Interesting perspectives about different types of pregnancy care providers and how they approach labor and birth. I’m a quasi-retired Certified Nurse Midwife (CNM). I say sort of retired because after 27 years of being on call for days at a time, and delivering more than a thousand babies, I transitioned into full time OB/GYN office work as a nurse practitioner. I’ve worked in every kind of birth setting – tertiary care center, community hospital, free-standing birthcenter and at home.
Anyway, yeah, pregnancy, labor and birth are different for every woman, and even every pregnancy. It helps if you go into it with an open mind, become as informed as possible, and keep reminding yourself that women have been giving birth for thousands of years, that your body knows how to do this, and that most (maybe all) of what you’re experiencing is normal, or at least in the range of normal. And that it’s OK to ask if you’re not sure.
BUT. It’s also really important to make choose a well trained/educated care provider who is philosophically compatible with your own approach to health care. And if that person has partners who might be on call when you are giving birth, it’s important to know that too.
Some women are most comfortable with the old fashioned father-style doc who is friendly and caring, but doesn’t share a lot of information or decision making – that woman’s eyes glaze over when I start talking about the pros and cons of continuous electronic fetal monitoring for labor for example at a prenatal visit – she just wants me to tell her what’s going to happen, not why or “maybe this, maybe that”. Some women come in knowing they want an epidural for labor, and I’m fine with that as long as I know she’s heard about both pros and cons. Other women are hoping for “natural” (unmedicated) labor and birth. Philosophically, that’s my preference too, but I still want her to educate herself about pros and cons of epidurals, and to know that in rare cases, I have encouraged a woman in prolonged difficult labor to try an epidural in hopes of getting enough relaxation to progress and get a vaginal birth instead of a C section.
There are also women come in with a ten page birth plan with items like “no episiotomy under any circumstances” and ” don’t cut the cord until it stops pulsating” and I have to explain that those are my favorite ways to work too, but sometimes circumstances change suddenly, and if the baby’s heartbeat tanks, I might have to make a last minute decision to get the baby born by cutting an episiotomy, and I’ll have a few seconds to tell them what I’m doing and why, but I won’t have time for a discussion. We will be able to debrief about it afterward. I’m going to keep her preferences in mind, and honor them as much as I can, while giving her the best advice I have and keeping safety as a priority. If she doesn’t feel she can trust me to do that, then she might be more comfortable with a direct entry midwife and a home birth.
For women who prefer home birth with a direct entry midwife, I would just encourage you to ask good questions when you interview about complications and labor transfer rates and about what kind of experience (and equipment) they have for emergencies. There are wonderful DEMs out there with great judgement and experience,and there others who have the best of intentions but don’t transfer to the hospital unless it’s a trainwreck.