creating a human connection with the nurses and provider caring for you and your baby.

DON’T: Expect care providers or nurses to offer much in the way of comfort during labor.
It is not the responsibility of a care provider or nurse to make a birthing mother comfortable. Their first priority, and indeed, their entire job, is the safety of mother and baby. Period. Your comfort is a distant second to safety, and that’s exactly the way it should be.

DO: Hire a doula to offer you comfort and support.
Your comfort is the entire responsibility of your doula. Period. That is all that she is there for. Emotional, physical, and informational comfort and support are her expertise. You will not be disappointed if you lean on a doula for this need.

DON’T: Make demands.
This only causes a heightening of conflict. If you want something different than protocol, shaking your fist and demanding it is not the right tack. You might get your way, but you may not end up getting the best care if you treat the nurses as if they were there to grant your every wish.

DO: Ask for exceptions.
Think about it. How would you feel if a stranger came to your house, and began to dictate to you how to load your dishwasher, feed your kids, or fold your towels? You would be offended. This is what we do when we demand our way in labor. When you want something outside protocols, try this: “I understand that this is your normal protocol, but I need you to make an exception for me this time. Thank you.” This invites conversation and cooperation, and is less likely to put a nurse (who is technically your advocate) on the defensive.

DON’T: Be rigid.
Refusing to budge on the smallest things is unfair, especially when you are asking for things outside the box. Remember, you are a rare breed to these nurses. Asking them to step outside their norm is a big deal. Respect that.

DO: Be flexible.
Compromise is the name of the game. For example, here in Colorado Springs, a Hep lock buys you pretty much anything you want in most of the hospitals. It helps them to see that you are reasonable, and that you understand why they do what they do. It makes them far more open to your requests and out-of-the-box needs.

DON’T: Wait until you are in labor to make your birth plan known.
It is completely unreasonable to spring a birth plan on unsuspecting staff and providers. You can’t count on appointment conversations to be remembered, simply because of the sheer volume of patients a hospital-based provider might see in any given month. Not to mention the fact that you are likely to have a care provider you’ve never met catching your baby!

DO: Discuss everything on your birth plan prentally.
Write your birth plan early, in second trimester, and tackle one issue at a time in those 7-10 minute appointments. Discuss the benefits, risks, and alternatives ahead of time, and really make sure you and your provider are on the same page. If they are willing, have them sign it–this doesn’t make it a legal document, but it proves to the staff and on-call doc that your care provider is on board with all your requests.

In short, it pays to be kind. Always be kind. You never know what kind of day your nurse or care provider has had. You have no idea what is going on in the room next to you. I am not making excuses for bad or disrespectful or hurried care. I want to remind you that everyone in scrubs is a human being, just like you. There is rarely a reason to walk into a labor and delivery ward with guns blazing. Even if you had no other choice in your care. The ones providing it are just as human as you are, and if you can leave them feeling respected and understood, you are helping to pave the way for the next woman who wants out-of-the-box care.

It may be your birth, but it has ripple effects. Whether it’s for the positive or negative is, at least in part, up to you.

How do you handle differences of opinion in your care? What are the most diplomatic ways you have used to self-advocate without a situation erupting into WWIII?

Grace & Peace,
Tiffany

A Message About Preeclampsia to Every Mother

Wednesday, June 4th, 2014

If your care provider is seeing a slight increase in your BP, a bit of protein in your urine, and asks you questions about headaches, swelling in your hands and face, pain under your ribs on the right, and if you’ve been seeing spots, they may tell you that you are turning preeclamptic. The Preeclampsia Foundation website can help clarify a lot of what they are telling you, and give you some tools to partner with your care provider in making sure of your diagnosis. Before you can proceed, having a good understanding of what you are facing is important for you and your baby’s health. A preeclampsia diagnosis is nothing to sneeze at, and therefore, it behooves you to learn what you can in order to participate fully in your care, and to make decisions based on information and instincts, rather than fear.

