Finding the right medical provider... for YOU!

We all remember doulas are not medical providers, right? Perfect. So now that we’re on the same page about that crucial information, how do you pick your medical provider? Who you choose to be your doctor or midwife has a large effect on the type of delivery experience you will have. It is a big decision and should be done with deliberation. Here’s our recommendations for how to choose and how to see if a medical provider and you are a good match.

Choosing your care provider

First, understand that you don’t have to choose the first provider you meet.

Did you know, you can meet providers for an interview before you are even pregnant? This can also be a great time to talk about what lifestyle changes can give you the healthiest pregnancy or even help you conceive!

But let’s say you didn’t do that (because most people don’t). Now you’re pregnant and you go to your first prenatal appointment and…..wah wah. There’s just something missing. You start to panic. Take a breath and realize something important:

you may have committed to this appointment, but you haven’t committed to your whole pregnancy with this provider.

The good news is: you can always switch providers! This is definitely easier after one appointment than after 10 appointments. This is also easier in the beginning of your pregnancy. But switching providers can be done at any point. You just need to be up front about your gestational age and find a provider who will accept you anyway. You may feel guilty but remember: This is your one chance to give birth to this child and you have the right to work with someone you feel comfortable with.

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Second, pick a birth location.

We know; it seems odd to start with a location and go backwards to the provider, but let us explain. Many providers will only deliver in certain locations and if your heart is set on a particular location, your provider choices may be limited.

If you are interested in a hospital birth, have you researched which hospitals in the area are most likely to give you the experience you are looking for? Most have a free tour of labor delivery. Once you find a hospital that feels right for you, find what providers deliver there. Just being practical, you also want to check which are covered by your insurance.

Or you may be interested in having your baby at a birth center, a sort of intermediate between a home birth and a hospital birth. Baby+Co. is the only one in Knoxville and they have their providers listed on their website. See how this birth location changes you options from “everyone who delivers babies in Knoxville” to a much smaller number of choices?

Or you may interested in a home birth. Less medical providers offer home birth as an option but it is definitely an option in the Knoxville area, though, with Rachel and Rebekah at Roots and Wings Midwifery, Debi Church, Teresa Steen, and Lisa Coomer offering their services. This is by no means an exhaustive list, but I hope you catch my drift.

Next, check with your insurance to see how much the location/provider you found costs.

Okay, so this step isn’t glamorous, but is important. Some locations or providers may be out-of-network (aka might be more expensive) or may not take your insurance. Practically, it’s nice to know this right up front, preferably before you have an expensive co-pay for your first prenatal visit. Even worse, if you fall in love with a practice and later realize you can’t afford to go there for your pregnancy.

Now all you have to do is schedule your appointment and see if you are a good fit for one another.

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How to see if you and your provider are a good fit.

First, figure out your view of birth.

This is a quick introduction to the two main views of birth culture, the midwifery model and the medical model, and a review of the evidence. Realize your belief may fall anywhere in the spectrum between these models.

First, the midwifery model of care. This is a good explanation by the National Association of Certified Professional Midwives. Essentially, providers who follow this believe that pregnancy and childbirth are normal life processes. Pregnancies with providers who follow this model tend to have longer prenatal appointments that focus on overall well-being, more continuous support during labor and delivery, and less interventions during labor and delivery (including birth by cesarean). Often these providers are midwives and often clients have low risk pregnancies.

Second, the medical model of care. Essentially, providers who follow this model focus on preventing, diagnosing, and treating the complications of pregnancy and delivery instead of holistic psycho-social care. Pregnancies with providers who follow this model may use very similar care for both high risk and low risk patients, leading to more interventions both during pregnancy (more lab tests or ultrasounds) and birth (including more birth by cesarean). Often these providers are doctors and some of their clients are high risk (although many are low risk, too).

In case that was confusing, this article gives good descriptions of the two models.

Next, get the evidence.

Always come back to that evidence-based information. According to a Cochrane Review, that analyzed over 17,000 expectant parents and babies, pregnant patients who received midwife-led continuity of care were:

  • Less likely to have an epidural;
  • Less likely to have an episiotomy;
  • Less likely to have preterm birth;

They also had:

  • Increased chance of a spontaneous vaginal birth (without vacuum or forceps);
  • Lower risk of losing their babies;
  • No difference in the number of cesarean births.
  • No adverse effects compared with other models.

Of note, they did not include any pregnant people who had home births or those with existing serious pregnancy or health complications in their analysis, so this may not apply to those situations.

So with all that information in mind, what do you think?

Next, ask your provider about her view of birth.

Often providers fall on a spectrum somewhere in between these two models. Although it tends to be that more midwifes follow the midwifery model and more physicians follow the medical model, providers are individuals and may not follow this trend. You’ll just have to meet them and see how closely their preferences align to yours.

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Once you know your provider’s views of birth culture, ask her how often they stick to it.

Remember: you can ask your provider anything you want! She might not always give you an answer. In fairness, she might not know her statistics off the top of her head. But you can always ask (and keep asking at later appointments!). You’re not trying to “trick” your provider, you’re just trying to see if the way they practice supports the type of birth you want to have.

For example, let’s pretend you want a low intervention, hospital birth. Your provider works in a hospital and says she believes pregnancy and birth are natural processes. Great – but don’t stop there! Ask, “How often do you use interventions with things like continuous electronic fetal monitoring or continuous IV fluids?”. If she says she uses those interventions routinely with every patient, her style of practice doesn’t match what you’re looking for.

You may need to differentiate between her practice and the location, because this gives valuable information. For example, you want to ask both, “What is the rate of cesarean at your hospital?” and “What is your personal rate of cesarean birth?”

Or “How often do clients transfer from all six Baby+Co. birth centers to the hospital for an epidural?” and “How often do your clients transfer from the Knoxville Baby+Co. birth center to the hospital for an epidural?”

I am not trying to tell you a right and wrong answer to any of these. I just want you to be fully informed and involved in your choice.

After all, you only get to birth this baby one time and who you ask for help is both highly personal and will have a big impact on your experience.