How to choose the right care provider for your gentle birth plan?

Originally written for Glam-O-Mamas blog website

​You are pregnant and you want to have a special experience with the birth of your baby. May be you psyched yourself up for an un-medicated normal delivery or you would like to go for a water birth. You might have read other women’s stories who consciously chose no medical interventions in birth or feel inspired by one of your friends who seem to be raving about her Hypnobirth experience.  You might have a very clear idea of how you want to birth your baby or you might be still in the searching mode and rely on the help of your care provider to assist you with the gentle birth plan.
 
But then you have your next appointment with your doctor and bring up some points from your gentle birth plan, you notice they are met with a blank stare. It is even more discouraging when the blank stare is followed by remarks such as “Are you sure you do not want any epidural? You will be in so much pain, why do you want to do that to yourself?” or “No episiotomy? I always perform an episiotomy because I do not want you to look ugly down there”.  
 
Big red flags here! An OB-GYN who shows no interest in your birth preferences or openly discards them during the prenatals will most likely not respect them during your birthing time. Given that most women give birth nowadays in the hospitals it is really your doctor who can make all the difference in your birth experience by being part of your gentle birth team or directly opposing it, thus leaving you in the mercy of the hospital protocols.
 
As a doula I always start working with my clients by asking if they are happy with their main care-provider – do you feel supported in their vision of birth? Does your doctor really listen to you? How much time do you spend with your doctor discussing your pregnancy progress? Does your doctor show openness to accommodate your birth preferences if they divert from the conventional medicated approach to birth?  If you feel somewhat ambiguous or not completely sure in the support of your doctor in your gentle birth plan, it is a reason to seriously question if your doctor is the right person to be on your birth team.
 
Members of The Gentle Birth in the Philippines community share that it sometimes takes interviewing three to five doctors to find the one who is fully supportive of your birth plan. The group has also a growing list of highly recommended care providers that have a proven track record on gentle birthing.
 
Here are some main questions that you may want to take up with your care provider before settling for the RIGHT ONE:
 
1.  “Under what circumstances would you suggest an induction to start the labor?”

Some doctors will only start labor artificially for genuine medical indications such as sever high blood pressure or pre-eclampsia, which is indeed a warrant for intervention.  Judging by the accounts of the average hospital birth experience a large number of doctors routinely suggest induction on the due date or a few days after. Some doctors of Chinese descent even tend to pull out a “lucky calendar” suggesting the “lucky day” to give birth, meaning to be induced to give birth. The truth is that every doula and birth professional knows that getting your labor induced is the first step towards a Cesarean birth. Inform yourself well about the notion of term and due dates so as to be equipped with arguments and not be bullied into the Pitocin drip on your “Estimated Due Date”.  The article “Evidence on inducing labour for going past your due date” by Evidence Based Birth is an excellent resource for this.

 2. “What are your views on time limits during each state of labor?” 

If you have given birth already and felt pressured through the process you might recall your doctor conveying to you after yet another internal examination (IE) that you are only dilated X amount of centimeters while you were supposed to be already fully dilated at most or hitting the transition at least. You would wonder – what is that golden standard of dilation you are being held to? The fact is that till the day of today the majority of OB-GYNs expect all women to dilate according to the “Friedman’s Curve”. Friedman’s curve is a graph that obstetric care providers have traditionally used to define “normal” length and pace of labor. If a woman’s cervix does not dilate according to this schedule, she may be diagnosed with “failure to progress” and taken to the operating room for a Cesarean. Mind however that the Friedman curve was originated as a result of the study conducted back in 1955 when most women in labor were sedated into unconsciousness by the “twilight sleep” and most babies were delivered by forceps. In the modern time most researchers came to the definitive conclusion that we can no longer apply Friedman’s curve to women of today’s world. Too many things have changed since 1955 in terms of the physicality of mothers (age, weight) and other medical interventions in birth.  For more insights on Friedman’s curve read the article read the article “Friedman’s Curve and Failure to Progress: A Leading Cause of Unplanned C-Sections” by Evidence Based Birth.
 
3. “How often do you find it necessary to cut an episiotomy?” 

There is a lot of misconception about how you will look like “down there” after giving birth and it seems like a lot of doctors capitalize on the fear of tearing by offering routine episiotomies (surgical cut of the perineum).  Episiotomies can be indeed helpful in case of long or obstructed labor, however, when performed routinely they pose a risk for a mother’s well-being. The studies show that selective episiotomy policies appear to produce less perineal trauma, less suturing and fewer complications compared to routine episiotomy policies.
 
I recall when I accompanied once a first-time mother to the appointment with her OB-GYN we were discussing the birth process, when the doctor raised her hand and twisting her two fingers in a scissor like gesture she said: “…and then we deliver you from your baby!” Well, that was obviously a clear physical sign of a doctor with a routine episiotomy policy before the question was even asked. For more information on the topic read “Evidence Based Medicine: Episiotomy” by Mother of Fact.

4. “How will you feel if I want to be off the bed during labour and for the birth of my baby? 

Imagine an elephant or a cow mother being laid on her back and her legs tied up on the stirrups. I guess anyone who would dare to come near the animal in this position should fear for his life. How come we have a situation where human mothers are forced to stay put on their back during one of the most athletic exercises of all times which is birth?!  If you look closely at many traditional cultures you will rarely see a portrayal of a woman giving birth laying on her back. She will most likely be squatting or on her fours or leaning against her support person to let the gravity work with her body in order to release the baby. These same positions are possible in the comfort of your birthing room. You have the right to labor and give birth on the bed, near the bed, in the pool or on the floor if you like to.
 
Once I coached a second time mother in hypnobirthing techniques to make her second birth a more pleasant experience. The mother was disgruntled with her first birth experience where she was forced to lay on her back while the staff coached her to push. The second time around she was determined to claim back her power to birth the baby the way she wanted. So when the time came to push the baby out she jumped off the bed to utter dismay of the attending resident, found her comfortable squatting position supported by her husband and her baby was out in a few deep breathes. The resident had no choice but to squat together with the mother to catch the baby.
 
 5. “How will you feel if I want to have my husband and/or my doula during the entire process of birth?” 
​
Multiple studies have shown that the mere presence of a dedicated female companion other than the medical staff drastically improve the birth outcomes in terms of mother’s satisfaction and in terms of the decreased rate of interventions. Doula, a professional birth companion who provides emotional, psychological and informational support will stay by your side for the entire duration of your birth tending to your needs and guiding through the process where needed. A doula does not replace your husband but works in synergy with the birthing couple as a whole. Whether you decide to employ services of a doula or not, you have the right to a birth companion of your choice at all times, be it your husband, sister or mother. Unfortunately not yet all hospitals in The Philippines are on board yet in terms of allowing a  birth companion inside the labour and delivery rooms, but the leading establishments such as Makati Med, both St Lukes, Medical City, Asian Hospital, Cardinal Santos hospital have all been welcoming of partner assisted births including the presence of a doula.
 
 
The bottom line is that the choice of facility and more so your main care provider is crucial for the success of your gentle birth plan. Make sure that your doctor is guided by the most updated evidence based research and not by the protocol for the sake of the protocol. Each birth even if you have given birth to several children is unique and sacred, and most importantly it is YOURS! Therefore, be critical and choosy with people you get on your birth team making sure they reflect and embrace fully YOUR vision of the birth of your baby.