Find Better Care
If you current care provider is not fitting the bill, then you deserve better. You can change care providers right up until the time that you are in labor and it is never too late to create a better experience for you and your baby. American obstetrics is an industry. Even though we spend the most amount of money on healthcare and use the most technology, 40 other countries have better neonatal outcomes. But good care is out there. Don't sell yourself short!
An excellent care provider should be "Mother-friendly" and will respect that you always have the final say. They will not push unecessary interventions and they they will do whatever it takes to help you have the most natural experience. They would spend at least a half hour with you at every visit, allowing plenty of time for your questions and offering good nutritional counseling. Mostly, they would offer total flexibility in your birth and would encourage you to stay home as long as possible
A good care provider generally would not do vaginal exams prior to labor or encourage stripping your membranes, would not deny you the right to refusal of offered procedures, would not encourage medications in birth, would not routinely do non-stress testing, bio-physical profiles, or ultrasound, would not fail to thoroughly explain the full risks of any common procedure, and would not assume that they are the ones who makes decisions in your birth.
Every individual has different preferences in their care and it is important that you Care Provider is in tune with your needs and your Birth Wishes. A group of experts in birthing care came up with this list of 10 things to look for in a care provider and ask about. Medical research supports all of these things. Be sure to find out how the people you talk with handle these ten issues about caring for you and your baby. You may want to ask the questions below to help you learn more. Click here for care provider definitions.
1. Ask, "Who can be with me during labor and birth?"
Mother-friendly birth centers, hospitals, and home birth services will let a birthing mother decide whom she wants to have with her during the birth. This includes doulas, fathers, partners, children, other family members, or friends.
2. Ask, "What happens during a normal labor and birth in your setting?"
If they give mother-friendly care, they will tell you how they handle every part of the birthing process. For example, how often do they give the mother a drug to speed up the birth? Or do they let labor and birth usually happen on its own timing? They will also tell you how often they do certain procedures. For example, they will have a record of the percentage of C-sections (Cesarean births) they do every year. If the number is too high, you'll want to consider having your baby in another place or with another doctor or midwife.
Here are some numbers we recommend you ask about:
Mother-friendly birth centers, hospitals, and home birth services are sensitive to the mother's culture. They know that mothers and families have differing beliefs, values, and customs and they will support you in doing what you want to do.
4. Ask, "Can I walk and move around during labor? What position do you suggest for birth?"
In mother-friendly settings, you can walk around and move about as you choose during labor. You can choose the positions that are most comfortable and work best for you during labor and birth. (There may be a medical reason for you to be in a certain position.) Mother-friendly settings almost never put a woman flat on her back with her legs up in stirrups for the birth.
5. Ask, "How do you make sure everything goes smoothly when my nurse, doctor, midwife, or agency need to work with each other?"
Ask, "Can my doctor or midwife come with me if I have to be moved to another place during labor? Can you help me find people or agencies in my community who can help me before and after the baby is born?"
Mother-friendly places and people will have a specific plan for keeping in touch with the other people who are caring for you. They will talk to others who give you birth care. They will help you find people or agencies in your community to help you. For example, they may put you in touch with someone who can help you with breastfeeding.
6. Ask, "What things do you normally do to a woman in labor?"
Experts say some methods of care during labor and birth are better and healthier for mothers and babies. Medical research shows us which methods of care are better and healthier. Mother-friendly settings only use methods that have been proven to be best by scientific evidence. Sometimes birth centers, hospitals, and home birth services use methods that are not proven to be best for the mother or the baby. For example, research has shown it's usually not helpful to break the bag of waters.
Here is a list of things we recommend you ask about. They do not help and may hurt healthy mothers and babies. They are not proven to be best for the mother or baby and are not mother-friendly.
The people who care for you should know how to help you cope with labor. They should know about ways of dealing with your pain that don't use drugs. They should suggest such things as changing your position, relaxing in a warm bath, having a massage, and using music. These are called comfort measures.
8. Ask, "What if my baby is born early or has special problems?"
Mother-friendly places and people will encourage mothers and families to touch, hold, breastfeed, and care for their babies as much as they can. They will encourage this even if your baby is born early or has a medical problem at birth. (However, there may be a special medical reason you shouldn't hold and care for your baby.)
9. Ask, "Do you circumcise baby boys?"
Medical research does not show a need to circumcise baby boys. It is painful and risky. Mother-friendly birth places discourage circumcision unless it is for religious reasons.
10. Ask, "How do you help mothers who want to breastfeed?"
The World Health Organization made this list of ways birth services support breastfeeding:
Below are definitions of various types of care providers in pregnancy. As your doula, I am happy to provide references based upon your wishes.
Certified Nurse Midwife: Has graduated from a school of nursing, passing an exam to become a registered nurse and has completed one or more years of additional training in midwifery. His/Her education focuses on normal health care during the childbearing years, parent education, and prevention and screening for possible problems and newborn care. He/She specializes in the care of uncomplicated, normal pregnancies and births. To become certified he/she must pass an exam administered by the ACNM.
Certified Professional Midwife: Has graduated from a midwifery school and completed an apprenticeship with an experienced midwife or has completed an extensive apprenticeship with an experienced midwife. The focus of her education is health care during the childbearing period, parent education, prevention and screening for possible problems and newborn care. They specialize in the care of uncomplicated, normal pregnancies and births. To become certified she must pass both a written and skills exam administered by NARM.
Lay/Direct Entry Midwife: Has completed an apprenticeship with an experienced midwife. May have attended additional workshops and classes to supplement her education or she may have attended a midwifery school. Her focus is on homebirth and birth center births and the care of uncomplicated, normal pregnancies and births. She may be affiliated with a medical doctor but she is not under the physician’s directive. She is either in the process of becoming certified or chooses not to be certified.
Family Practice Medical Doctor: Has graduated from medical school and completed two or more years of additional training in family medicine. The focus of education is on the health care needs of the entire family. To qualify for board certification, her/she must pass an exam administered by their professional society.
Obstetrician: Has graduated medical school and has three years of clinical and surgical training in the gynecology and obstetrics (the pathology of pregnancy, labor and birth). Much of the focus of the education is on detection and treatment of problems. To qualify for board certification, her/she must pass an exam administered by their professional society.
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