However, it is important to note that, if you do have preeclampsia, you are in a situation where the benefits of certain interventions (such as induction or occasionally cesarean section) very likely outweigh the risks of waiting it out. Preeclampsia doesn’t play fair. It is imperative that you speak clearly with your provider, and make sure you understand why they are suggesting certain procedures. Even if they are necessary, they can be hard to take in if you were planning an unmedicated vaginal birth. Knowing really is half the battle in this case. Do not be afraid to learn about preeclampsia, learn about the way your care provider treats it, and walk forward in confident awareness of the power you still have to choose rightly for you and your baby.

Some things to consider if your blood pressure slightly elevated during only one prenatal visit, and in the absence of other symptoms:

  • What is your stress level like?
  • Have you been sick lately?
  • Are you dehydrated?

Some questions to ask if you have more indicators and/or symptoms:

  • “Am I being diagnosed with preeclampsia, or are these numbers borderline?”
  • “Could this be pregnancy-induced hypertension? If so, how do you normally treat it? Can it lead to preeclampsia?”
  • “What other symptoms might come to light if it is preeclampsia?”
  • “Do I have the option of monitoring BP at home, and being checked every couple of days, or does this need to be taken care of now?”
  • “Is the protein in my urine shown via a reagent strip, and if so, can we double-check it with a 24 hour catch?”
  • “What are my options for induction if it becomes necessary? What are the benefits/risks/alternatives of each method? Which do you prefer, and why?”
  • “How soon do you typically decide to move on to a cesarean section if the induction does not work?”

Preeclampsia is not the end of the world, though it is serious. It is just one of several curve balls that get thrown at some women. It is not something that we currently know how to prevent with any degree of scientific certainty. We have a lot of ideas of what seems to help, but nothing we can hang our hats on just yet. One thing that I think is so important to understand is that we can do everything “right,” have a textbook healthy pregnancy, and still end up with preeclampsia or other problems. We are never guaranteed a “good” outcome when it comes to anything in life, and we should not expect our births to be any different.

What matters most is to do the best we can with what we have, and to be flexible when we are handed something unpleasant, difficult, or even downright terrifying. We face our fears and challenges head-on, and make the best decisions we can within our circumstances. We do not lose our power just because of a medical diagnosis. We just lose a few options we otherwise would have had. Never be afraid to ask your care provider, “Why?” The more you understand, the less scary it will be for you, and the better you will be able to process your birth after the fact.

Preeclampsia or no, your birth is still your birth. You are already a good mother. You can do this.

What do you know about preeclampsia? Where did you get your information? Have you had preeclampsia before? What was your experience with it? What did you learn from it? What advice would you give to someone facing a similar situation? Share your story in the comments…

Grace & Peace,
Tiffany

 

Book Review Friday: “Giving Birth” by Catherine Taylor

Friday, May 23rd, 2014

Giving BirthGiving Birth by Catherine Taylor
My rating: 5 of 5 stars

This is one of those books which I wish I would have taken notes throughout, to better enable me to review it accurately. Her tone, her writing style, and the content were all excellent.

Her writing style is accessible, honest, frank, and open–the way a good journalist’s should be. Her descriptions of the various women she meets, the places she goes, and the births she attends as an observer or doula are vivid without being wordy.

I found myself moved to nearly to tears several times (I’m not much of a crier, so “almost to tears” is saying a lot) throughout the book.

It’s picture of midwifery as a profession, from Certified Nurse-Midwives to direct-entry midwives is respectful and unbiased. She shares the reality of the political landscape all midwives must work in, the challenges they face, and the little triumphs on behalf of women and their babies.

Even if you are not into birth, I would recommend this book to every woman – whether you plan to have children, have children already, or plan to never have children. It can speak powerfully to any of us.

View all my reviews

Doulas Benefit Care Providers, Too.

Monday, October 28th, 2013

Image credit: apperson.com/support

I’ve written a lot about the measurable benefits of trained labor support for women and their families, which is important. However, I believe firmly that doulas have great potential to benefit care providers and staff as well. As one more important piece of the birthing puzzle, doulas can either add to or detract from the big picture of any birth they attend.

When a doula is at her best, when she understands her role and her scope of practice, she brings freedom, communication, and peace to the place of birth.

Part of my Scope of Practice as a CAPPA-certified Labor Doula reads as follows:

During labor and birth, the labor doula provides the mother and her partner with physical, emotional, and informational support. She facilitates and promotes self-advocacy, informed choice, and effective communication between the family and care providers. She seeks to foster a cooperative, respectful, and positive atmosphere with all members of the birth team so that the mother can birth with confidence. (emphasis mine)

What does “effective communication” look like at a birth?

