Your Birth, Your Choice- Understanding Your Options for Care Providers
Curating Your Team
Welcoming a new life into the world is a journey filled with excitement and anticipation. As you prepare for this incredible experience, one of the most crucial decisions is selecting a prenatal care provider. When you feel confident in your provider and believe you are partners in the decision-making process, you're more likely to have an empowered and satisfying birth experience, regardless of the outcome.
Questions To Ask Yourself When Choosing Your Birth Team
● Do I feel autonomous?
● Do I feel heard?
● Am I treated with respect?
● Am I respectfully given an informed choice with the option of informed refusal?
● Is my care collaborative or hierarchical?
● Do I feel comfortable asking questions?
● When I ask questions, am I satisfied with how they are answered?
● Does it feel right?
● Does my gut agree with my head & my heart about who I’m working with?
Your choice of care provider will influence your entire prenatal, labor, and postpartum experience. There are several types of care providers, each with their own approach to childbirth.
Midwives
The midwifery model of care is a holistic approach to childbirth that emphasizes individualized, patient-centered support throughout pregnancy, labor, and postpartum recovery. Unlike traditional obstetric care, which often focuses primarily on medical interventions, midwifery prioritizes the physical, emotional, and psychological well-being of the mother and baby. They are experts in physiological birth! This model encourages informed decision-making, fostering a collaborative partnership between the midwife and the expectant parents. They also specialize in well-person reproductive and perinatal health care but are not trained as surgeons.
There are many different credentials and titles that midwives hold, and each midwife’s path is as unique and diverse as birthing people are. Whichever title or training your midwife holds, they should bring a high standard of holistic care throughout your time together.
Types of Midwives
• Certified Nurse Midwives (CNM) are nurses with medical training, who specialize in reproductive care. They often focus on a more personalized and holistic approach than traditional nurses, emphasizing natural birth and minimal interventions when possible. Wilmington has certified nurse-midwives (CNMs) who are trained to handle low-risk pregnancies and can provide care in various settings, including hospitals and home births. It is important to note that CNMs follow the most medicalized path to midwifery, and are most likely to work in hospitals or in a combination of spaces (hospital + birth center; hospital + home birth).
• Certified Professional Midwives (CPM) are trained as community health providers who specialize in reproductive care. They are certified through a national organization, such as the North American Registry of Midwives, and undergo rigorous education and clinical training to ensure high-quality, safe care. They generally prioritize natural birth practices, with an emphasis on minimal interventions. Their holistic approach is rooted in respecting the natural process of childbirth and ensuring informed choices for the individual. CPMs offer support for home and birth center births. CPMs are generally not permitted to practice in hospitals. In North Carolina, CPMs are licensed to provide care in home and birth center settings, but hospital privileges are typically reserved for licensed physicians and Certified Nurse Midwives.
• Direct Entry Midwives (DEM) are trained through apprenticeships and midwifery schools. They may also pursue state-approved licensing. Their training typically focuses on providing care during pregnancy, labor, birth, and postpartum. DEMs are qualified to provide care in home or birth center settings and focus on supporting low-risk pregnancies and natural births. In North Carolina, Direct Entry Midwives are not allowed to practice in hospitals. They are legally allowed to provide care in home or birth center settings, but they do not have hospital privileges. However, they may collaborate with physicians or CNMs for medical interventions or hospital transfers if needed
• Lay Midwives are usually trained through apprenticeship or self-study, rather than attending an accredited midwifery school or obtaining professional certification. They may provide prenatal, labor, birth, and postpartum care in home or birth center settings, and may be sought by families looking for a more traditional or holistic approach to childbirth. In North Carolina, lay midwives are not legally recognized as licensed practitioners and are not allowed to practice in hospitals.
Because there is a wide range of midwifery models, and because regional and local policy can greatly impact both the scope of midwifery practice and the settings in which midwives can serve, it is important to clarify what type of midwifery care is available in your area. You can find a list of midwives local to Wilmington, NC, on my resource page here.
OB/GYN
Obstetricians (OBs) are medical doctors specializing in pregnancy and childbirth. Obstetrician/gynecologists work in well-person reproductive and perinatal health care and are trained as surgeons. They are well-suited for high-risk pregnancies or if you prefer a more traditional medical approach. They are experts in treating perinatal complications and patients who are higher-risk. Nearly all OB/GYNs attend births in hospital settings. Wilmington has a number of experienced obstetricians who practice at our local hospital. There are also several OB/GYN offices in the area who practice alongside midwives.
It’s important to note that because of the training and experience OB/GYNs receive, they may have less familiarity with clinically healthy, low-risk pregnancies and physiological birth. Combined midwifery + OB/GYN practices are a good fit for many patients, regardless of risk status, and provide a more person-centered care model with increased access to medical technologies.
You can find a list of OB/GYNs and combined midwifery + OB/GYN practices local to Wilmington, NC, on my resource page here
Family Physicians
Some family doctors also provide prenatal and obstetric care. They offer a holistic approach and can be a good option if you prefer continuity of care with a provider who knows you well.
