13. Choosing a Care Provider
Hello, Sister! Welcome back to this space of shared wisdom and empowerment! Today, let's dive deep into the crucial topic of selecting a care provider for your pregnancy and shaping the birth experience you envision. Whether you're well-versed in the myriad options within your community or stepping into this exploration for the first time, this discussion aims to provide valuable insights and space for introspection.
As you embark on this journey, take a moment to ponder two fundamental questions:
1. "What do I REALLY want for this pregnancy and birth?"
2. "Who do I SEE in attendance of this birth?"
Now, let's navigate the "WHO" aspect. Before delving further, let me emphasize that there's no judgment here. My goal is not to sway your choices but to empower you with information. If you've read my blog post on Informed Choice & Asserting Your Rights, you know how crucial it is for women to have the FULL SPECTRUM of options – negatives and positives alike. Armed with comprehensive information, you can make an informed decision that aligns with what's best for you. Let's embark on this journey together, celebrating the diversity of choices and embracing the power of informed decision-making.
Obstetrician (OBGYN):
An obstetrician or OBGYN, a skilled surgical expert specializing in pregnancy and childbirth, primarily operates within the hospital setting. This care option is favored by approximately 90% of American women. Their services typically encompass 10-12 prenatal visits, each lasting approximately 15-20 minutes, occasionally conducted with a nurse. The delivery occurs in a hospital setting, and a single postpartum visit, scheduled around the 6-week mark, takes place at their office.
Potential drawbacks may arise when choosing an Obstetrician for your pregnancy and birth. Their approach is often rooted in the belief that childbirth is inherently risky and requires strict control. Consequently, the care provided tends to be routine, lacking a personalized touch that caters to the individual needs of each woman. Discussions about nutrition are infrequent, and education on the physiological aspects of childbirth is often overlooked. Obstetricians commonly rely on technology, sometimes neglecting the importance of intuition and natural instincts in the birthing process.
Furthermore, the obstetrician themselves may lack formal education on physiological childbirth, with hospital courses typically emphasizing the medical model of care specific to that institution. Autonomy exercised by women in declining tests and procedures may be met with resistance. Additionally, communication gaps can occur, making it challenging to reach the doctor or nurse outside of scheduled appointments or after hours.
The expenses associated with a hospital birth under the care of an OBGYN can exceed $10,000 or more for prenatal services, coupled with an additional $10,000-25,000 (or more) for the actual delivery. It's essential to note that these figures do not encompass postnatal care, baby-related expenses, pediatrician fees, testing fees, and other potential costs.
Certified Nurse Midwife (CNM)
A Certified Nurse Midwife (CNM) is a registered nurse with additional specialized training in pregnancy, childbirth, and postpartum care. While many CNMs practice in hospital settings, some extend their services to out-of-hospital births at birthing centers or even in the comfort of homes. CNMs commonly integrate medications into their practice but generally exhibit a greater inclination towards supporting natural, physiological labor compared to traditional OBGYNs. Their services and costs closely mirror the conventional OBGYN schedule for prenatal appointments.
Certified Professional Midwife or Certified Midwife (CPM or CM)
A Certified Professional Midwife (CPM) is an individual who has undergone apprenticeship under a preceptor midwife, attended a midwifery school, or a combination of both. To earn certification, a CPM must pass a comprehensive exam administered by a professional organization. Typically, CPMs exclusively attend out-of-hospital births, and in emergency scenarios, many are trained and authorized to administer drugs when necessary.
Traditional or Direct Entry Midwife
The Traditional Midwife, a dwindling but essential presence, represents the most ancient form of midwifery, often vanishing or operating in clandestine realms. A Traditional Midwife emerges from a deep sense of community duty, responding to the needs of her people. These midwives carry a profound calling, undergoing training under the wing of another Traditional Midwife, combined with rigorous independent study. In a deliberate choice, Traditional Midwives often eschew certification or licensing, relying exclusively on non-drug interventions, such as the judicious use of herbs when deemed necessary.
