The End Starts at the Beginning

It takes 9+ months to get here, and many decisions along the way

As a doula, I look forward to a long career serving expectant families. With each birth, I gain valuable experience which helps me guide the next family I serve. As I've written on my website, my goal is to increase the positive experiences of women and their partners in pregnancy and childbirth, in a way that aligns with their goals and values. This includes hours of physically demanding work, an unpredictable schedule, having to leave my own family for hours or days, and emotional skills like holding space without judgment, and putting my clients' needs before my own. Often it can take days to recover from a birth. And you know what? I love it. 

But I know that my enthusiasm and expertise in supporting a client is not all it takes to maximize the chances of a positive birth experience. The client plays the biggest role. Obviously, the birthing person is working the hardest, growing a baby then meeting the demands of labor. But it's the choices my clients make, often before they even think about hiring a doula, that have a great influence on what they will experience on the day they meet their baby.

​Recently I shared an article on the Elevated Birth Facebook page from ICAN (International Cesarean Awareness Network), listing the Top 11 Ways to Decrease Your Risk for a Cesarean. While some expectant couples opt for Cesareans, most desire to give birth vaginally, resorting to surgical birth when medically necessary for the health of the baby or mother. As the rate of Cesarean birth is on the rise, accounting for roughly 1/3 of all births in the United States, questions have arisen about the numbers and reasons for unnecessary, or preventable Cesareans. Individual physicians serving the same population, in the same hospitals, can have drastically different Cesarean rates, indicating that the attending physician is a key factor in whether a mother ends up with a Cesarean. Choice of provider (doctor or midwife) is the number one factor on ICAN's list.

If reduced risk for a Cesarean is a woman's goal, then choosing her care provider carefully is key. But looking at the bigger picture, if a positive birth experience is the goal, then choosing the right care provider is essential. A woman can end up with a Cesarean and feel happy about the outcome, and she can also give birth vaginally with no complications and feel traumatized. And vice versa.
 
There are three reasons for the disparity in outcomes. First of all, the care provider (or team of providers, in some cases), sets the tone for how the relationship will go. This includes whether or not:

• Questions will be answered fully and respectfully
• Policies and procedures will be evidence-based and the couple will be able to exercise informed consent before they will be applied (more on informed consent later)
• Communication is open and effective between all parties
• The couple's input and preferences will be respected
• The couple will be treated with respect and care at all times

Not all care providers will meet a couple's expectations in these areas. Some care providers are well-intentioned but act out of their own biases, or act without obtaining the consent of the patients in their care. (These areas comprise the idea of informed consent: Do I have enough information to make a decision, and do I consent to that action/decision?) And some care providers are just not a good fit, for a variety of reasons.

Second, the choice of care provider dictates where the birth will take place. If an obstetrician is hired, the birth will almost certainly be at a hospital where the OB has privileges. Depending on the midwife, and the laws in that state, the birth may be at home, at a birth center (either freestanding or attached to a hospital), or at a hospital. Each of these locations has its own restrictions, policies, and limitations, which can influence the overall birth experience.

Finally, a client's knowledge about the birthing process, and what to expect from the care providers and the birthplace, will greatly impact the birth experience. Becoming educated on the benefits and risks of medical interventions, the roles and limitation of the staff,  and the physiology of birth can impact expectations about birth, or lead to making different choices in labor based on learned information. 

Expecting couples can play an active role in the beginning of pregnancy, to maximize the chances for a successful end to it, by choosing a care provider that aligns with their goals and values. Sometimes clients are unsure of what they value; they haven't experienced pregnancy and labor before and so don't know what kind of provider or location they would prefer. Or they already have given birth, but are faced with new circumstances or want to avoid the negative experiences of previous births. 

If they are unfamiliar with their options, consulting a doula can be a way to sort through the choices available in their area. Even those who are far along in pregnancy, who have been seeing the same provider throughout, still have options and can change to a provider that meets their needs more closely. Or they can choose to stay with their care provider, but communicate their needs and desires more effectively. There are always options. 

For a quick, fun way to jumpstart thoughts on where you might want to give birth based on your personality,  take this Birth Quiz from The Birth Hour podcast website. It may make you think more deeply about who you choose as your care provider!

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