Part of preparing for a natural birth is choosing a care provider supportive of your plans for birthing. Even if your care provider is very pro-natural birth, however, you need to discuss your plans for labor and your newborn so you know both of you expect the same things. This is true regardless of where you’re birthing: home, birth center, or hospital. Today’s article covers how to talk your plans over with your care provider so they really listen.

Your Care Provider’s Role

You should understand your doctor or midwife’s point of view before you begin discussing things with him or her. Of course I’m talking about knowing if your provider is pro-natural birth (and prefers see moms laboring and birthing without intervention). But you’ve probably already checked out your provider’s views and history in regards to their opinion of natural birth.

What I mean when I say “understand their point of view” is getting really clear that your care provider is there to oversee the safety of you and your baby.  That’s why you hire and obstetrician or a home birth midwife – you want somebody experienced there to watch over you and your baby as you go through birth.

It is true that you may want support and guidance from that person, especially if you’ve hired on a midwife.  But their primary role is going to be monitoring you and baby throughout labor (even if that simply means observing rather than doing things like vaginal exams or hooking you up to a continuous fetal monitor).

They want to ensure that things are moving smoothly and safely, and they may step in if you’re struggling or need to work with baby to help him/her move down and have labor progress.

When you understand this point of view, you can discuss your wishes (which are probably for a very “hands off” birthing) in a way that takes your care provider’s role into account.

For example, with my sixth baby’s birth, I really wanted to be able to feel him crowning and bring him up myself – no flashlights or midwife’s hands in the way.  I knew, however, that my midwife wanted to be watching to make sure all was moving smoothly.

I talked with her and discussed that I’d like her to observe from close by, but step in only if the second stage didn’t seem to be going smoothly.  This is just what happened – Corwin was born very smoothly and my midwife watched quietly from beside the birth tub as Scott and I brought him up.  When I wanted to make sure Corwin was breathing and “starting up” just fine, she was able to offer me assurance that all looked great because she was closely observing even though she wasn’t immediately “touching.”

A Partner and an Adviser

You are an intelligent woman.  You may think that’s obvious, but when many of us enter a doctor’s office (or a midwife’s office) we assume more of a child to parent role – rather than an adult to adult role.  You’re a grown woman about to have a baby and you can think and make choices for yourself.  Your care provider is a partner in your pregnancy and birth – not a director, master, or parent.

You should feel like you’re being listened to, respected, and taken seriously anytime you discuss an issue with your care provider.  Both of you have the same goal: a healthy baby and a healthy you.  There should be mutual respect.

Your doctor or midwife does have a lot of experience with pregnancy and birth.  He or she is a valued adviser you can go to for advice and perspective on your situation.

Again, this is a respectful relationship.  You can ask your doctor or midwife for his or her advice and input, but that doesn’t mean you must take that advice or make that choice (you may decide to decline prenatal testing they offer, for instance).  It’s your pregnancy, your birth, and your baby.

It’s important to weigh the advice of a professional you bring as part of your pregnancy and birth experience, however.  As I said, this advice is generally based on a lot of experience and comes with perspective you may not have from your own pregnancy and birth experiences.

Plan to Discuss, Not Debate

You’re intimately concerned with the well-being of your baby (and your own health and well-being through your pregnancy and birth).  Of course your doctor or midwife also highly values the safety and well-being of yourself and your baby, but it’s true that nobody will ever be quite as passionate about your child as you are!

You may do research and gather knowledge that your care provider is not aware of yet – and that’s okay.  As I said above, you want them to listen to you respectfully.

But when you present your information, or just your point of view, remember that your care provider is an experienced adviser.  Don’t go into things with an adversarial mindset.  It’s not you vs. the doctor or you vs. the midwife.

You are a team working together for your baby’s health and for your own health.  If you feel like every discussion becomes an argument or a confrontation, it’s probably time to find a new care provider.

But watch your own attitude.  Be wiling to present information before you go on the defensive.  Give your doctor or midwife time to consider and present their opinion before you assume you’re going to have fight it out.  And, again, if every appointment turns into a fight, you may want to seek a second opinion or consider a new practice.

Put Evidence on the Table

Doctors and midwives are really busy, and a lot of the best information about obstetrics, maternity care, and newborn care is cutting-edge research (or recent scientific acknowledgment of past wisdom).  They may not have time to follow articles spread out among a wide range of journals, and articles relevant to mothers and babies are spread far and wide – from obstetrics to midwifery to metabolic to psychology journals and beyond.

You can bring evidence to your care provider in support of your point of view.  This is one of the most important things I do for my MamaBaby Birthing students – I help them gather evidence to dialogue important points with their doctor or midwife.  This helps a mom to make a choice that’s backed by evidence, and it’s a way to present it that’s respected by your care provider.

I had a student who was particularly worried about the impact of early cord clamping on her baby’s health.  Delayed cord clamping is becoming more and more mainstream, but it’s still common practice in most hospitals to clamp the cord immediately.  My student knew this was the case at her hospital and with her OB.

