Creating Your Birth team

Your birth team are the crucial group of people who will be present and attentive throughout your labor and birth experience. The scope of these people is from family to health care professionals, to doulas and don’t forget husbands. The birthing environment is one of extreme fragility. You want to feel safe, supported and comfortable in this space and the people present can very easily alter the energetics either negatively or positively. In this blog were going to cover all groups of people to help you decide who you want on your birth team, we'll explore medical and non-medical team members as well as why you may want certain people there and others not there. I have much more on creating the ideal birth space here!

In the first trimester of pregnancy, it is very important to decide who your health care providers are going to be. Not only for prenatal care throughout your pregnancy but also who will be attending your birth. This could be an OBGYN that you’ve seen for years and are comfortable with or a new team of OB’s that your friend recommended, or it could be a midwife/group of midwives. Some women do choose to freebirth or give birth without a medical professional but that is a topic for another blog. An OB and a Midwife play similar roles in the sense of ensuring a healthy pregnancy and delivery of baby as well as healthy mom postpartum. So, what are the differences between and OB and a midwife?

Medical birth team:

An OBGYN is a medical doctor who specializes in Obstetrics which is essentially a field of surgery. They tend to lean more towards the medicalized side of pregnancy and birth prescribing prescriptions as opposed to natural remedies. They view the process and outcome of pregnancy, labor and birth as their responsibility and are less willing to let anything go wrong regardless of the low risk of a pregnancy and more likely to control the situation using interventions. As well as pushing a more medicalized birth agenda with medical induction, pain medication, optional c-section or even just being quicker to opt for an emergency c-section (particularly if the labor is inconvenient time wise for them.) Now this is not true for all OB’s but from what I've seen as a doula and learned from other doulas is that is pretty typical. An OB typically practices out of a hospital which is where your baby would be delivered. In addition to the OB being there while you gave birth there would also be a team of nurses present at any given time during your stay in the hospital. Typically, these nurses check vitals, time contractions, do cervical checks etc. Some women have reported up to 7 people being in the hospital room at a time when they were in labor.

This route of care will also provide you with the least flexibility in terms of your choices. Hospitals typically have mandates/ requirements and routines for procedures to be done to you and your baby during labor, birth and postpartum. This is not to say you don't have a choice on what they do or don't do to you and your baby, but you may receive some push back for declining certain procedures in this setting. Most OB's practice in a group setting so depending on when your doctor is scheduled, they may or may not even attend your birth. This means you may have a doctor who you’ve never met. In this setting you are mainly cared for by the nurses and the OB will come in typically towards the end of labor when you are fully dilated to "deliver" the baby. The hospital requires you to stay for at least 24 hours postpartum and you and your baby will be cared for by a postpartum team of nurses within that time frame. 

The next option in terms of care would be a Midwife. The midwifery model of care is very different than obstetrics. Midwives typically operate under a patient-first model of care, viewing the mother as responsible for her own well-being as well as the well-being of the baby. This model of care also (in most cases but not always) approaches things more holistically, understanding the connection of mind and body. It regards birth as a natural and physiological process as opposed to a medical emergency. Depending on where you live this type of care could be an independent midwife without an office (also known as a Certified Midwife), doing home visits for prenatal care and home births for delivery or it could be a team of Certified Nurse Midwives practicing out of a Birth Center. There are also midwives who have no formal training but learn midwifery by shadowing more experienced midwives known as Lay midwives. In some states midwives cannot become certified unless they are a nurse or even practice legally if they are not Certified Nurse Midwives. When choosing your birth team, you'll want to do some exploring to see what options are available in your particular area.

A Midwife operating outside of a Birth Center- typically a certified midwife or lay midwife is essentially the primary caregiver throughout your pregnancy and will be the one attending the birth of your baby. These midwives will also have a backup midwife in case two women are in labor at the same time. So, in this case you would only get to know two women during your pregnancy and would for certain have either of them attending your birth. This care can feel more intimate than if you were to have a whole medical team. If you desire a more intimate connection with the person attending your birth, this would be the best option for you!

At a Birthing Center under midwifery care there is most likely a team of Certified Nurse midwives as well as Nurse practitioners that rotate appointments and attend births. In this case you would most likely meet more people, and it is uncertain of who exactly will be attending your birth until you actually arrive in labor. There are some Certified Nurse midwives that practice out of hospitals as opposed to a Birth Center which is not connected to a hospital. In this case you would get care from likely a team of two midwives- so it can be more intimate- but the delivery is in a hospital room with potentially many of the hospital nurses present and part of your birth team.

