Choosing a Care Provider & Birth Location

Choosing a care provider that is right for you can greatly increase your chances of having the birth experience that you want. Do you already have a care provider? Ask yourself this: Is this person or group going to help me achieve the birth that I want, or is the person or group going to be an obstacle for me as I try to achieve the birth that I want? Your care provider will have a huge influence on your birth experience so put some thought into it. If you feel your current care provider is going to be an obstacle, you can change to a different care provider. Sometimes a woman feels she is too far into her pregnancy to switch, but until the baby has been born, it's never to late for her to switch.

There are several options for care, each with their own pros and cons. It might make more sense to decide first where you want to give birth, and then pick a care provider who can accommodate your preference.

Choosing a Place for Your Baby’s Birth:

Choosing where you give birth can affect things such as the speed of your labor, your comfort level, how much medical intervention you experience, and your overall satisfaction with the whole labor and birth. In Tampa, women have three options, all of which are covered by most insurance plans: a hospital, a birth center, or at home.

Which birth environment is safest? Studies have shown that home births, births in birthing centers and births in hospitals are equally safe. Recent studies show definitively that there is no improvement in outcome, for mother or baby, in hospital births as compared to those that happen at home or in a birthing center. In fact, there is an indication that outcome is actually slightly better in low-risk births out of the hospital.

The most important part of choosing a place for your baby’s birth is choosing a place where both partners feel comfortable. It is a good idea to tour a few hospitals and birthing centers as well as discuss homebirth with a practicing midwife before deciding.

Hospital Births

Reasons to choose a hospital:

  • You are a high-risk patient and are more likely to need access to the latest medical technology.
  • The doctor or midwife you chose attends birth in a hospital and you prefer to use this person for your birth over anyone else.
  • You may feel most comfortable being in a hospital setting.
  • You plan to use drugs such as an epidural or narcotics to manage pain during labor.

Reasons not to choose a hospital:

  • During doctor-attended hospital births, labor is generally expected to conform to a certain pattern the hospital has deemed “normal.” If your labor deviates in some way you are more likely to receive medical intervention in an attempt to bring the labor closer to conformity.
  • Statistically you are more likely to deliver by cesarean section.
  • Hospitals and doctors who deliver in hospitals may have strict regulations such as a policy limiting the number of people who can attend the birth with you, a policy prohibiting you from eating during labor, and/or a policy regarding whether you must wear fetal monitors continuously.
  • In a hospital you may be moved from room to room for triage, delivery, and postpartum.
  • You may have less privacy in a hospital.
  • You may not feel as comfortable or relaxed in a hospital setting.

Birth Center Births

Reasons to choose a birth center:

  • Birth centers and licensed midwife attended home births are as safe as hospitals with the benefit of a significantly lower rate of cesarean section.
  • Birth centers offer a more home-like feel which is more conducive to relaxation. Many have Jacuzzi tubs for labor/delivery and kitchens to prepare meals.
  • There will not be a lot of people coming in and out of your room and the staff will be small and will probably be familiar to you.
  • You will most likely be in the same room and have freedom to walk around if you so desire.
  • You want more breastfeeding help and encouragement than a hospital offers.
  • You want to go home within 4-12 hours after your birth.
  • You want newborn tests and procedures delayed so you can have more time for immediate bonding with your new baby.
  • You do not want pain medication available to you.

Reasons not to choose a birth center:

  • You have a preexisting medical condition, such as diabetes, epilepsy, anemia or high blood pressure that makes it advisable to be in a hospital setting from the start.
  • You have been defined as high-risk, which means you have a medical condition that necessitates a hospital birth.
  • You have already chosen a care provider with who you wish to deliver and they are not affiliated with a birthing center.
  • You want more control over your environment than a birth center can provide. In this case, home birth might be most appropriate for you.
  • You feel insecure about the concept of a birth center birth.

Home Births

Reasons to choose a home birth (most above bullets from birth center births also apply):

  • It is the environment you will have the most control over. Generally, it is the most conducive to relaxation.
  • At home you avoid unnecessary medical interventions and are much less likely to end up delivering by cesarean section.
  • Many experts believe that you, and your baby, will have a reduced chance of getting an infection if you are not in a hospital. Hospitals are notorious for spreading staph, and other infections to patients. You are already used to the bacteria present in your home and have probably developed some immunity to them.
  • You want newborn tests and procedures delayed so you can have more time for immediate bonding with your new baby.

Reasons not to choose a home birth:

  • You live more than 30 minutes away from a hospital.
  • You have a preexisting medical condition, such as diabetes, epilepsy, anemia or high blood pressure that makes it advisable to be in a hospital setting from the start.
  • During pregnancy, if you have bleeding, premature labor contractions, high blood sugar or protein in your urine.
  • You are generally in poor health, smoke or are extremely overweight.
  • You are living in a home you don’t feel is comfortable enough right now, or you don’t like the environment.
  • There is very little privacy where you live, or you live with people who you would rather not be with during the actual birth.
  • You feel insecure about the concept of a home birth.

Choosing your Birth Attendant:

Once you choose WHERE you want to give birth, the next step is to choose a provider.