Licensed Midwife (LM)
A Licensed Midwife is a midwife, potentially certified, who possesses an additional layer of credentials in the form of a state-issued license. Licensure entails adherence to a set of rules and regulations stipulated by the state, establishing a governing framework that the midwife must comply with to secure and sustain her license. It's worth noting that not all states regulate midwives, and therefore, do not offer licenses. Similarly, Certified Nurse Midwives (CNMs) are subject to specific rules and regulations within their certification. These regulations often contribute to heightened anxiety for many expectant mothers as their pregnancies progress, as their midwife may be unable to attend their birth under specific circumstances. For instance, some women find themselves discontinued from their midwife's care simply because their pregnancy has reached the 42-week mark.
A Certified Professional Midwife (CPM)/Certified Midwife (CM)/Licensed Midwife (LM) provides services comparable to those of an OBGYN in terms of visit frequency. With typically 10-12 prenatal visits, conducted either in their office or clinic, some may even offer home visits. These appointments generally last 45-60 minutes. The midwife covers standard testing and discusses topics such as vaginal exams. Frequently, an assistant or student is brought to your birth to enhance support. During the postpartum period, they extend 6 weeks of personalized visits for both you and your baby. The focus of your care spans physical, mental, emotional, and spiritual well-being, with the whole family encouraged to participate in the process. Notably, most practitioners are respectful and understanding when a woman chooses to decline any or all testing, avoiding unnecessary hassle.
The potential drawbacks of selecting a Certified Professional Midwife (CPM)/Certified Midwife (CM)/Licensed Midwife (LM) for your pregnancy and birth should be approached with the awareness that not all midwives share the same practices. Some may tend towards more medicalized care that lacks extensive individualization. Occasionally, midwives may transfer your care if your situation falls outside the defined rules and regulations set by the state. This could include scenarios like reaching the 42nd week of pregnancy, having a prior C-section, expecting twins, or declining any state-mandated tests or interventions. Unfortunately, only those women who neatly fit into the state's predetermined criteria are accepted as clients, leaving others outside of this defined "box" ineligible for midwifery care. Regrettably, women experiencing miscarriages or complications may find themselves without the support of a midwife. It's also important to note that most midwives do not engage in well-woman care.
Some noteworthy advantages include the potential availability of educational courses recommended or created by CPMs/CMs/LMs for their clients. As a client, the accessibility to call, text, and email your midwife often results in prompt and reasonable responses. Importantly, CPMs/CMs/LMs are well-versed in emergency situations and possess the training to adeptly manage most of them in a home setting.
The cost of birthing under the care of a Certified Professional Midwife (CPM)/Certified Midwife (CM)/Licensed Midwife (LM) typically ranges from a flat rate fee of $3000 to $5000+, often accompanied by a pre-determined payment plan. Additional fees may include expenses for lab testing, ultrasounds, birth kits, and other related services.
Midwife under a PMA
A PMA Midwife, distinguished by their training, skill, and experience, may hold certification as a CPM. What sets them apart is their intentional choice to maintain autonomy and operate independently of government control. These midwives exclusively provide care for home births. Their services encompass 10-12 prenatal visits, often conducted in the comfort of your own home. Frequently, an assistant is brought to your birth to enhance support. During the postpartum period, they extend 6 weeks of personalized, in-home visits for both you and your baby. The focus of your care spans physical, mental, emotional, and spiritual well-being, with the whole family encouraged to participate in the process.
A PMA Midwife is available to attend any woman who shares similar beliefs and seeks a birthing experience outside the conventional system. Emphasizing the priority of the relationship between the midwife and the woman, finding the right match is crucial for a transformative experience. PMA Midwives extend compassionate support for various forms of loss and often provide additional guidance and education on nutrition and fertility.
PMA Midwives are renowned for fostering a sense of community. This community offers a supportive network of women to lean on, coupled with educational courses that impart knowledge about undisturbed, physiological birth. PMA Midwives maintain accessibility beyond scheduled appointments for non-emergency queries, concerns, and counseling. They are reachable through phone, text, or email to ensure ongoing support and connection. PMA Midwives are adeptly trained to manage most emergencies that may arise during home births.
Possessing a wealth of knowledge in nutrition, herbs, essential oils, and a solid understanding of alternative health, PMA Midwives also maintain a comprehensive network of alternative health practitioners. The cost of birthing with a PMA Midwife is generally tailored to a sliding scale, typically ranging between $3000 and $5000. Individual payment plans and potential barter arrangements are also considered to accommodate diverse financial circumstances.
