Choosing a Prenatal Care Provider

The type of care the pregnant woman wants should be reflected in who she chooses to provide her care. Unfortunately, though, not all varieties of care are found in all areas. Most women in the US go to an obstetrician for the duration of their pregnancies, and the highest number of patients admitted to hospitals in this country are women about to have a baby.

When I was pregnant for the first time, I signed up with an OB just like everyone else I knew. I picked a female because I had heard so many other women say that they felt more comfortable with female doctors, especially in this situation. Women are more sympathetic because we're all on the same side, right? I'm sure that's true for many female MDs. I can't say whether it was true for mine or not because I barely saw her. Halfway into my pregnancy, after I had done some research and decided that I wanted to try to have a natural birth, I was also considering a home birth. I spoke to another woman who had brought up the issue of home birth with our shared OB, whose reply was, "What, do you want your baby to die?"

I never went back to that OB, because I found a perfect combination of support for natural birth and quick medical attention if necessary. In a suburb of my community was a small hospital which had the ideal arrangement. The prenatal clinic was run by midwives in conjunction with OBs, but the doctors only saw the high-risk pregnant women; all "normal" (low-risk) pregnancies were directed to the midwives. The hospital had a birthing center attached, run by the midwives, and was equipped with labor pools, a doula program, and comfortable, single-patient labor rooms and a separate postpartum wing. If anything went wrong, the doctors were around the corner, and an emergency surgery room was not far. The emphasis, though, was on non-interference with the natural rhythms of labor and birth. Both of my babies were born there, the second in a warm pool of water.

This is an extremely rare arrangement. I don't believe many places like this clinic and hospital exist throughout the country. Most women will have to choose between doctors and midwives, between hospitals and home birth (or a freestanding birth center). Most of the time, that decision is between two different worlds.

My experience with obstetricians was rough, and I found mine to be cold and clinical, emphasizing the pathological side of birth. She stressed interventions (she tried to convince me to get an amniocentesis for my first pregnancy, even though I was young and wouldn't terminate even if the results showed anything) and rooted my fears that somehow birth is unnatural and needs to be carefully watched and managed. I believe that there is a place for obstetricians, and it is not with normal birth. Not many OBs have ever even seen a normal birth. Midwives specialize in this area, and their personalized support and desire to educate spreads enthusiasm instead of fear. I understand that this is an oversimplification, because of the polarization of doctors and midwives. In my current community, if a woman wants a natural birth without interventions but not a home birth, her best option is to see the only local OB who is sympathetic to this point of view. One local doula says that if you don't want a c-section here, you need to arrive at the hospital while you're pushing.

My point in telling all of this is that the person a pregnant woman chooses to give her care, does matter, especially for first-time mothers. As a society we keep believing that doctors always have our best interests in mind and always know the best things to do, and women having their first babies have been taught to be scared and to doubt their ability to handle giving birth. In some cases doctors do have expertise, but I don't believe as a whole that doctors should have so much jurisdiction in the area of normal birth. Doctors are trained to interfere, not to stand by and let nature take its course. Doctors are impatient and have schedules and many patients. They give stimulating or inhibiting drugs so that labor follows a prescribed course, an action especially dangerous for first-time mothers, who usually need more time to give birth. If a woman's OB disagrees with her about what kind of birth she wants, she will probably not get what she wants. I have very rarely seen or heard of anything that contradicts these statements.

I wish all communities had both doctors and midwives, but at least doulas can be found in most areas now. Doulas are a step towards filling the void in personalized care, but the same rule applies to them as applies to both doctors and midwives: the most important thing is that the pregnant woman feels comfortable in their presence, secure in the knowledge that her care provider will give her the kind of care she desires and will support her in her reasonable decisions.

Still more to come!