Choosing your Birth Doctor or Midwife

Choosing a birth doctor or midwife is a key step and will heavily influence many things about how your birth will proceed. Be cautious in your selection. They should provide prenatal care, will manage the birth, and will make choices that affect your birth process.

Not all doctors will hear your desire for a natural or drug-free birth the same way. Stories abound of doctors who say they offer a natural birth, but when push comes to shove (so to speak), they show a different face, following practices that make induction and other intervention much more likely.

One merely needs to look at the alarming and increasing rate of inductions and caesarean sections to understand this idea.

Parents sometimes end up with a birth so very different than their declared desires, and a postpartum period in the hospital (for mother and baby) so out of their control and that so violates their values. They feel betrayed and on a course that sets the stage for future health problems for both mother and baby.

Ask penetrating questions of any doctor you might use. You must be the one choosing the doctor–not your husband, not the medical system.

Think of the things you are concerned about and ask “What do you do IF such and such happens?” Get specific answers.

Based on Dr. Ginsburg’s training and experience, here are some things to ask of any birth doctor or midwife.

  • Ask what their “induction rate” is. The induction rate is how often the doctor uses drugs to push a woman into labor because the doctor decides the labor has not happened soon enough. The less often the doctor does it, the better. Labor induced by drugs is more intense and difficult for the mother, and because of this often leads to the need for other medical interventions because the body is not completely in its own rhythm. These interventions seem to demand more intervention, more technology, making birth more and more complicated, and caesarean-section (c-section) more likely.
  • Ask the doctor what his/her c-section rate is. The lower the better here. Compare it to the rates of midwives you interview. You want to avoid c-sections if at all possible.
  • What are their indications for induction? “Indications” are rules they use to guide their choices. Not all doctors use the same rules.
  • How do they handle babies that are overdue? How many weeks do they consider “overdue”? This varies, and some doctors may start counting from an earlier point. If they deem a baby is overdue (which can vary doctor to doctor), doctors usually induce labor contractions quickly and powerfully with a drug called pitocin. Natural doctors (and midwives) usually start with particular foods or gentle herbs to nudge the body into stronger labor and contractions instead of using drugs. These often work well.
  • Do they allow food and drink during labor? This is essential to keeping the woman strong, but sometimes the doctor or hospital restrict them! Women in labor are like marathoners. They need food and drink.
  • Do they allow you to get out of bed and walk around during labor, or squat or move on all fours? Can you think of anything sillier than forcing someone doing intense exercise to do them all on their back, in only a single position, even if the exercise is better done in a different position? Every woman benefits from moving around and testing different positions during labor.
  • Do they routinely insert IVs in the woman? Not a good sign.
  • For contrast, here is a more conventional approach to choosing a birth doctor, which starts off by suggesting you a doctor from your health insurance network. We disagree. Although midwives and alternative births are finally being covered by some insurance companies, keep in mind that the better doctors, especially holistic doctors that spend more time to really help you, cannot afford to be in most, or any, networks. Make your best judgement. This decision will set the direction for a lot of what happens in the next year, such as whether your doctor leads you more to a natural birth or to a medicalized, technological, and possibly surgical birth, and the health issues that medicalized birth often produces may be with you for a very long time.
  • Choose the birth doctor or midwife you believe will give you the education and coaching you want. If you want to breastfeed, make sure the doctor or midwife knows this territory. If you are going to use them to coach you in this, then make sure they do it all. Keep in mind that medical schools rarely teach anything about the physical or emotional support necessary for successful breastfeeding.You might need to go out of network in order to find the birth doctor you want.