It looks like a bridge. A sturdy, well-built bridge that begins with openness, humility, and an extended hand from the doula to the staff member or care provider that does not interrupt their conversation with the client.

It’s remembering that the client chose her care providers just as much as she chose her doula.* That fact alone should elicit basic human respect from the doula toward those caring for her client. Period. Regardless if that respect is returned or not. Doulas do no one any good unless we do our best to leave those chips on our shoulders at home. We do best when we take the high road, and treat everyone on the birth team with dignity and respect.

Side note: respect doesn’t mean agreement or likeability. It simply means getting along, and choosing to work together toward a common goal: The safety and health (physical, mental, and emotional) of both mother and baby.

When a doula sees herself as an integral part of the birth team, and understands that everyone else there has their place (as long as her client chose them), there are a lot of benefits she has to offer to the care provider and staff she is working with.

Among those benefits:

  • Added perspective–Doulas can often get very creative when coming up with ways to help a labor progress effectively before medical interventions are truly needed. Care providers often appreciate suggestions that don’t interfere with safety, and that seem to help the mother.
  • Someone labor-sitting–Care providers are rarely available to labor sit as long as a doula can. Even home birth midwives may not have as much opportunity to do so, and usually arrive later in labor than a doula would. This means that a doula can fill in the provider and staff on what has been going on, what tricks have been tried, and things that may be relevant to improving her client’s care. The doula can often provide clarification where the mother’s or partner’s recollection is fuzzy. This helps the care provider have a more accurate picture of how labor is going.
  • Continuity of care for patient–This is one of the hardest things to provide as a care provider. Nurses, doctors, and hospital-based CNM’s change shifts–no matter what. Even home birth midwives may have to send a backup if two births are happening simultaneously. The doula provides one continuous thread of care, and we all know that this works out to better quality care in general. Also, can bond more quickly with the new people on shift, making her care easier for the staff and/or care provider, as they have to spend less time establishing trust.
  • Bridge of communication with patient–Doulas teach their clients to ask good questions, relevant to their own care, and how to understand the answers they’re given. This helps the client to build trust in her chosen provider, which makes caring for her easier for the care provider. A doula’s presence should facilitate togetherness at a birth, not a sense of “us vs. them.”
  • Extra set of hands–As much as care providers love to do hands-on care, many times they are simply not able to do so. Doctors, nurses, and even home birth midwives and their assistants, can easily get bogged down by charting, checking and setting up needed equipment, and (in hospitals) caring for other patients. This is as it should be, since the safety and health of the mother-baby dyad rests on their shoulders. Any non-clinical care they get to do is icing on the cake. Doulas have no such worries impeding their care. Non-clinical care is their only focus.Therefore, care providers are able to focus solely on their number one priority: the health and safety of mom and her baby.

I know that the above benefits are really more indirectly beneficial to the care provider. However, when there is benefit to the birthing woman, there is benefit to her care provider as well. The patient load of most OB’s is such that it can be extremely difficult for them to individualize care. After all, the care provider has as little time, per appointment, to get to know their patient as the patient has to get to know them.

Therefore, if there is any way for a doula to help build bridges, encourage their client to ask good questions, and utilize whatever time they have with their care provider, it enables and empowers the care provider to do what they want to do most: Provide evidence-based, individualized, humane care to their patients. This results in good feedback for them, and encourages them to be more open to the next client asking questions or wanting something different than the basic standard of care.

In short, the presence of a doula can mean heightened communication, empowerment, and a positive experience for everyone on the birth team, not just the mother.

*I understand that many women only have very limited, or no choice, when it comes to their care provider, due to geography, local/state laws, financial constraints, or other factors. Still – they ultimately still have chosen their care provider, rather than birthing unassisted at home. Therefore, they are placing some modicum of trust in that care provider. I appreciate feedback on this.*

Care providers: How often do you work with doulas? What do you appreciate most about good doulas? What tips might you offer to doulas who are still learning, or who need to understand your perspective better? What ideas do you have to foster better relationships between clinical and non-clinical professionals?

Thanks for reading!

