Finding the Right Health Care Provider and Birth Place

Why finding the right health-care provider and birth place for you are so important.

By Ann Grauer, CD(DONA), PCD(DONA), LCCE, FACCE

Maybe you haven't started buying baby gear yet, but there are two major items that you should be shopping for: a birth place and a health-care provider. If you're healthy and have a low risk of complications, having a planned birth at home or free-standing birth center is just as safe as at a hospital.

Location, Location, Location

A comfortable environment that makes you feel relaxed and supported will help your body move through the important process of giving birth. You have a much better chance of giving birth without medical interventions if you're surrounded by people who share your birthing goals. Should the need for medical interventions arise it is important to know which interventions are available at your birth place and what processes are in place should you need to change locations during the birthing process. Take some time to research your options and choose a birth place that is the best fit for you.

At a birth center or your home (attended by a midwife or doctor), you'll have a team trained in labor support that sees birth as a normal life event rather than an emergency waiting to happen. Most healthy women can choose to give birth in a birth center or at home. If you have a serious medical condition, or are at a higher risk of developing a complication in pregnancy and/or labour, you will likely want to opt for a hospital birth with an obstetrician.

If you choose to give birth in a hospital, there are a few things you should be aware of. Many hospitals routinely rely on medication and technology, rather than using them only when you need them for a specific problem. Although it tends to be harder to relax and work with your labor in a hospital, but it doesn't have to be. Choose a hospital that encourages you to stay active in labor and does not impose a lot of restrictions on you (like not eating or drinking and requiring continuous electronic fetal monitoring). The support and encouragement of people who know you and who care about you will help you feel safe in an unfamiliar place. You also might want to consider hiring a doula. A doula is a professional support person who provides continuous emotional and physical support during labor and birth.

Midwife? Physician? Obstetrician?

Your next step is finding a health-care provider who works in the birth place you've chosen. A doctor who gives a good gynecological exam may not be the best person to guide you through pregnancy and birth. Take time to consider the following three options:

• A MIDWIFE provides pregnancy and birth care. They have deep respect for the natural process of pregnancy and birth. Certified midwives (CMs), certified professional midwives (CPM), and certified nurse midwives (CNMs) have advanced training and have passed rigorous certification exams; CNMs usually have a master's degree. Studies show that midwifery care is not just safe but is very appropriate for healthy, low-risk women.
• A FAMILY PHYSICIAN provides comprehensive medical care, including prenatal care, which recognizes that most pregnancies don't require intervention.
• AN OB/GYN is a surgeon who specializes in the care of the female reproductive system, including prenatal care and childbirth. Family physicians and midwives will refer you to an OB/GYN if complications arise.

Trust Your Instincts

Ask your friends and coworkers who are already moms about their providers and interview those that sound promising. Above all, listen to your gut. If something doesn't feel right, that provider isn't for you.

If at any time you don't feel comfortable with your health-care provider or planned place of birth, it's okay to look around and consider making a switch. The insight you gain during the months of pregnancy may lead you to realize that who you chose in the beginning is not who you wish to have with you at birth. When the big day comes and you have a trusted provider by your side, you'll be glad you took this decision seriously.

For More Information

There are several helpful decision-making tools available for choosing a birth place and care provider. Some of these include:

• Informed Decision Making FAQ
• Choosing a Care Provider
• Changing your Care Provider
• Childbirth Connection tips on choosing a birth location and care provider
• American Association of Birth Centers' information for parents
• The Leapfrog Group's information on U.S. hospital rates of early elective deliveries and maternity care (click 'safety of selected procedures' and check the box for 'high-risk deliveries')
• International Cesarean Awareness Network's resources on access to vaginal birth after caesarean (VBAC) in hospitals near you
• Transforming Maternity Care's list of other helpful information aboutmaternity care in your state.
• More information on midwives (MANA) (ACNM)
• Find a midwife in the US (MANA), (ACNM)
• Find a midwife in Canada
• American Congress of Obstetricians and Gynecologists' physician directory