Regardless of the type of midwifery care you receive it is more holistic and less medicalized. Most Home Birth midwives do not offer or even keep pain medicine on hand. Midwives are trained in some kind of medical capacity, certified nurse midwives having the most medical training from going through nursing school prior to becoming a midwife. All midwives and Birth Centers are trained for emergencies and have emergency plans in place that should be discussed in case an emergency were to arise. But overall midwifery care consists of less procedures, requirements and more choice/ flexibility when it comes to what your birth experience looks like and the decisions that can be made to tailor that experience to your desires. It is worth considering when choosing your birth team also thinking about the location that you would give birth in if that was your team. For example, if you are greatly afraid of giving birth at a hospital it may be worth not looking at Ob's or midwives that operate out of a hospital but a home birth or birth center option (unless you have an awesome Doula to work through your birth fear with.) 

Non-medical birth team:

It's also important when creating your birth team to think about the non-medical people who you would like to be present. With that it's important to remind you that the birthing environment is one of extreme fragility. The energy that someone brings to the room can completely change how you feel and your comfort level. A person who could help to advocate for you as well as help you navigate pregnancy, and your birth experience is a Doula.

Doulas are defined as non-medical but emotional support people. Some Doulas however do have some kind of medical training or knowledge. These women are there to understand you, your individualized needs and wants, to ensure that things are sought through in the way you desire throughout your pregnancy, labor, birth and postpartum. A Doulas role can vary from birth to birth, and it entirely depends on what you (the birthing mother) may need during the time period mentioned above. As a Doula myself I have attended births where the mother seems to have everything under control, but the dad needs help and reminding to drink water and eat to keep going and being supportive to his wife. The complete opposite is true, the mother needing more support, and the dad is cruising through.

Research shows that women who have a doula are more likely to be satisfied with their birthing experience as well as more likely to have a vaginal delivery. I share more on the benefits of a vaginal delivery here! It is also known that doulas decrease the use of pain medication and epidurals during labor as well as overall labor time. A big role in the work of a Doula is education. Educating the mother on what is going on during pregnancy, birth and postpartum to eliminate so much of the unknown. In the way education is empowerment to the mother and husband allowing them to have the birth experience they desire. For more on the benefits of a doula check out this blog post.

The next people you may be considering as a part of your birth team are family members. I feel like this is the group of people that need the most consideration when choosing. It is great to have support from someone you trust and are completely comfortable with during labor and delivery- say, someone like your mom- but also there is sometimes conflicting thoughts, ideas and views on things that may be important to you that will cause tension in this extremely fragile environment. It may be worth thinking about any negative experiences you’ve had with the people you choose to be present at your birth and if that has been resolved or if there is still resentment from it. It may also be worth considering why you want this person present, will they be helpful to you or is it because they want to be there and you feel guilty saying no. As mentioned previously the birth team you choose can make or break your birthing experience and for this reason saying no to someone coming because you aren’t 100% comfortable with them being present is completely reasonable and I pray that they would understand that also.

The last (but definitely not least) person to talk about is our Husband. Now I'm sure for the majority of women reading this having him present is not a choice it’s non-negotiable. I agree, having him there is essential. The father can play such an important role in the birth experience. Helping to create a safe place for his wife, being strength for her when she needs it and even catching the baby, announcing the sex if it’s a surprise and cutting the cord. In the past and in movies fathers were not seen as an essential member of the birth team. They were seen as someone to sit and wait while the woman does all the work. This tide is starting to change. Many fathers in this generation are starting to see the importance and benefit of being attentive during this life changing event and are actually wanting to be there.

I recommend that Dads be involved in as much of the process from pregnancy to postpartum as possible. Reading the books together, taking classes together, and really getting on the same page as the mother with how she sees it all unfolding. This not only strengthens the relationship with husband and wife it also eliminates room for being resentful towards the husband for not doing something or doing something in a way that wasn’t agreed upon. I have heard of many fights starting because husbands don’t understand fully why the mother doesn’t want to give the baby formula even though they are struggling so much with breastfeeding. This, among other things, is something that should be discussed with your husband before the heat of the moment. I personally love the book Husband Coached Childbirth by Robert A Bradley for dads to read in regard to the birth experience. It goes into great detail what the process is like and how to be most helpful.

Childbirth is such a vulnerable and intimate experience, who you choose to be present can truly impact your overall experience in a positive or negative way. This is why it is so important to be picky and discerning when creating your birth team. Don't hesitate to shop around when it comes to the medical team you chose. Be sure you feel 100% yes when deciding and don't settle! Women who feel loved and supported by those present are more likely to have a positive experience and also rely less on medical interventions. With the clarity from this blog, you should feel more empowered when choosing your birth team.

If you're still feeling stuck or don’t have the clarity you desire schedule a free 30-minute breakthrough call with Maggie Eisenhuth, Doula, Childbirth educator, Womens Holistic health practitioner and Orthodox Christian mom for additional support, guidance and empowerment!