As any pregnant woman knows, there is no shortage of advice surrounding childbirth. From trusted friends to random strangers, everyone has an opinion about "the best" way to give birth.

But women feel more satisfied with their birth experience when they are empowered to make their own choices. Pregnancy and childbirth can be unpredictable and even risky, which is why women need respectful caregivers to keep them safe and well-informed.

Women and their caregivers want the same thing: a healthy baby and healthy mom.

However, birth philosophies differ greatly among women and providers. Given this, what should pregnant moms consider?

Choice of provider

Perhaps the most important choice is your provider. From the beginning, your doctor or midwife will shape your pregnancy and childbirth choices. The first question to ask yourself is, "Does this person practice according to evidence-based medicine standards?" This can be hard to know, but asking early in the pregnancy about birth practices like episiotomy, frequency of C-section and labor induction rates can help you determine your provider's philosophy.

The next questions to ask yourself are "Does this person respond to my concerns and questions in a kind, respectful manner?" and "Does he or she make an effort to explain recommendations in a way that I understand?" If the answer is "no" to any of these questions, it may be best to search for a new doctor or midwife. The sooner the better!

Choice of birth setting

By choosing a birth provider, you also are choosing a birth setting. Doctors and midwives may have privileges to deliver in certain hospitals but not others. In addition, some providers (usually midwives) deliver in birth centers and homes. When it comes to hospitals, rates of intervention can vary widely. For example, in Milwaukee, C-section rates vary between 20.36 and 28.25 percent at different hospitals (see for more info). This can be an indication of a birth unit's culture. Unfortunately, other statistics such as induction and epidural rates are not readily available, but your provider may know if you ask.

Having a birth plan

Some women like to write down their birth preferences ahead of time. If you have chosen a provider and birth setting that you trust to support your birth choices, you may find that a birth plan is not necessary. However, birth plans may help clarify what is really important to you and communicate your desires to nurses and other staff who you are meeting for the first time on the day you give birth. The downside of birth plans is that they are sometimes designed without much flexibility or understanding that certain complications may require a change in the plan. For example, if you want intermittent fetal monitoring but need induction or ask for an epidural, continuous monitoring will be required to keep your baby safe. Make sure you've gone over your birth plan with your provider ahead of time so he or she understands your preferences and is able to make clarifications as needed.

Being willing to accept the unexpected

It is good to think about and communicate your preferences for childbirth ahead of time. However, it's also important to accept that birth can be unpredictable. If you have the right team on your side, you are likely to feel safe and respected regardless of your birth outcome. And no matter what happens, when that baby is in your arms, you will have a lot to be proud of.■

Ann Ledbetter is a certified nurse midwife at Sixteenth Street Community Health Centers.


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