Doula
A Doula serves as a non-medical support person, dedicated to providing continuous emotional, spiritual, and physical support to a mother throughout her pregnancy and birth journey. While lacking medical training, a doula is frequently certified, trained, and highly skilled to support you throughout your pregnancy, birth, and postpartum.
Birthkeeper
A Birthkeeper is a guardian of the sacred space, empowering women to embrace the fullness of their power. Their role extends beyond conventional support, guiding individuals to trust, connect, and listen to their bodies, babies, and intuition throughout the birthing process. With birth experience, training, and profound respect for the sanctity of birth, a Birthkeeper holds space for the spiritual, physical, and emotional aspects of the journey. They are a trusted, wise presence—a hearthmother—nurturing an environment where fears, hopes, and dreams are acknowledged and respected, ensuring that each birth is a deeply seen, heard, safe, and respected experience.
Montrice
A Montrice is a woman who fulfills the role of a doula but also provides clinical support. A Montrice is someone who has training in assessing a woman’s vital signs, palpating fetal position, monitoring fetal heart tones, and checking cervical progress; if requested. Many CPMs/CMs/LMs will perform the services of a Montrice when a woman wants to be monitored at home but deliver in a hospital setting. Once at the hospital, the Montrice will switch to a fully doula role.
Freebirth/Unassisted Birth
Embracing the option of a freebirth or unassisted birth is both valued and viable! There's no obligation to have a primary care provider for your pregnancy and birth. Opting for this choice empowers a woman and her family to trust their own intuition, draw upon their knowledge, and consecrate all decisions unto the Lord in the journey of bringing new life into the world.
The services offered are entirely customizable based on your preferences. You have the flexibility to bring in someone like a Birthkeeper to hold emotional, spiritual, and physical space with you. Your prenatal care can be tailored to include practices like nourishing meals and holistic self-care, addressing your spiritual, emotional, and physical well-being. If you choose, you can decide to handle some or all of the "clinical tasks." Many women opting for this approach seek support from friends, community, and alternative care practitioners to create a personalized and well-rounded support system.
Potential drawbacks may arise when women feel unsupported or choose this option due to a belief that assistance is unavailable, sometimes unaware of the option to hire an unlicensed midwife. Opting for this path without seeking out community support can potentially lead to feelings of isolation. Additionally, there's a rare chance that a complex situation in pregnancy or birth may go unnoticed. This path is open to anyone; you have the autonomy to manage your own care and plan for an unassisted birth. Embrace your personal power and wisdom, learning how to conduct any clinical measurements you may wish to perform, and if desired, take charge of ordering your own lab tests. The journey is yours to navigate with the empowerment to make decisions that align with your unique preferences and circumstances.
Birth education offers a multitude of avenues to explore based on your preferences. Numerous incredible options exist for delving into the understanding of physiological, undisturbed birth. From engaging books and valuable resources to supportive communities, the possibilities are diverse and cater to a range of learning preferences.
The cost of an unassisted or freebirth is essentially free, with expenses determined by your choices related to health, wellness, consultations with any birth support persons, birth supplies, education, and more. The financial aspect is customizable based on your individual preferences and priorities.
There you have it—a quick rundown of various care provider options! Keep in mind that not every area will offer the full spectrum of choices. Seek recommendations and guidance from your birthing community to discover the type of birth support that resonates with you. Recognize that there's no one-size-fits-all solution, and the right care provider for one woman may not be the ideal choice for another. I encourage you to invest time thoughtfully exploring your options, engaging in intentional decision-making. Prayer, journaling your beliefs about birth, visualization, and praying over your birth can be powerful tools in this empowering journey.
What type of birth do I want?
Why do I want to have my baby in that way?
What are the benefits of that type of birth?
How will that type of birth benefit me?
How will that type of birth benefit my baby?
Crafting your birth WHY and assembling your birth TEAM is undeniably one of the most crucial aspects of inner work you'll engage in.
Happy Planning, Sisters!
Stay Wild & Free,
-Brandy
I believe that every woman deserves to feel heard, respected, and empowered during this sacred time.
That’s why I created this comprehensive 13-page guide to conversations with your care provider.
Let this guide be your companion in forging a strong partnership with your care provider, ensuring your journey is as unique and special as you are!
