Selecting Your Care Provider
When I first became a doula, I discovered something about obstetrical care which shocked and saddened me; I realized through my experiences that birth outcomes and interventions are shaped drastically by which medical professional is present. Their individual care-style, medical preferences, and birth philosophy impact outcomes, perhaps more than any other factor. For example, some doctors are more likely to suggest certain interventions than others, based on their own comfort levels and preferences.
For this reason it is so critically important to select a primary care provider for your pregnancy whose birthing values align with your own, or, a care provider with whom you feel your values will be heard, even if they differ from theirs. This can be difficult in a scenario in which many people feel there is a power imbalance, with the care provider being perceived as the person in authority (PSA: It’s your body and you have authority here, FYI).
In my practice here in Canada, I have noticed that many people do not know their options for care provider throughout pregnancy and birth, and are just referred blindly by their family doctor. I always shed light on this when meeting with expectant parents for the first time.
In most of North America, there is a “three tier” system for pregnancy care. The primary care practitioner for a pregnant person is usually one of three things:
An Obstetric Gynecologist (a.k.a. ObGyn)
A Family Doctor with Obstetrics Specialty Training (a.k.a. Delivery Doctor)
A Midwife
In other places in the world (for example in the United Kingdom, where I grew up), ObGyns are reserved for high risk or complicated pregnancies (e.g., pregnant people over the age of 40 or with health concerns, IVF recipients, or pregnancies with multiple babies).
Here in North America, ObGyns take care of complicated and high risk pregnancies too, but are also often supporting low-risk, uncomplicated pregnancies. Sometimes a referral is given from a family doctor, and sometimes the patient self-refers. Many people have an ObGyn even if they are low-risk and do not technically “need” that specialist level of care.
I believe this happens for a few different reasons:
ObGyns have been considered the normative model of care for all pregnant people in North America since the medicalization of childbirth began in the late 1800s. Family doctors therefore refer to ObGyns by default, because it is historically the standard practice. However, modern research shows us that this “standard practice,” dating back over a century, is not necessarily resulting in the best birth outcomes.
Pregnant women self-refer to ObGyns without knowing they have other options for their care during a low-risk, uncomplicated pregnancy.
Pregnant women request ObGyn care because they have the impression they give the “highest level of care.” While ObGyn doctors do receive more years of education, they may not have experience with low-risk pregnancies and low-intervention births.
There is low availability of midwives and delivery doctors, and ObGyns have space to take people who are referred later in their pregnancy.
Generally, ObGyns have a more “medical” mindset around birth. They are trained in a medical setting, and their practice is focused on a hospital model of care–i.e., taking care of people who are sick (which low-risk pregnant people are not). They are trained in complicated cases, see more complicated cases, and therefore lean towards a more medical approach to care. Humans are not objective. We will always be affected by what we see the most. An ObGyn who sees more complications due to the nature of their patients (high-risk cases) is therefore more likely to resort to medical means and interventions to manage childbirth, even in low-risk cases.
On the other end of the spectrum are midwives. Their practice is usually centered around uncomplicated, low-risk patients. Their philosophy is usually non-medical, more holistic, and focused on the natural process of pregnancy and childbirth. For midwives, birth is seen less as a medical event, with pregnant people being seen as very distinct from other “patients” (i.e., sick people) in the hospital system. Midwives see uncomplicated, unmedicated, physiologic birth (defined as birth that is powered by the innate human capacity of the birthing person and fetus) far more often than ObGyns, so are less likely to carry out procedures and interventions to manage childbirth. They act more as a witness to the body’s process of birth, rather than a manager in the delivery of a baby. They are trained to assess for scenarios where interventions are needed, but do not resort to them as keenly as ObGyns, instead supporting the birthing person by encouraging the use of different positions, comfort measures, and coping techniques to assist their labouring body.
For example, where an ObGyn may reach for a vacuum to assist a baby who is low in the vaginal canal but very slowly moving down, a midwife may be more likely to encourage a birthing person to move into a squatting position to help the baby descend.
Of course, these descriptions are generalizations. Each ObGyn sits somewhere on a spectrum of natural to medical, and each midwife sits somewhere on this spectrum also. But generally, ObGyn care is more medically focused and midwives more physiologic. I find that Family Physicians with Obstetrics training sit somewhere in between the two, with more variation between doctor to doctor, depending on their individual experiences in obstetrics care, plus the policies and cultural norms of the places where they have practiced.
It is so important to research who your care provider will be. If you realize you are not aligning with your provider’s values and approaches, I strongly encourage you to seek out a new provider. This is something I can support you in doing. This is also crucial for your feeling of safety and comfort during the birth and for your birth outcomes. In scenarios where it is not possible for a change in provider, or you have no guarantee of which provider will be present at the birth, as your doula, I offer strong advocacy and firm boundaries with care providers when it comes to prioritizing your birth philosophy and values.
You are the leader in the care of your body and your baby. Your philosophies, values, and preferences should be honoured. Ensuring your provider understands and hears your desires is crucial for your birthing journey. I can help in making this happen.