Grace & Peace,
Tiffany

What You Need to Know About Birth Plans

Friday, September 27th, 2013

As a doula, I require all of my clients to put together a birth plan, discuss it with their care provider, and to provide me a hard copy. I make very few exceptions to this requirement. I believe firmly that a birth plan is a critical piece of the puzzle in good perinatal care.

As much as we want to believe that our prenatal care is individualized, it often is not. Even home birth midwives can get into a “this is how I always do it” habit, though that is far less likely. Still – I have learned to never take anything for granted when it comes to care providers.

I spend a good amount of time with each client in helping them form their own unique birth plan, and provide them with role-playing opportunities that teach them how to have open, honest, and clinical discussions with their provider about their individual needs. If I am hired late into the third trimester, that is almost all I end up doing prenatally – birth plan work.

It’s that important.

That said, I don’t particularly care for the term “Birth Plan,” and I use it only because that’s the common vernacular. I think the word “Plan” conjures up images of precise blueprints and/or legally binding documents. A birth plan is neither of those things, and the sooner we understand that, the better.

Instead, I believe that birth plans are tools designed to help you, your care provider, and any staff you encounter to communicate effectively about your individual needs and expectations regarding your care.

It provides a basic framework that helps your care provider and staff to better care for you, but it does not legally bind them to your every whim and wish.

Instead, a birth plan gives you and your care provider an opportunity to pursue individualized care together, and to be on the same page before you go into labor. It has the potential to build rapport, trust, and respect between you and your provider–a critical factor in enjoying a positive, healthy birth experience, no matter what the circumstances end up being.

For this reason, I really prefer the term “Birth Preferences,” “Birth Goals,” or even “Birth Desires.” Those make a lot more sense to me. When a birth plan is viewed this way, it is often much easier to mentally and emotionally process anything that derails those plans.

Birth is still unpredictable, and there are no guarantees, no matter how safe we have made it. The reality is that birth is like any major event we plan: There will always be at least one thing that does not go the way we expect it to, for good or ill.

Mommas get sick. Babies get sick. Babies get into funky positions. Mommas get exhausted. Heart rates get wonky. Side effects of drugs happen. Things stretch on longer than we thought, or go far faster than we anticipated.

Stuff happens.

Overall, birth is a safe and healthy process, but it has a lot of variables within a very wide range of Normal. Accepting that fact, and writing a birth plan with flexibility in mind is key to processing those funky things that happen during our births.

I find that the most flexibly written birth plans get the most respect from staff. They see clearly that my client has done her research, and has realistic expectations. Frankly, I find that my clients are more likely to get exactly what they want when their language is open and flexible.

I also find that when things get weird in a birth, staff and providers tend to bend over backwards to keep the spirit of the plan intact. They seem to view themselves as being on my client’s side, and try very hard to make it work within the parameters this particular labor has laid out for them.

My clients come out of these births processing all of it in a very healthy way. They understand that they don’t have to like what happened, but if they felt respected, understood, and as though their choices mattered, they are often okay in the long run. They understand that it’s okay not to be okay for awhile. They grieve the stuff they didn’t like, but are grateful for the support and good care they received within the circumstances their birth chose for them.

Care they might not have received had they not communicated clearly what they hoped for, ahead of time, via their birth plan.

So, when writing your birth plan, be careful about the language you use. Really examine how it comes across, and how you view your relationship with your care provider. Some basic tips:

  • Open with a sentence like: “We understand that circumstances may arise that preclude the following desires, but we expect to be fully informed before consenting to any procedure that may be proposed, and we appreciate your help in achieving a healthy and pleasant birth.” This lets them know you understand that birth has a lot of variables, and that you are willing to work with the staff.
  • Have a short introductory sentence or two explaining your overall desires. (Natural birth? Well-timed epidural?) The staff will automatically know what requests will go along with that, and you can eliminate a lot of specifics. For example: If you know you want an unmedicated birth, and state that fact right away, you won’t have to tell them you’ll want to move around, have dim lighting, etc…
  • Keep it simple. It shouldn’t be more than one page long.
  • Use bullet points and clinical language.
  • Tailor it to your provider’s practices, as well as the protocols at your place of birth. If you know they do rooming-in, you don’t need to request it.
  • Do your research. Take an independent childbirth class. Hire a doula.
  • Take your first draft to your provider and ask specific questions. “Under what circumstances might you do an episiotomy?” This helps you know if something needs to be added or taken off the plan.
  • Have a cesarean plan. Look up “Family-Centered Cesarean,” and choose your top 3-5 items you think might be important, and add those.

