How will your birth turn out?
Of course there is no way of knowing for sure. One of the exciting, and scary,
things about having a baby is that so much of it is a surprise! Your choice of
caregiver though will affect the choices available to you and may affect the
sort of birth experience that you have.
There are two types of care - we will call one routine,
and one personalized.
Routine:
Routine care is the most common form of care in most
Western countries. It is called "Active Management" by
the medical profession. Routine care involves having
routine procedures and protocols that are applied to all
pregnant women. For example, an obstetrician may give
all pregnant women iron tablets, regardless of whether
they have iron-deficiency anemia or not. The reason for
this is that the caregiver is taking a "just in case"
approach. This can seem very reassuring. However, it
also means that the unique and individual needs of you
and your baby are not being taken into account. It also
means that you will be exposed to a number of
interventions that are not medically necessary but are
routine.
Personalized: Personalized care is more commonly
provided by midwives although many obstetricians do take
this approach as well. It is called "Expectant
Management" by the medical community. In this approach
nothing is routine, with protocols and hospital policies
being less significant. Rather than treating all
pregnant women the same, each woman is looked at
individually. If she is showing signs of iron deficiency
anemia for example, the caregiver might prescribe iron
tablets. The interesting thing is that the research
shows that mothers and babies are just as healthy with
this approach as they are with routine care. The benefit
is that you and your baby are being treated as unique
individuals with unique needs, you will be exposed to
less interventions, and have more choices available to
you.
How can you tell if your caregiver is routine or
personalized?
It can be really difficult to know which type of
caregiver you have at the moment, especially if this is
your first baby. If you have a routine caregiver there
are a few clear signs though which include:
-
Your prenatal appointments are generally short,
often no more than 5 minutes
-
Your caregiver always checks the baby using
ultrasound rather than his/her hands on your belly
and a tape measure
-
You may have been having vaginal examinations
throughout pregnancy and will probably be having
them every appointment from 38 weeks
-
Your caregiver may be reluctant to talk about a
birth plan or tells you not to worry about anything
and let them take care of it all
It can be helpful to have a few simple questions to ask
your caregiver to get a clear idea on where they stand
and then to be able to identify whether or not you have
similar beliefs. The B'LIEFS tool can be helpful for
this:
B - Bed
(how do you feel about me being in positions off the bed
for labor?)
L - how Long?
(what sort of time limits do you have for first stage or pushing?)
I - Induction
(under what circumstances would you induce labor?)
E - Episiotomy
(how often do you find it is necessary to do an episiotomy?)
F - Food
(how do you feel about me eating and drinking during labor?)
S - Supporters
(what are your thoughts on me having a doula or additional supporter)
Even if you decide that you are comfortable with having
routine care, asking these questions helps you to
identify what is important to you and whether you and
your caregiver are on the same page. Your doula or
childbirth educator can help you to practice these and
similar questions and how to explore your options if you
decide you would like a different approach from the one
you currently have.
This article is reprinted with permission from
Childbirth
International