Maternal-Fetal Medicine Specialists
For high-risk pregnancies, these specialists offer advanced care and monitoring. They often work alongside OB/GYNs to provide extra support and expertise.
Doulas
While not medical professionals, doulas provide invaluable support during labor and birth. They offer physical, emotional, and informational support to individuals during pregnancy, childbirth, and the postpartum period. They assist expectant parents by offering guidance on birth plans, coping techniques for labor, and comfort measures, such as massage and relaxation techniques. Doulas also serve as advocates for the birthing person, helping to facilitate communication with healthcare providers. Their primary focus is to ensure a positive and empowering experience for the family, providing continuous support tailored to the individual's needs.
Family & Friends
Birth is not a spectator sport!
Everyone attending your birth has a role to play. Your comfort and safety are the most important factors when choosing your birth team.
As mammals, our labor process is similar to other animals, like cats, who seek a dark, quiet, and private space to give birth. They may even pause labor if they sense they’re being observed or feel unsafe. Humans experience the same hormonal responses—if we don’t feel completely safe, our bodies release stress hormones that can halt or slow contractions and increase pain. Even pressure from a provider or loved ones can trigger stress, delaying labor.
Stress hormones can overpower oxytocin, making it harder to relax and progress in labor. This response is unconscious and cannot be rationalized away. A common issue arises when a friend or family member from out of town stays with the pregnant person, eagerly observing for signs of labor. Their excitement and anxiety about the birth may unintentionally create stress for the pregnant person, further delaying labor. We recommend that out-of-town guests stay elsewhere, not in the home of the pregnant person, to avoid this stress.
Some suggestions of criteria when choosing who will attend your birth:
❏ They are comfortable around nudity
❏ You will be comfortable being nude around them
❏ They are comfortable with your chosen birth plan and environment
❏ They will not get scared when labor gets intense
❏ You will not be stressed around them when the labor gets intense
❏ You can let go and get “primal” in front of them
❏ They will not be offended if you ask them to leave at any time in the labor and birth
❏ You will feel comfortable asking them to leave at any time in the labor and birth
❏ They won’t bring drama or their own agenda
If you are left with unchecked boxes, you may want to have a conversation with your support team before making any decisions on who’s invited to attend your birth.
Making Your Decision
Sometimes the biggest risk factor in our birth is the provider we choose. The doctor or midwife you choose to attend your birth increases or decreases your risk of achieving the birth outcome you desire. Here are some additional questions to consider.
When choosing a care provider and birth location, also consider the following factors:
Consider Your Birth Preferences
Your birth plan can significantly impact your choice of provider. Reflect on your preferences and research how different providers align with them:
Hospital Birth vs. Home Birth: If you’re leaning towards a hospital birth, OB/GYNs and some CNMs will be ideal. If you’re considering a home birth, a CNM with experience in home deliveries would be a better fit.
Pain Management and Interventions: Discuss your preferences for pain management and medical interventions. Some providers are more supportive of natural birth techniques, while others may be more inclined to recommend medical interventions.
Your Birth Plan: Think about your preferences for labor and delivery. Do you want an unmedicatedl birth, or are you considering pain management options? Your birth plan will influence the type of care provider and birth setting that best suits your needs.
Medical History and Risk Factors: If you have any medical conditions or risk factors, choose a provider and location equipped to handle your specific needs.
Research Providers
Choosing the right prenatal care provider is a deeply personal decision that will impact your pregnancy journey. Take the time to research and meet with potential providers, and trust your instincts to find someone who aligns with your needs and preferences. Your prenatal care provider will play a pivotal role in ensuring a healthy and supportive experience as you embark on this new chapter in your life. Wilmington is home to a range of reputable prenatal care providers. Each office offers unique services tailored to women's health. You can find a list of care providers local to Wilmington, NC on my resource page here.
Check Credentials and Experience
Once you have a list of potential providers, it’s essential to verify their credentials:
Board Certification: Ensure that your provider is board-certified in their specialty. This certification indicates that they have met the rigorous standards of their profession.
Experience and Specializations: Look into their experience, especially if you have a high-risk pregnancy or specific needs.
Schedule Consultations
Meeting with potential providers in person is crucial. Use these consultations to:
Discuss Your Needs: Talk about your birth plan, preferences, and any concerns you may have.
Assess Compatibility: Evaluate how comfortable you feel with the provider. A good rapport and open communication are key to a positive prenatal care experience.
Explore the Office Environment: Check if the office staff is friendly, the facility is clean, and the overall environment is welcoming.
Provider and Facility Tour: Schedule visits to meet potential providers and tour birth locations. This helps you get a sense of the environment and whether it feels right for you.
Evaluate Insurance and Costs
Understanding your insurance coverage is vital. Confirm that the provider and facility are covered under your plan and inquire about any out-of-pocket expenses you might incur. Understanding the costs and what’s covered can help prevent unexpected expenses.
Get Recommendations
Seek recommendations from friends, family, or local parenting groups. Personal experiences can provide valuable insights into the quality of care and the provider’s approach.
Congratulations on your upcoming arrival, and best wishes on finding the perfect prenatal care provider to guide you through this special time!