Be decisive and clear in your desires, but remember to stay open as well. Choose carefully your hills to die on, and let everything else go if it becomes necessary. Ask questions. Even if all you can think is to keep asking “Why?” That one word can gain you a lot more information when a decision becomes critical. Open your eyes, and walk forward confident in your desires, your ability to birth, and your ability to make good decisions for you and your baby.

You are already a good mother. Go for it.

I could write mountains of information on this subject, but this post would get too long. Did you write a birth plan? Why or why not? Do you feel your desires were respected? Do you feel it created a sense of cooperation with the staff who cared for you? Why or why not?

Grace & Peace,
Tiffany

Some Say I Am Brave

Tuesday, May 8th, 2012

Image from http://www.vickidonlan.com

Some say I am brave for choosing homebirth. To me, that’s like saying I’m brave for having a big wedding. No matter how involved the planning, we all know the real work of marriage starts when the wedding is over.

So it is with birth. Our childhood, our growing up, and our pregnancy is the training ground. Birth is the opening ceremony. Motherhood is the marathon.

Some say I am brave for choosing homebirth. Others would counter that choosing a hospital birth is brave.

I say choosing to become a mother is brave, no matter where you choose to bring your child into the world. I say learning to make fully informed decisions — guided by a beautiful hybrid of evidence-based information and your intuition — is brave.

Doing this often means going against the flow of society in general, and the tide of modern obstetrics in specific.

It means navigating endless resources, asking questions, and taking time to figure out answers. It means identifying, confronting, and processing fears, anxieties, and stressors that hinder you from being able to fully trust your body and your chosen care provider. It means letting go of a process we have very little control over, when all is said and done, and forming realistic expectations about your birth based on your unique emotional health, health history, and risk factors.

It means being able to tell your well-meaning loved ones that you appreciate their input, but that you are choosing a different way than they did. It sometimes means being willing to give up your ideal for reality — whether that entails a homebirth transfer, an unplanned cesarean, or an accidental homebirth.

The location of your birth doesn’t matter nearly as much as how you got there.

Navigating the road on this journey isn’t as simple as using GPS systems to decide where to turn. It’s less like a road trip, and more like a sea voyage. You may have all the tools in the world in your boat, but unless you use them, the horizon looks exactly the same no matter which direction you look. Sure, you can guess which direction is the right way to go, but you can’t really know unless you have a destination in mind, and you’re able to use the tools around you.

It’s up to you to pick up those tools and make use of them. No one else is really in that boat with you.

It’s up to you to be brave.

Where do you want to go?

Do your homework. Take nothing for granted. Never say never. Then, when you know where you want to be, pick up the tools you have and get yourself there. No one else can (or will) do this for you.

Some say I am brave for choosing homebirth.

What really made me brave was my willingness to open my mind and look beyond the status quo at all the options available to me. That was the hard part. What continues to make me brave is looking four little ones in the face each morning, and loving them in spite of the challenges that mothering them presents.

Some say I am brave. I say that all mothers are brave; some just have not figured it out yet.

When did you realize your bravery as a mother? In what moments have you been brave as a mother?

Pick up good books. Take an evidence-based childbirth class. Know where evidence-based information resides on the internet. (It’s not typically at BabyCenter, just FYI.) Ask questions of your care provider every appointment. Hire a doula. Look outside your box. Interview providers you might not have considered. Confront your anxieties and fears about birth – with professional help if you think you need it.

Grace & Peace,
Tiffany

 

A Glimpse of the Homebirth Difference

Tuesday, May 1st, 2012

A client of mine had her home visit from me this morning. It coincided, on purpose, with the 36 week homebirth visit from her midwife. I cannot say enough how lovely the experience really is.

