Choosing a Care Provider: For Your Pregnancy
Hey, Sister! We’re back!
Today I’m going to take a dive into choosing a care provider and the type of birth that you want! Maybe you know all the options you have within your community, maybe you don’t! Maybe some of this will be all new information for you and will give you space to question your full spectrum of options and begin truly asking yourself;
“What do I REALLY want for this pregnancy and birth?”
“Who do I SEE in attendance of this birth?”
First, let’s start with the WHO: Now, let me preface this with this, I am NOT judging anyone. I am not trying to convince anyone to make one choice or another. If you’ll go back to my video and/or blog post about Informed Consent versus Informed Choice, you’ll see that I find it extremely imperative that women are given the FULL SPECTRUM of options. All the negatives, all the positives. Once you have the full spectrum of information, you can then make a very informed decision. The decision that is best for you.
Obstetrician (OBGYN):
An obstetrician or OBGYN is a surgeon who specializes in pregnancy and birth. Obstetricians practice almost exclusively in the hospital setting and is the care choice of 90% of American women.
Their services typically provide 10-12 prenatal visits lasting maybe up to 30 minutes. Sometimes these visits are with just a nurse. Delivery at a hospital. Usually one postpartum visit at 6 weeks, in their office.
The potential drawbacks of choosing an Obstetrician for your pregnancy and birth: An obstetrician’s care is based on the foundational belief that birth is dangerous and must be controlled. Their care tends to be routine, impersonal, and not individualized based on the unique woman. Nutrition is rarely spoken about during pregnancy and education surrounding the physiological way birth works is not educated on. Obstetrician’s rely on technology and dismiss intuition and instincts. The obstetrician himself or herself rarely has any education courses to teach about birth. Hospital courses will teach the medical model of care and the standard procedure done within that hospital. Women are often hassled whenever they exercise their autonomy and decline tests and procedures during pregnancy and their birth. You aren’t always able to talk to your doctor or the doctor’s nurse if a question or issue arises between appointments and/or after hours.
The cost of a hospital birth with an OBGYN: Can be upwards of $10,000 or more for prenatal care, another $10,000-25,000 (plus) for the birth. This doesn’t include after care or baby care, pediatrician fees, testing fees, etc.
Certified Nurse Midwife (CNM):
A CNM is a registered nurse who went on to have additional training in pregnancy, birth and postpartum. Most CNMs will practice in a hospital but some may attend births out of the hospital at birth centers and some even at home births. CNMs typically use medications as part of their practice but do tend to support natural, physiological labor more than the typical OBGYN.
Their services and costs are very similar to the standard OBGYN schedule of prenatal appointments.
Certified Professional Midwife or Certified Midwife (CPM or CM):
A CPM is someone who has apprentices under a preceptor midwife, attended a midwifery school or some combination of the both. A CPM sits for an exam to then be credentialed by a professional organization that will grant certification. CPMs typically only attend out-of-hospital births and many can and will use drugs in emergency situations.
Traditional or Direct Entry Midwife:
This is the most ancient type of midwife and is becoming harder and harder to find; or they’re going underground. A Traditional Midwife is a woman who has become a midwife because her community needed her to be one. These midwives have a calling. Traditional Midwives are trained under another Traditional Midwife and intensive independent study. Traditional Midwives typically choose to not become certified or licensed and exclusively use non-drug interventions such as herbs when occasionally needed.
Licensed Midwife (LM):
A Licensed Midwife is a midwife who may or may not also be certified, who holds another layer of credentials in the form of a license. Licensure is of the state and the state becomes a governing body of rules and regulations that the midwife must adhere to in order to obtain and maintain her license. Not all states regulate midwives and don’t offer licenses. CNMs are also regulated by rules and regulations within their certification.
These rules and regulations is why many women feel anxious towards the end of their pregnancies because their midwife “can’t” attend their birth under certain circumstances. Like, for example, many women are dropped from their midwife’s care simply because their pregnancy reached 42 weeks.
The services of a CPM/CM/LM are similar to and OBGYN in the frequency of visits. 10-12 prenatal visits typically in their office or clinic, though some many only do home visits. These visits are typically 30-45 minutes long. All the standard testing, vaginal exams will be talked about but most are respectful and not hassling when a woman declines any and all testing.
The potential drawbacks of choosing an CPM/CM/LM for your pregnancy and birth: Not all midwives are the same. Some practice more medicalized care that isn’t individualized to a great extent. Sometimes midwives will transfer your care if you fall outside the spectrum of the rules and regulations set forth by the state. Some examples are: Reaching the 42 week mark of pregnancy, prior c-section, expecting twins, you decline any test or state-mandatory intervention. So, only women that fit into the “box” the state has deemed “acceptable” can be accepted as clients. Women who are experiencing miscarriages or end up with a complication are prohibited care with the midwife. Most midwives do not do any kind of well-woman care.
