You’re Pregnant! Now What?
You just found out you’re pregnant! Congratulations! Now you may be thinking, “where do I start?”
Let me tell you about the one aspect of your pregnancy and childbirth experience that will make all the difference, and not a decision that should be taken lightly.
The answer is… your care provider! Yes, your obstetrician, family doctor, midwife, or whomever you choose to deliver your baby and look after you for prenatal care (and don’t forget they will be looking after you in the postpartum period as well).
Why is this the most important aspect of your pregnancy and birth? Because this is the person you will be working with to bring a human being into the world. You will be relying on your care provider for:
- Answers to your questions.
- Advice on medical decisions about your body and your baby.
- Guidance through the whole process (a doula is also a great investment and guide!).
Depending on where you are giving birth in the world, this process is going to look different. Some of you may have ample choice between care providers. You may be free to choose whether you want an obstetrician, a family doctor, a midwife, or another type of care provider. Some of you, unfortunately, may have limited choice.
So why am I telling you this, and why does it matter so much who helps you get your baby out?
Have you heard of the medical versus midwifery model? If not, let me tell you more about them.
These models define the way pregnancy, labor and birth is viewed and therefore how you and your baby are treated throughout the course of your prenatal care, labor and postnatal care.
The Midwifery Model
The midwifery model of care has high confidence in the natural birth process. It believes that woman’s bodies are not flawed, and if given the chance and adequate time, the baby will come without problems. This means woman are supported to let labor take its normal, physiological course of action without interventions.
The midwifery model is predominantly made up of midwives, who are highly trained professional’s. They can step in when there is an issue, or when they believe there may be an issue arising.
They refrain from intervening in a normally progressing labor as to not introduce any complications. When intervening, they will start with the least invasive methods and progress from there. Midwives know when they need to refer the mother to an obstetrician.
When it comes to prenatal (and postnatal) care in the midwifery model, appointments are long and not rushed. Since birth is viewed as emotionally transformative and a womans state of mind can affect labor, they focus on your health individually and more holistically.
You will be asked questions about your mental health, your eating habits, exercise habits, along with many other aspects of your health. If you are having trouble in any of these area’s, you will be directed to resources for a solution or be provided with a listening ear if that is all that is needed.
Information is given on certain prenatal test’s and you are asked if you would like to participate or not. You are encouraged to think about your decisions and make informed medical choices for yourself and your baby.
The Medical Model
The medical model views birth as dangerous and risky. It is no wonder because an obstetrician, which makes up the majority of care providers practicing in this model, is trained to care for woman with high risk pregnancy’s, who are at high risk for complications or who do have complications.
When an average, low risk woman (85-95% of woman) is seen by an obstetrician practicing in the medical model, they are being given care that views pregnancy as an illness and inherently dangerous.
The medical model is set on managing risk, which can mean interfering before there is a problem. Many risks are discussed, and sometimes unfortunately, exaggerated. This creates an atmosphere of fear towards birth.
Medical interventions are seen to improve labor and birth, rather than letting labor take its natural course, undisturbed. Caregivers may use interventions that have the fastest effect, rather than starting with the least invasive and working up, like seen in the midwifery model.
The Cascade of Interventions
Some people are reassured by the use of technology and interventions, but research shows this isn’t always the safest way to care for mother and baby. This is where, what is called “the cascade of interventions”, starts.
This means that when one intervention is started, it may lead to more and more interventions being needed. This introduces more risks for the mother and baby that were not there before. For example:
- Pitocin is used to begin an induction (artificial oxytocin, the hormone that makes contractions happen).
- This causes contractions to be longer and stronger than naturally occurring ones.
- This usually leads to woman asking for an epidural because the pain is stronger than natural contractions.
- Epidurals create the risk of longer labor and the need for more Pitocin, abnormal heart rate patterns in baby, and therefore a vacuume or forceps birth or cesarean section.
Interventions should only be performed when the benefits of using them outweigh the risks. This is why it is important to learn about the risks and benefits of the many interventions used in childbirth.
The prenatal care in the medical model, may focus on looking for abnormalities, and closely monitoring for problems. Visits are usually short and may not leave much time for questions. The emphasis of appointments is to go over test results and numbers. Prenatal tests are presented as routine rather than optional. All tests are in fact, optional.
Ask Good Questions
As you can see there are many differences to these two models of care. I want to make it clear, that these are models of care, not a reflection on any care provider specifically.
Although it may be called the “midwifery” model and “medical” model, some obstetricians practice within a midwifery model, and some midwives practice within a medical model. This is why it is important to interview your care provider and ask good questions.
Now that you understand the different models of care, you have a better idea of what you will be dealing with when you choose a provider. If you have the option to interview providers, do so. Interview from both models of care, if you wish.
Maybe you are someone who absolutely would never think of giving birth anywhere other than in a hospital. Find out if midwives in your area can support your birth in the hospital, many do.
If you’re set on having an obstetrician or that is your only available choice, make sure to interview more than one. Even if you like the first one, interview at least one more. You will have no opportunity to notice differences if you only speak to one.
What Do I Do Now?
Now that you know you need to choose a provider very carefully, what are your next steps?
The next step would be to learn what informed decision making and evidence-based care is. This way, when you go to interview your potential provider, you will be able to ask good, strong questions that will get you good, strong answers. A good, strong answer is one that is based on current, reliable scientific evidence.
Questioning Your Care Provider
When questioning your care provider they should be ready and willing to answer your questions. They should give you appropriate, thoughtful answers and be happy to provide a more in depth explanation of anything you ask.
You should never feel like your questions are being brushed off, ignored or rushed. If the care provider is answering with sarcasm, or scare tactics beware that this may spill into how they care for you. Know that you can always change care providers, no matter how far along you are in your pregnancy.
Remember, you are choosing this person to help you bring a human being into this world, that is no small decision! Choose carefully and be as informed as possible!
For more in-depth knowledge and information check out the following resources I used to compile this post:
- Pregnancy, Childbirth and the Newborn by Simkin, Whalley, Keppler, Durham & Bolding.
- The Official Lamaze Guide by Judith Lothian and Charlotte DeVries.
- Pocket Guide to Comfort Measures for Labor & Delivery by Rebecca Dekker and Anna Bertone.
You can also read my birth story here. My birth was with midwives who practiced in the midwifery model. I was extremely happy with the care I received.
Which model of care did you have? Did you feel heard and well cared for by your care provider? Let me know in the comments!