My client was asked many pertinent questions about her physical and emotional health; her stress levels and what she’s doing to cope; her nutrition, hydration, and rest; and what she was hoping to have on hand at the birth for her comfort. Everything from essential oils, to where the birthing pool would be, to checking the availability of all of her supplies was covered. Then, oh joy! the midwife listened to the baby, and we got to stand in silence and awe of the precious sound.

I was delighted when my client allowed me to palpate her belly, under the supervision of the midwife and intern midwife, to get an idea of baby’s position.

Everything about this appointment was professional, warm, friendly, thorough, and centered on the mother – my client.

For a whole hour of her day, my client got to experience attention and love being centered on her and her baby. She got to be loved at the beginning of her busy day.

It was beautiful, and I can’t think of a single hospital experience — no matter how kind and warm the nurses are — that equals the time devoted to my homebirth clients. What a privilege to be a part of the journey of those who choose this “road less traveled.”

Grace & Peace,
Tiffany

All We’re Really Trying to Say

Tuesday, December 20th, 2011

There is a misconception I have noticed among the general population in regards to birth professionals who advocate for the kind of birth outlined in the above photo. How surprised they are when they learn that doulas, childbirth educators, and midwives are actually all for advances in technology and care. We just desire that practice be driven by evidence, not by the shiny new toy.

Let me explain.

I think part of the misunderstanding lies in the belief that because birth professionals outside the medical profession unapologetically share what is scientifically verifiable to be the healthiest norms for mothers and babies, that we are therefore against hospitals/technology, etc. Nothing could be further from the truth!

Speaking for many like myself, what we really desire are two things: 1) True cooperation between hospitals, doctors, and midwives, so that women and their babies get the best, individualized care, and 2) Practices based on the most scientifically sound evidence, rather than the shiniest new toy or convenience for the care provider, or any other reason than the medically verifiable health and well-being of the mother-baby dyad.

Cooperation between the medical establishment and midwifery care isn’t an either-or proposition. Advocating for normal childbirth does not equal opposition to hospitals and all they offer.

Normal birth and all that it implies is a truth with a solid foundation of evidence – nothing more, nothing less. It is not a commentary on any individual woman’s story. It is not a value judgment on the choices made by any woman. Every birth experience is valid, and has inherent value. Every birth is still a miracle. Birth is always sacred and special , no matter how the precious little ones make their appearance.

Every birth is ours, as women, to own and learn from. The planned cesarean is no less valid than the natural home birth so many birth professionals support and love.

Information shared about normal birth is what it is: statements of fact, backed up by evidence, and fueled by an undeniable passion for helping women empower themselves to make truly informed decisions regarding the care of themselves and their babies.

A passion to change the world.

To change the world through loving women and their families, and building bridges of communication between women and their chosen care provider. If we can do those two things, the rest will follow so much more easily than if we tried to force it.

To accomplish the change we are advocating for, we need to speak. Out loud. About unpleasant, but truthful subjects.

And we need to do it all through the filter of love and compassion.

I encourage you to take our words to heart if you can. If it’s too painful – speak out. Find out why it hurts so much to hear about another beautiful home birth. You matter. Your voice matters.

Thanks for hearing me out.

Tiffany

Choosing Your Care Provider: After the facts…

Wednesday, December 15th, 2010

When it comes to choosing the person who will help us usher a new human life into the world, we women have a tendency to default to the lowest common denominator:

  • Who our insurance will cover.
  • Who is closest to our home or work place.
  • Who all our girlfriends/sisters/cousins go to.
  • The first one we see with a nice website. (I kid you not.)

With a great amount of luck, you might hit on a care provider who practices in a mother-friendly and/or baby-friendly way (the two are not mutually exclusive – what is good for one will almost always be good for the other). However, not one of the above reasons is a good enough one to base a decision on. They might be a good place to start your search, but these reasons, alone, are flimsy.

Remember, there are at least nine or so months to decide who will have the honor of catching your baby – and believe me, it is an honor. Any provider who views it as less than that should not be catching babies! So, take your time. There is no rush. There is a lot more information out there than you may have previously known.

To start, you need to know, first of all, what kind of options you have. If you have visited my site more than once, you are probably aware that I am a big supporter of midwifery and home birth. I have good reason. They are perfectly viable options. (Visit my Homebirth & Midwifery page for information.) However, those might not be the right options for every birthing woman.