Some perks: Sometimes these midwives will have an education course that they recommend or have created for their clients available. Much of the time, as a client, you’re able to call, text and email your midwife and get a fairly reasonable response quickly. CPMs/CMs/LMs are trained in emergencies and can handle most at home.
The cost of a birth with a CPM/CM/LM varies but is usually a flat rate fee of $3000-5000 with a pre-determined payment plan. Other fees include any lab testing, ultrasounds, birth kit, etc.
Midwife under a PMA:
A PMA Midwife is a trained, skilled and experienced midwife, who may be certified as a CPM, that chooses to remain autonomous and outside of government control. These midwives only attend home births.
Their services provide 10-12 prenatal visits; typically at your own home. Much of the time they will bring an assistant to your birth. In the postpartum season, they provide 6 weeks of customized, in-home visits for you and baby. Your care if focused on physical, mental, emotional and spiritual health and the whole family is encouraged to attend.
A PMA Midwife can attend any woman with similar beliefs and who wants to birth outside of the system. The relationship between midwife and woman is a priority. Being rightly matched makes all the difference. A PMA Midwife can support loss of all varieties. Many PMA Midwives also offer support and education for nutrition and fertility.
PMA Midwives are known for their community. A community of other women to lean in on, education courses that teach undisturbed, physiological birth.
PMA Midwives are typically available between appointments for non-emergency questions, concerns, counseling and are available via phone, text or email.
PMA Midwives are trained to handle most emergencies at home.
There is an extensive knowledge in nutrition, herbs, essential oils and working knowledge of alternative health along with a network list of alternative health practitioners.
The cost of a birth with a PMA Midwife is typically on a sliding scale between $3000-5000. An individual payment plan and/or possible barter.
Doula:
A Doula is a non-medical support person who is focused on supporting a mother through her pregnancy and birth with continuous emotional and physical support. A doula has no medical training but is often certified and held to the rules and regulations of their certifying body.
Birthkeeper:
A Birthkeeper is someone who holds space for women to find the fullness of their own power, to learn to truly trust, connect and listen to their bodies, their babies, their intuition and to give birth in a way that makes you feel seen, heard, safe and respected. A Birthkeeper is a person with birth experience, training and a deep respect for the sacredness of birth. The keeper of space. Holding space for the spiritual, physical and the emotional. Holding space for your fears, hopes and dreams. A trusting, wise woman, hearthmother.
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:
Having a freebirth/unassisted birth is a valued and viable option as well! You don’t HAVE TO have a primary care provider for your pregnancy and birth. When choosing this option, a woman and her family rely on their own intuition, knowledge and consecrate all their decisions unto the Lord.
The services provided are whatever you create! You may hire someone like a Birthkeeper to hold that emotional, spiritual and physical space with you. Your prenatal care may just be eating well and taking great care of yourself spiritually, emotionally and physically. You may decide to do some or all “clinical tasks” if you so choose. Many women choosing this option will reach out to their friends, community and alternative care people for support.
Some potential drawbacks: Sometimes women feel unsupported or choose this option because they think no one can help them or they aren’t aware of the option of hiring an unlicensed midwife. If choosing this option and not seeking out community, it can feel isolating. Rarely, a complicated situation in pregnancy or birth can be missed.
Anyone can choose this route and anyone can do their own care and plan an unassisted birth. You can enter fully into your own power and wisdom, learn how to do any clinical measurements you may be interested in performing and even order your own lab tests; if desired.
Birth education can be any avenue in which you desire! There are many incredible options out there to learn physiological, undisturbed birth. Lots of books, resources and communities!
The cost of an unassisted/freebirth is free despite what you choose to spend on your health, wellness, consults with any birth support persons, birth supplies, education, etc.
So, there you have it! A quick rundown of your options of care providers! Now, not every area will have this full list of options. Ask around your birthing community for recommendations and guidance for finding the type of birth support you’re feeling most drawn to. There really is no one-size-fits all, obviously! And, the right care provider for one woman won’t be the right care provider for another woman.
I recommend that you take your time to thoughtfully and intentionally seek out your options, pray about your options, journal what you believe about birth, visualize and pray over your birth.
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?
Handcrafting your birth WHY and your birth TEAM is arguably one of the most important pieces of inner work that you’ll do.
Happy Planning, Sisters!
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