Obstetricians

Obstetricians (OBs) are medical doctors who have had a 4-year residency training in the field of obstetrics and gynecology. Where and when they received their training can have a strong influence on how progressive they are, or how open they are to input from their patients. It is important to remember that an OB is a highly trained surgeon. Many OBs treat a pregnancy as a medical condition that must be managed and treat a laboring woman as a surgical patient. Look for an OB who is willing to listen to your wants and desires concerning your birth and uses evidence-based use of technologies instead of “standard procedures.” Also watch out for OBs who won’t share their intervention rates or prefaces it with, “well, I see a lot of high-risk patients.” If your OB has a high intervention rate they are more likely to view your pregnancy as a medical event and suggest interventions no matter what your birth plan states.

Midwives

The apprenticeship model has been the foundation of medical training of physicians and it is the model used by midwifery training as well. A midwife must attend at least fifty births before taking her national exam. Ironically, many doctors finish medical school having only attended one or two births. Throughout the history of the world, a midwife, either formally or experientially educated, has been the most common type of birth attendant. Today midwives attend about 80% of births world wide, and almost 10% of births in the United States. In the US, several types of midwives are available. Some start out as nurses, and some receive their training through apprenticeships or various midwifery certification programs. In general, midwives differ from OBs in that they view birth as a normal process instead of a condition that needs to be managed. Midwives also care for mother and baby as a unit and respect the connection and need of the mother and baby to stay together. Midwives are trained in newborn care and newborn tests & procedures. This differs from the obstetrics model of care. Once a baby has been delivered, an OB is no longer responsible for the baby, and newborn evaluation, tests and procedures are done by a pediatric nurse, a pediatrician or a neonatologist. Another difference in care is that a midwife is generally with you throughout your labor. With an OB, you will be interfacing with a labor and delivery nurse for the most part. The OB may come and check on you once or twice during labor and then show up for the delivery.

You also have several options as to what type of practice you choose:

A Group of Obstetricians
Place of Delivery: Hospital
A group is a good choice if you like all the members of the group. Usually doctors take turns being “on call” and whoever is on call when you go into labor will be the one to deliver your baby. If there are one or two doctors in the group you are not comfortable with, it may not be a good choice.

An Obstetrician in a private practice
Place of Delivery: Hospital
With an Obstetrician in a private practice, you can form a relationship with one person and know that they will be the one to deliver your baby. This can be an ideal arrangement if you want to deliver with an OB in a hospital. You may be inconvenienced by having some appointments rescheduled if the OB is delivering a baby during your appointment time.

A Group with Obstetricians and Midwives
Place of Delivery: Hospital
Obstetricians who work in a group with midwives tend to be a little more progressive. If you choose a midwife from the practice and complications arise such that you need an OB’s care, someone from your same group will be on call and there will be no need to switch providers. Again, it is important that you pick a group where you like all the members. This can be a good choice if you like the idea of having a midwife but feel most comfortable giving birth in a hospital.

A Group of Midwives
Place of Delivery: Hospital, Birth Center or Home (depending on the group)
Groups are usually small so you can get to know all the midwives. Again, it’s always important that you like everyone in the group.

A Midwife in a private practice
Place of Delivery: Hospital, Birth Center or Home (depending on the midwife)
You have one person providing all your prenatal care and delivering your baby. You may need to reschedule an appointment if your midwife is with a laboring mom during your scheduled appointment.

Questions to Ask

It’s important to interview caregivers to make sure you find someone you like. Follow your gut response to this person as to whether or not you like the person and find out some information about their practice and policies. Here are some questions to ask:

  • If you are not available at the time of my labor and birth, who usually covers for you? If I want to meet that person ahead of time, will you facilitate that?
  • Will you help me with nutritional guidelines or refer me to someone you trust who can? What are your views on weight gain during pregnancy?
  • How are partners (husbands, etc.) involved in prenatal visits, during labor, and at the birth?
  • What sorts of prenatal testing do you normally recommend?
  • For home births and birth centers: What backup hospital do you use? Under what conditions do you transport a patient to the hospital?
  • What labor positions do you recommend to your clients? Do you encourage movement during labor? Can I try different positions for pushing?
  • How much fetal monitoring do you routinely use during labor?
  • Approximately how many of your clients have unmedicated births? What is your rate of cesarean section, and under what circumstances do you usually advise them? Your rate of episiotomy? Do you rupture the membranes to speed up labor?
  • Under what circumstances are forceps or vacuum extraction used? How often?
  • How long after birth is the umbilical cord cut?
  • How often do you use pitocin or other labor inducing drugs? Under what circumstances?
  • What will happen if I go past my due date? If I am healthy and my baby is healthy, how long past my due date are you comfortable letting the pregnancy continue?
  • What would be your routine for the baby and me directly after birth? Will I hold the baby immediately at birth? When is the umbilical cord typically clamped and cut?
  • What is routinely done if my bag of waters breaks prior to the onset of labor? What kind of time constraints will I be expected to deliver my baby in after the bag of water has broken?
  • How do your feel about other children, friends, or family attending the birth?
  • How much postnatal care do you do? If this is a home birth, how long would you stay in my home after the birth?

See also: How to Find a Florida Hospital’s Cesarean Section Rate

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