Pregnancy & Birth

Choosing Your Health Care Provider and Birth Setting

I had a long, intense labor at the hospital, and Annie, my doula (trained birth assistant), was great. She helped me in and out of the shower, got me on the birthing ball, pressed hard on my back during the worst of the contractions, told me I was doing a great job at birthing my baby. When I was about 9 centimeters dilated, the baby’s heart rate dropped. The nurse had me change positions—roll on my side, get on all fours—to see if that would help. She paged the obstetrician on call, who came in immediately. He looked at the monitor results, tried a few more position changes, and came over to the side of my bed. He squatted down on the floor so that his eyes were level with mine, and told me that he was concerned that the baby wasn’t getting enough oxygen, and that he thought I should have a C-section. I knew cesarean sections were frequently done unnecessarily and I wanted to avoid one if at all possible. He listened to my concerns, agreed with me that cesareans are overperformed— but also said that in his judgment this one was necessary. . . . While I wish the C-section hadn’t been needed, I so appreciate how attentive and respectful all my providers were.

After talking with Jennifer (a midwife who attends home births), I knew I wanted her to be my provider. She told me about some of the births she had attended, and told me what I could expect. “You’ll be in your own home,” she said, “comfortable and secure, surrounded by people you love. You can labor as you need to, with all of our support, and when you’re ready you can reach down and birth your baby.” She presented a beautiful picture of what birth could be. During my prenatal visits I would go to her house, sit on the couch in her living room, drink tea. While we talked she would do small checks on the baby, measure my belly, ask me how I felt. She was very organized and motherly, and provided all the appropriate medical care. . . . I always felt important, like she cared about me and really wanted me to have the kind of pregnancy and birth experience I wanted. And I never felt like she had her hand on the door, waiting to go. . . . I loved being treated like a healthy pregnant woman, not like someone who is sick and needs treatment.

Where we give birth and who attends us throughout pregnancy, labor, and birth can powerfully affect both what happens to us and our feelings about our experiences. Because of this, it’s important to take the time before becoming pregnant or early in our pregnancies to learn about our options and make thoughtful decisions.

An optimal provider and birth setting will offer you:

• care that is consistent with the best available research on safety and effectiveness
   
  
• an environment and treatments that enhance, rather than interfere with, the natural process of pregnancy and birth
  
  
• individualized care that takes into account your health needs (and those of your baby) as well as your personal preferences and values
  
  
• abundant support, comfort, and information¹

A skilled and attuned provider helps each woman step into motherhood in the best physical, emotional, and spiritual condition possible for her. Identifying your priorities, learning about the differences among various approaches to childbirth, and finding out which options are available to you can help you make decisions that fit your circumstances and preferences. You can gather the information you need in numerous ways. You can talk with other women about their experiences and read birth stories and books about childbirth (see “Resources,” page 325). You can learn how your choice of provider and birth setting are linked, as some providers practice only in certain birth settings. (Doctors, for example, rarely attend home births, while some midwives cannot supervise your care in a hospital.) You can learn what you can do if you experience or anticipate complications and may need specialized care. You can find out which specific types of caregivers and birth settings are available in your area, and what your health insurance, if you have any, will cover. You can interview potential caregivers and take tours of different birth settings.

In the United States today, women’s options in maternity care are often limited by finances and by insurance or managed care requirements. If you are pregnant and cannot afford insurance, you may be able to receive Medicaid coverage, which is available to pregnant women in all fifty states. You may be eligible once you are pregnant even if you were refused previously, when not pregnant, because the eligibility requirements are different for pregnant women. In addition, a special program called Presumptive Eligibility pays for medical care for pregnant women whose applications have not yet been approved. Medicaid eligibility requirements vary from state to state. To learn about local services and find out if you are eligible for Medicaid or other government benefits, ask your health care provider for help, call your state Medicaid office, or look online at www.govbenefits.gov/.

In the future, women’s options for maternity care may narrow in the United States. Because of lifestyle and liability concerns, fewer young doctors are choosing to specialize in obstetrics. At the same time, certified nurse-midwife programs are closing, for a variety of reasons. We can work toward making a wider array of childbirth options available to all women by supporting organizations that advocate on behalf of these options. (For more information, see Chapter 18, “Advocating for Mothers and Families.”)

End of excerpt
Excerpted from Chapter 2: Choosing Your Health Care Provider and Birth Setting in Our Bodies, Ourselves: Pregnancy and Birth © 2008 Boston Women's Health Book Collective