Choosing a Provider- Where Do I Start?

Choosing a pregnancy provider who will positively support you throughout your pregnancy and birth experience is without a doubt one of the single, most important decisions you will make on your journey to parenthood. Pregnancy providers- whether they are midwives, family doctors or OBs, have different understandings and approaches to pregnancy and birth.  Being aware of these different approaches to birth and finding one that works for you does not need to be a difficult experience.  Here are some factors for you to consider when you are choosing a supportive pregnancy provider.

Never, Ever Too Late to Switch Providers

I initially thought about putting this tip last, but because of how important it is, I want to emphasize it early on.  It is ABSOLUTELY, POSITIVELY NEVER TOO LATE to switch providers in pregnancy.  And I mean, never too late! I have personally seen clients switch providers at 36 weeks pregnancy, others at 38 weeks- one week before they ended up having their babies, and clients who literally switched providers while in labor- hours after the mother’s waters had released (water broke)! None of these families ever regretted their choice to move away- once it had become clear to them that their original pregnancy provider couldn’t provide them with the support they were looking for.  Many times this becomes apparent late in pregnancy and each one of them made the conscious choice to choose a more supportive pregnancy provider.  If you ever find yourself entertaining this decision, my advice would be to not hesitate.

Consider a Midwife (whether in a hospital-birth setting, birth center or for a homebirth)

There are three types of providers who are trained in caring for you during your pregnancy and birth- midwives, family doctors (much less utilized nowadays) and OB/GYNs.  Midwives are specifically trained in how to care for women during their healthy, low-risk pregnancies and birth.  During birth, they are trained in how to handle emergencies that may arise (whether it’s postpartum hemorrhage or neonatal resuscitation) and when/how to call in on an OB’s expertise as it is needed.  Midwives view pregnancy and birth as a natural, physiologic process that requires little intervention; yet they also recognize situations that need closer monitoring and care, and are able to transfer care to a specialist as needed.

I’m personally emphasizing midwifery care here because it is a very much under-utilized aspect of pregnancy and birth care that can significantly help improve our birth outcomes in the United States.  Other countries world-wide recognize this and use midwifery care much more than we do in the US; their maternal outcomes are much better than what we have here.

A few things to note- Some midwives support births in a hospital-setting if that is what you are more comfortable with, and others support births in birth centers and at home births.  They also provide general annual well-woman care outside of pregnancy, including pap smears, breast exams for continuity of care after pregnancy and birth.  It is important to note, not all midwives practice in the same way- some are limited by their hospital, insurance coverage, training and/or consulting OB in their approach (whether they support VBACs, time limits on breaking/releasing of waters, pregnancy going beyond 41 weeks, etc).

 Location and Insurance Coverage

Some people tend to look for a pregnancy provider who is closest to their home or place of work.  Although this is a positive, it should not be your main factor in choosing a provider.  Traveling 35 minutes each way monthly/weekly to visit a more supportive midwife or OB practice is really and truly worth it.  They can make all the difference in your pregnancy and birth experience!

Insurance coverage is a limitation for many families, but I have also worked with single-income and middle income families who chose to invest in the birth provider of their choice.  If your insurance does not cover providers who you think will be most supportive of your plans, consider what you can do to invest in a more supportive provider.  Out of hospital midwives provide fair price packages that include the complete prenatal, birth and postpartum care.

Location of Birth

Think about where you would feel most comfortable, relaxed and in your element when you are giving birth.  The environment you are in makes a huge difference in your birth hormones– and those birth hormones drive your birth.  For some people this might be a hospital setting, for others it might be a birth center or at home.  These different places have their different pros and cons, and consulting with a local birth expert might help you figure out what your best options are.

Recommendations From Local Doulas, Birthworkers & Parents

One of the best ways to find out who the supportive providers in your community are is by reaching out to local doulas and birth workers for their knowledge and experience.  Many times, these doulas can give you advice on what local families have experienced with this provider or they can share questions that you can ask your potential provider to understand their approach more.  Doulas and birth workers can often tap into a national network of doulas to share with you info on best local VBAC providers, supportive providers, etc.  I have a list of some of some great providers local to the NOVA and DC Metro area here (not a comprehensive list).  Some of them are better for different situations, and not all of them will be the best provider for you.  Reach out if you want to explore which option might work best for you.

Another great resource are local online Facebook groups and parents’ groups who may share similar perspectives on pregnancy, birth and parenting with you.  For one, ICAN has many local chapters (International Cesarean Awareness Network) that have online Facebook groups and meet in person monthly to provide support to families who have underwent cesareans and families who are seeking VBACs.  The ICAN of Northern Virginia has a Facebook group for parents who have had a cesarean and are looking for peer support.  Many times, people share with each other their experiences with local providers when they were seeking a VBAC, etc.  You can join that Facebook group here.

Interview Your Provider and Ask Questions

Along with these different factors that you want to take into consideration, here are some quick interview questions to ask when choosing a supportive provider.

• • What is your protocol if I go over 40 weeks pregnancy? Some providers will want to induce at 40 weeks, 41 weeks and others at 42 weeks pregnancy.  Inductions generally lead to higher rates of cesareans and affect the hormones of birth, breastfeeding and bonding in different ways.  Consider a provider who will not induce before 42 weeks of pregnancy.  You may end up giving birth at 39 weeks and not needing any of this.  On the other hand, you may reach 40 weeks still pregnant, and then start feeling the pressure and added stress of a provider who wants to induce you when you are not desiring it.  Factors like ‘advanced’ maternal age (over 35 years), gestational diabetes, etc, can affect this from one provider to the next.
  • What is your protocol if my water breaks (releases) before pressure waves (contractions) start?  Some providers want to induce immediately, others will wait 8-24 hours if birth waves (contractions) have not started on their own.  Some will want baby born within 12 hours, others will personalize your care and as long as mother and baby are healthy,  allow birth to unfold over a number of days in some cases.
  • Does the place you support birth at include options other than continuous monitoring during labor (e.g. auscultation or intermittent monitoring of baby)?  If not, consider a provider who supports births elsewhere.  Research and evidence are showing more and more that continuous fetal monitoring does not improve results for baby or mother and leads to higher incidences of cesareans.
  • What are your cesarean rates? Induction rates?  VBAC rates? Assisted birth rates?  Transfer rates (for a birth center or homebirth midwife).  Your chance of having one of these will be as high as your provider’s rates.  Ask about the rates at the hospital you will be birthing at as well.
  • Do you have time limits on my labor if baby and I are doing well?  How about time limits on how long I can push once I’m in 2nd stage? Some providers put a 2 hour time limit, despite recommendations by ACOG for a minimum of 3 hours for first time moms (+1 if on an epidural).
  • Do you support my desires for delayed cord clamping? Immediate skin-to-skin for baby?  Eating in labor?!- Yes, this will also be affected by the hospital your provider supports births at.  Since eating and having energy in labor is recommended by many international organizations, and even ACOG (the American College of OBs), then yes, a place that does not support this is NOT an ideal place for you to give birth.

Finally, I want to emphasize that there is not one perfect provider for everyone.  Some providers are perfect for the births that follow a very ‘average’ timeline, but not great for those who have certain unexpecteds that arise during labor.  Because your birth is one of those great unknowns, it is best to stack the odds in your favor with a provider who will give you the best options in any case that may arise.  And as always, as long as you have done your best, the rest will come.