Finding the caregiver who is the best match for your needs is one of the most crucial steps in preparing for your birth.
The first step in choosing a caregiver is to decide what your priorities are. Imagine what you would like your birth to be like. What are the top three or four priorities for you? Different families will have different priorities. Some may want to avoid episiotomy. Some may want to ensure medical pain relief is available immediately on request. Some may want to go into labor spontaneously (instead of having an induction). Some may want a high level of medical supervision. Some may want to give birth off the bed. You might want ALL these things, or something completely different. Your doula can assist you as you get to know your options and identify your priorities.
Styles of care
The caregiver you choose provides you with professional medical care and expertise, but the person who is ultimately responsible for your care, and your baby’s care, is you. One of the most surprising things to learn is that medicine is as much a skilled art as it is a science. And the “art” part means that for most things relating to pregnancy and birth, there are differences of opinion on what you might do. Safety is top priority for everyone involved in birth, but there can be different opinions on how to be safe!
There are all sorts of practitioners who care for pregnant women, including obstetricians, family doctors (general practitioners), nurse-midwives, direct-entry midwives, registered midwives, and lay midwives. Each caregiver will have his or her own way of working and approach to birth. Not all doctors, or midwives, are the same or have the same views! Most of the time, they will fall into one of two camps.
The first approach is called “active management.” Practitioners of this style generally believe the safest way to handle birth is to be “active” — to use medical methods of controlling the process to try to prevent problems from arising. Active management uses routine procedures for all women — sort of like a “set menu” in a restaurant where everyone eats the set meal the chef is skilled at preparing. Some women feel very safe and cared for with this approach, which relies heavily on the caregiver to make decisions.
The other approach is called “expectant management.” Practitioners of this style generally believe the safest way to handle birth is to observe carefully, but to “do” as little as possible, unless there’s a specific problem arising in an individual woman. Little is done routinely, because routine interventions are recognized to introduce their own risks. Expectant management is like a full a la carte menu — you can choose from a range of different dishes depending on what you like and avoiding foods that don’t agree with you.
Now that you’ve decided what your priorities are, and you understand the range of possibilities caregivers may offer, you can ask friends for recommendations. Keep in mind to consider whether your friends had the same or very different priorities from you! Did they prefer the set meal or the a la carte menu? Once you have some names to consider, try meeting with two or three caregivers, or even more, to decide who you feel most comfortable with.
Making a choice
Remember, the key is a good match. Your priorities, or a caregiver’s approach, are not “good” or “bad” in themselves. They are what’s right for you, and what’s right for him or her. What’s important is making a good match between what you want and what your caregiver will feel comfortable providing. Don’t expect to go to an Italian restaurant and ask for Japanese food!
It can be hard work to find a supportive caregiver. But doing the work before your birth can avoid stressful tensions arising in late pregnancy or during your labor. Remember, your doula can help you through this process. That’s what she’s there for!
Questions to Ask Your Caregiver
Before you think about what you are going to ask your caregiver, think about what your own priorities are and what kind of caregiver you are looking for. For more detail, see our page on choosing a caregiver.
When you meet with a caregiver, ask open questions. Open questions are ones that have to be answered with an explanation, not just a “yes” or a “no.” If you want to avoid episiotomy, ask “how often do you find it necessary to cut an episiotomy?” If the caregiver says it’s necessary a lot of the time, keep talking to others who demonstrate with their practice that routine episiotomies aren’t happening.
Here are suggested questions covering some of the key topics women often want to discuss. If there is a topic you want to explore that’s not covered here, talk to your doula about how to discuss it with your caregiver, or use the open question format here to come up with your own wording. Remember that an “open question” is one that must be answered with an explanation, not just a “yes” or “no,” so the answer gives you the most information to go on.
“Under what circumstances would you suggest an induction to start labor?”
Some caregivers will only start labor artificially for medical indications such as severe high blood pressure or pre-eclampsia; others will routinely suggest induction, for example, on the due date or a few days after; talk to your doula about the pros and cons of induction in different circumstances.
“What are your views on time limits during each stage of labor?”
Some caregivers will be happy to watch labor take its course with no time limits, so long as the mother and baby are doing well; others will suggest speeding up labor with drugs after a certain number of hours, or to achieve a certain rate of progress; talk to your doula about the pros and cons of time limits.
“How will you feel if I want to eat and drink during labor?”
Some caregivers are comfortable with you eating and drinking as you please during labor and birth; others will ask that you not eat at all, or take only clear liquids, or only ice chips; talk to your doula about the pros and cons of restricting food and drink in labor
“How often do you find it is necessary to cut an episiotomy?”
Some caregivers will be accustomed to cutting an episiotomy in a large percentage of cases, or for all first-time mothers; others will cut them only rarely (perhaps for 5 out of 100 women); talk to your doula about the pros and cons of episiotomy and ways to avoid either a cut or a tear.
Position for birth
“How will you feel if I want to be off the bed during labor and for the birth of the baby?”
Some caregivers will insist you are on the bed for labor and/or for the birth of the baby, and may not be experienced catching a baby when the woman is not on the bed on her back; others frequently catch babies when the mother is in all sorts of different positions, such as all-fours, standing, kneeling, and so on. Talk to your doula about the pros and cons of being on and off the bed for labor and birth.
“How will you feel if I want to have a doula support me during my labor and birth?”
Some caregivers are enthusiastic about working with a doula as part of the support team; others are not comfortable with this. If your caregiver is not comfortable and you want a supporter there, how will you feel knowing he is not supportive of this?
When you ask these sorts of open questions, listen to the way your caregiver responds. Comfortable discussing matters with you? Interested in your perspective and desires? Telling you not to worry about it, he’ll take care of everything? Rushed? How do you feel about the way your caregiver responded to your questions? How do you feel about his views?