I helped her gather a wide range of journal articles and studies, as well as summaries written in plain language, to discuss with her doctor.  She felt that he was willing to listen on these points, though she wasn’t sure if it was enough to sway his practice for “everyone.”  This student had a great hospital birth that went so quickly the OB didn’t actually make it – but delayed clamping was on her birth plan and approved by her doctor, so the nurses respected her wishes.  Her doctor clamped and cut the cord when he finally arrived 😉

Bringing research to the table is a powerful way to dialogue on an adult level, so I recommend careful research as you consider your choices in birth.

Do remember that sometimes science lags behind – it’s actually quite hard to do studies on “normal” birth because birth is fundamentally altered by hospital protocols, where most studies are done.  But birth and the wisdom of the design behind it can and do triumph, so you’ll find many studies backing  aspects of physiological birth.

Compromise Can Help (but know what matters)

I do think there are times that compromise can be valuable in helping you get the birth that you want, especially in a hospital setting.  Unassisted birthing is an option for many women, but many more will want a midwife there, or will feel more comfortable in the hospital.  Some moms have pre-existing medical conditions that make a hospital the best choice – and perhaps with a more managed labor.

Most doctors and midwives are willing to work with you, however, to have the birth experience that you want for yourself and your baby.  The respectful discussion I’ve talked about in this article goes a long way towards creating a relationship that leads to a more peaceful birth where mama and baby are able to labor together without disturbance.  Interventions can be withheld – or substitutes introduced.

Fetal monitoring is a classic example: rather than continuous fetal monitoring (which has been shown to have absolutely no benefit for low-risk mothers and babies), fetal heart rate is often monitored every 15 minutes throughout labor.  This can be done by a nurse or midwife, who can wait to listen between contractions, or can listen for longer if she needs to monitor how baby does during contractions.

IV fluids are another example: many moms are able to get a hep-lock, which keeps a vein open and available at all times, but fluids are not actively pushed in unless needed.  Many healthy mamas can even advocate to go without IV fluids all together when laboring without medication or augmentation (such as Pitocin).

Another of my MamaBaby Birthing students felt very strongly about honoring the natural hormonal flow of labor and birth, and preserving that to create both safety and a time of bonding for herself and her newborn.  She knew that Pitocin or other synthetic oxytocin drugs shut down the body’s natural oxytocin flow, which increases the chances of hemorrhage and leaves a newborn and mama without the bonding exchange of oxytocin in the postpartum period (see Will the Real Oxytocin Please Stand Up for more on this).

Her doctor and nurse-midwife were both fine with her forgoing IV fluids during labor, but both worry greatly about postpartum hemorrhage and use Pitocin as a standard part of a managed 3rd stage (baby has been born and waiting to birth the placenta or afterbirth).  The truth is, natural oxytocin at normal levels for labor and birth generally stops postpartum hemorrhage as effectively as any drug – but doctors, nurses, and many midwives don’t see women with normal hormonal flows.

My student asked my advice, sharing that getting a Pitocin injection was a possibility for the 3rd stage (rather than having a Pitocin drip via IV). I recommended that she tell her doctor and midwife that she would be fine getting the injection – and then advocate for her baby to be put immediately on her chest, skin-to-skin, with quiet and lots of time to bond.  She was planning to go to the hospital late in labor to minimize early intervention, meaning a well-established labor and a strong hormonal flow.  One injection of Pitocin is probably not going to get in the way much, and it’s an acceptable compromise with her care providers, who truly feel it ensures safety.  If it gives them the peace of mind to give her and her baby an uninterrupted bonding time, it’s a good compromise.

This student arrived at the hospital late in labor and walked the halls for an hour, then went through triage and was assigned a room without IV hookup.  Sixteen minutes after getting to her room, while still standing beside the bed, she felt her baby coming.  She had just enough time to get onto the bed before her baby slid out!  Doctor and nurse actually missed her birth.  She did get the Pitocin injection a short time later, but her wishes for a beautiful birth and uninterrupted bonding time with her baby were respected.

These things might not be ideal to you – and that’s the time to carefully consider choices and possibly alternate birthing locations.  But many moms do want to birth in the hospital or with a care provider overseeing things – and discussion and compromise are key to having a great birth.

This Birth is Your Birth

Remember that this birth is your birth (and this pregnancy is your pregnancy).  Nobody cares more about yourself or your baby than you do – and that means you’re going to do your research and consider your choices carefully.  Do put in the time to understand all perspectives around maternity care and birthing issues.  When moms take notice of the evidence, and when mamas respect the design and power of birth, the rest of the world will take notice.

You deserve respect, even if a care provider disagrees with a choice you’ve made or something you’re proposing for your birth.  They should explain their position clearly and kindly.  If they won’t compromise or agree to your choices, they should explain why without being derogatory or insulting.  Do remember that just as it’s your right to make choices for yourself and your baby, it’s their right to request you find a care provider who will be a better match.  The key is that all of this dialogue is respectful.

As I mentioned above, if you feel confident in your choices and your care provider just doesn’t agree, it may in fact be time to look for another care provider.  Or if a provider doesn’t feel like he or she can work with the situation, it’s time to look for other opinions.  Find someone who will work with you – there are many great obstetricians, maternal-fetal medicine specialists, and midwives out there.  You can find one who wants to be part of your team – someone you can explore, discuss, and talk with about the issues that matter to you.