Tuesday, February 15, 2011

Finding The Provider For You

One of the very first things you need to do before finding the provider that fits with you is finding out what you believe about pregnancy and birth. If you don't know what you want, you won't be able to find a perfect fit.

Not only do you need to know where you want to give birth, but what you want to happen.

Do you believe birth needs to be managed, that it needs to be medicated and numbed? Do you believe birth is a natural bodily function, that needs to be worked with rather than feared?

Depending on how you view birth depends on what kind of provider you will be looking for.

There are two agreed models of care. There are many layers inbetween the two, but these are the basic foundations either side bases their practice and thoughts on.

I got these from Natural Parenting, they are just perfect for the definitions
Obstetric Model:
Basic Principle - Separation
1. Mechanization of the body
2. Isolation and objectification of the patient
3. A focus on curing diseases, repairing dysfunction
4. Agressive, interventionist approach to diagnosis and treatment
5. Alienation of the practitioner from patient
6. Reliance on external diagnosis
7. Supervaluation of technology
8. Hierarchical organization, the patient as subordinate to practitioner and institution
9. Authority and responsibility inherent in the practitioner

Midwifery (Holistic) Model:
Basic Principle - Connection
1. Views the body as an energy system interlinked with other energy systems
2. Insistence that total healing requires attention to the mind-body-spirit-emotions-family-community-environment
3. A focus on creating and maintaining health and well-being
4. Nurturant, relational approach to diagnosis and treatment
5. Essential unity of practitioner and client
6. Respect for the value of inner knowing (instinct)
7. Technology at the service of the individual
8. Lateral, webbed organization - networking
9. Authority and responsibility inherent to the individual (true informed consent and refusal)
Now, not every Obstetrician believes in the Obstetrical model and not every Midwife believes in the Midwifery model. I know some that are in different camps.

Which is where knowing what exactly you want comes in handy. If you are able to understand what kind of birth you want, if you are able to understand what kind of relationship you want with your practitioner, it is that much easier to find someone that clicks with you. A provider that agrees with you and will treat you as such.

Once you realize what you want, then you can go about finding the provider that fits. Whether that is the obstetrical model or close to it or so far from it you are at unassisted birth, you have made the first step to taking charge of your own birth. You have made the first step to finding out what YOU want and now you can go about finding the provider that fits with you.

When you decide to go about interviewing providers, one of the best things, especially if you want a natural birth, is to ask doulas, childbirth class teachers, La Leche League leaders, and anyone else that works in the birth community. I know a lot of people find their doctors through their friends, but know that what one person wants might not be what you want. Just because that midwife or doctor was great for your friend does NOT mean they will fit for you, even if you both want the same kind of birth. The best way is to truly find impartial support that has worked with all the providers, like the ones I listed a bit ago.

Have a list of at LEAST three different providers to interview if you can. That way you get different opinions, you interview more and you are able to better find someone that can fit with you.

Some great things to do, regardless of whether they are a midwife or a doctor are:

1. Make sure they are accepting new patients, and make sure they aren't overbooked. If your provider is overbooked for the month you are due, they won't be able to give you the attention you deserve during pregnancy and labor.

2. Write all your questions before going in. It is really easy to forget what was important when you start talking, and having them all written down can help you remember, and that way you don't regret not asking things.

3. Bring your partner with you! You both need to feel comfortable with this person, especially if your partner is going to play an active role in the labor and delivery.

4. Give them the benefit of the doubt until you learn otherwise. Don't go in there thinking they will be opposite or that you know what their answers will be. Go in with an open mind.

5. Make them give you specific answers. If you ask about their cesarean rate, don't let them say "it's average". Have them give you a percent. You need to know specifics so you can make an informed decision.

Some great questions you can ask:

1. How many babies they have "delivered" (I hate that word, a baby isn't a pizza)

2. Who you can contact in an emergency

3. Who covers for them if they are unavailable

4. How they handle high risk pregnancies

5. If they will help you write a birth plan and help you with what you want to do.

6. Ask about their percentages for:
-Transfers (mainly for homebirth or birthing center midwives)

7. Ask what practices they use that are routine (ie: vaginal checks before labor/during labor, electronic fetal monitoring, IVs, food and drink in labor, using water as pain relief, waterbirth, how they want you to give birth/if you can choose your own position, what happens to the baby after birth, if baby is suctioned, if baby is bathed, rooming in policies, etc)

8. When they want you to call (if homebirth) or come in (hospital/birth center) once you are in labor

9. What they do if your water breaks before labor

10. If a midwife, do they transfer your care for anything? If so, what/why do they transfer for?

11. What they consider overdue.

12. What they do if you reach 42 weeks or their definition of overdue

13. How long their average prenatal visit is

14. If in the hospital or birthing center, do they give you the consent papers before or during labor?

15. How often do they use ultrasound in normal low risk pregnancy

16. Do they use ultrasound to find baby's position or do they palpate the belly

And this is just the bare minimum! There are so many more questions that you can ask, depending on your own personal views on birth. The one thing to remember is to get straight answers, not "yes/no/maybe". You need someone that will be honest with you, not someone that is just in it for the paycheck.

Also, see if you can get referrals to patients they have used. See if you can talk to other families while you are in the waiting room. Talk to the nurses and assistants they have. A lot of what you will learn will not be from the actual interview, but what you see and hear around the office.

And ultimately, remember that this choice is never set in stone. Until that baby is born, you can change your mind. You can fire your provider at any time, even during your labor. It isn't set.

Your provider should not be restricting you during YOUR labor and delivery. You shouldn't be made to do anything. You are paying them, they are providing a service. Get what you pay for and don't stand for anything less.


Julian@connectedmom said... [Reply to comment]

oh how I wish I had read this befor Oliver was born!

Shawna said... [Reply to comment]

And people ask why I am so set on going to a birth center for my VBAC next time . . . =)

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