My main point in writing this is to encourage you to really slow down and think through all your options. Never automatically discount a particular type of provider without first learning the relevant facts.

In summary, your options for prenatal care and birth are:

1: OB/Gyn (Obstetrician/Gynecologist)
2: Certified Nurse-Midwife (CNM)
3: Family Practitioner
4: Direct-entry midwife (a.k.a. Registered, Certified Professional, or Lay Midwife)

Good information on the practical aspects of choosing a care provider is abundant. In fact, Childbirth Connection has an excellent resource on the nuts and bolts of care providers. I encourage you to check out this link to see this information.

After reviewing the basic facts about different care providers, I would like to address a factor that is often overlooked in a woman’s research.

We women have the very real ability to “just know” when something is or is not “right” in many situations. Instinct. Intuition. Gut feelings. Call it what you will, but it is more than emotion, and it is one link I often see missing from the list of reasons a woman gives for choosing her particular provider. Our instincts, in most cases, will steer us correctly. However, we have also been conditioned to ignore those instincts in the face of what we may see as an authority greater than our own, only to regret it later.

In addition to questions about a care provider’s policies, procedures, and statistics regarding various interventions (cesareans, inductions, epidurals, etc…), you need to seriously consider your instinct. It may be the most important factor in your decision, especially if you feel that you have all the black-and-white facts that you need to be fully informed about a particular provider.

After reviewing any provider’s answers to your interview questions, you need to ask yourself: “How did meeting with this person make me feel, at my gut-level?”

Did you feel safe? Did you feel respected? Did you feel as though you were taken seriously? Were all your questions answered in a satisfactory way? Did you “click”?

Even if the answers to these questions are all in the affirmative, is there something else that tells you that you “just know” that this person isn’t “right” for your care? If so, move on! Ignoring that gut-level instinct has the potential to keep you from having a truly good birth experience – even if the physical outcome is “good” overall.

Being fully informed will do you no good, whatsoever, if you choose a care provider against your best instincts. Also, keep in mind that instinct alone can sometimes be misleading too. Rarely, but it does happen.

When you pair instinct with a foundation of good, accurate information, you create an empowering situation for yourself. You take one step closer to trusting yourself in the exciting process of growing and birthing a baby, and that can never be a bad thing.

To see other posts (to be updated at least weekly until complete) in the Most Important Piece series, click HERE.

The Most Important Piece: Following Up

Saturday, December 4th, 2010

This is the the introduction to a series of six posts, inspired by this post, in which I will be writing about the critical role your support team and place of birth play throughout your pregnancy, labor, and birth. Over and over again, we find that a woman’s satisfaction with her birth experiences has less to do with how much pain she experienced, or the method of birth. It has far more to do with her feeling of autonomy, and her feelings of being supported (or not).

Women who feel as though things were just “done to them” throughout the childbearing year, especially through labor and birth, are more likely to struggle with feelings ranging from dissatisfaction to outright depression. In contrast, women who feel that they were the ones making the decisions, and that those decisions were fully supported by those around them, especially their care providers, are the ones most happy with their births.

Epidurals, IV narcotics, massage, showers, and position changes are all well and good. Valuable tools for pain management, but it turns out that having these things available is not as important as a support team who strives to empower and encourage women by practicing true informed consent, including informed refusal.

When the decision-making power is put into a woman’s hands, and she understands fully that it is she alone, along with her baby, who lives with any consequences of her decisions, good or bad, birth can be the most empowering experience in a woman’s life – even if the physical circumstances are not ideal.

Inspired by my mother’s critical role in my births, I have decided to write a series of posts about the various possible members of a typical birth support team.

I’ll be writing first about various care providers, the general differences between them, and how to choose the one who best suits you. I’ll talk about your partner/spouse’s role, and how birth has the potential to strengthen the bond between you. Doulas, of course will have a post all their own, including how to choose one based on your individual needs. Last, but not least, I’ll write about childbirth education options, explaining their role, as well as how to choose a good childbirth education course.

Join me for the next few weeks as I gather my thoughts together on this subject – it is truly the Most Important Piece of your birth experience, and I don’t want you to miss a thing!

I’ll be linking each post here, so you can have them all in one place. Please – always feel free to post a comment or question, or email me.

The Most Important Piece Series