Where you choose to give birth obviously can have an impact on how you labor and deliver, but I think an even bigger factor is who you chose for your prenatal care. Because you are ultimately in their care, its really important you work with someone who is on the same page as you in your mindset about pregnancy and birth desires. In a way, I see different providers as different levels of natural birth approaches, but each and every provider can be different in their views no matter what their title. So just because you pick an OB in a hospital doesn’t mean you won’t get a natural birth. It’s all about finding someone you click with and respects your vision for care and birth.
Most Americans are familiar with OB/GYN’s for women’s health and pregnancy. My first two pregnancies that was who I was referred to, it’s the norm in our society! These doctors gain their education through medical school and then specify in the OB/GYN field, they practice in a doctor's office and deliver in a hospital setting. They provide access to pain medications and preform c-sections if needed or desired. Because of their medical background their view on birth usually is focused on diagnosing and treating complications in a woman, which helps when a mom-to-be is considered high risk.
Care wise, doctors tend to spend less time with their patients than other providers because of their large number of patients. This is especially seen during delivery, the nurses are there most of the time and the doctor comes in to catch the baby at the end! Using an OB you also may rotate care so you are familiar to the face that delivers your baby depending on who is on call at the hospital. Most of them are not very familiar with a natural childbirth since many moms chose epidurals these days, so if you chose to use an OB, I would highly recommend hiring a doula to come, (more on that below).
Of course, different doctors may believe and practice differently so make sure you agree with the procedures and their overall mindset about birth. Some may push for Pitocin or c-sections at the slightest hint of risk or labor slowing down and then I’ve heard of some who were encouraging the mom not to have a c-section or get an epidural and instead stick to her original natural birth plan!
Certified Nurse Midwives
If you are leaning towards the idea of a more natural birth but feel comfortable in a hospital setting, using a CNM may be a great option for you. These are midwives who go through a nursing program first and then specialize in midwifery. Typically, they work in a hospital setting and under the supervision of an OB/GYN, but they can delivery in a birth center or at home).
In fact, there is a new birth center just opened in Statesville that is run by a doctor and several CNM’s. In the Charlotte area though most CNM’s work in and with a doctor’s office, such as Charlotte OB or Piedmont OB. Because of their midwifery training, they have a more natural approach to birth with minimal interventions. So being able to move around during labor, no IV’s tying you down, using monitors only sporadically, a tub to labor in for a natural pain relief, and using different pushing positions are more likely. But, because of the hospital setting there is still access to a emergency c-section (which care would be turned over to an OB) or pain medicine if it came to that point.
Care wise, they spend more time with you during prenatal appointments and labor, however, in our area most only work in the hospital on call during the weekday so if you deliver on a weekend, you would get an unfamiliar OB.
Certified Professional Midwives/Licensed Midwives
Before doctors took over the birthing scene in the past century, midwives were the norm and even today in most countries around the world they still are. CPM’s or LM gain their education and training at a midwifery school and then are licensed through an organization such as North American Registry of Midwives and are trained for out-of-hospital births with healthy moms and babies. They learn through direct experience via apprenticeships with other experienced midwives. Because they practice the midwives model of care that views birth as a natural and normal process, they aim not to use interventions but allow the body to do what its made to do. They like to form a trusting relationship with the mom-to-be and often prenatal visits last at least 30 minutes and they are present through the entire labor and delivery, as well as providing breastfeeding assistance.
Like I said, they use no interventions whenever possible, allowing the moms body to do what it needs to do and encourages eating during labor, the use of water to relax (and give birth in!), different positions and movements, etc. They can practice at a birthing center or at home, however, currently in North Carolina CPM’s licenses are not recognized. This is not to say you cannot have a home birth legally, but that the midwife could be arrested if issues arise (as has been seen in the news recently here in Charlotte), but that is a risk midwives take knowingly to help moms have control over her birth!
As I’ve talked about before, the Carolina Community Maternity Center is a great “in between” and safe option for having a home birth type experience with a CPM. In the event of an emergency, they would transfer and be with you during delivery at the hospital and many times they have back up OB’s that they have a good standing relationship with. One downside is that usually CPM’s are not covered by insurances (except for CCMC, its often covered out-of-network), however, it usually is cheaper than a hospital birth even with insurance!
While a doula is not a care provider, they are a huge help in preparing you and being your advocate for a natural birth, especially in a hospital setting, whether with a doctor or a CNM. They go through training and education for the role, such as through DONA International. Their job is to support you physically and emotionally during your labor, delivery, and postpartum. They often serve as your voice in the hospital setting when you are in labor, helping to stick to your birth plan when possible, like refusing pain medication or monitors if you don’t want them. They stay with you through the entire labor process so you have support constantly if needed.
There are many doulas in the Charlotte area, both for labor and postpartum, which can be found on websites like DONA or Doulas of the Charlotte Area. Brooke Atkinson is a doula who has had several natural births herself and has served women in many hospitals of the area. She’ll be helping me with an upcoming post with an inside look at the top natural hospitals in our area!
Just like with any important decision in life, do your research! Get references, hear birth stories of women who used the provider, and compare that to your birth desires. Other resources I found helpful in my research was the book Your Best Birth, by Ricki Lake and Abby Epstein, and recently there was a radio show about Midwifery on NPR that about care from all different providers.
Whatever you choose, own it! This is your birth, your experience, your baby. Choose the best “birth team” for you!