Who Attends Your Birth

When looking for someone to care for you and your baby, it’s important that the person you hire respects you, trusts you, and listens to you. In many places (such as the town I live in, Frankfort, KY) there is only one local place, and with a bit of travel, there are few semi-local offices to choose from for a hospital birth. In the only practice with hospital privileges, if you don’t already have a relationship with a specific provider, you’ll be supported by whoever is on call at that time. It can mean winding up with someone you don’t know or respect and doesn’t know your birth choices or why you’ve made them and may not respect those decisions.

Even if there isn’t access to a lot of options for hospital births, there are many places that have birth centers, and many more have access to homebirth midwives. There are social groups that support free birth, or unassisted birth, and can guide you on what you need to know to birth in your own way. For your ideal birth scenario, you may start with the type of provider you’d like to attend your birth, so research is important! Know that most of the time a care provider who works within a group and/or for a hospital isn’t going to want to bend the policies (notice they’re not laws, they’re policies) of their practice or the hospital they work for. Some will bend a few rules, but to an extent. Therefore, choosing where you feel safest to birth also has a bearing on who you will hire to attend.

Keep in mind while reading this, personalities, philosophies, exposure to events, and more can dictate the type of care you will receive from an individual. These blanket statements reflect the type of training they’ve received and not how they will necessarily treat you. I don’t endorse one type of provider over another and welcome you to find the personality that works with yours, as well as their unique approach to birth.

When looking at the types of providers, there are obstetricians, certified nurse midwives, certified professional midwives, direct entry midwives, and nurses with advanced degrees, like APRN. With APRNs their care style is influenced by the professionals they work with and where they received their training. Usually, they work in an OB office, but they have more of a nurse’s outlook on caring for the pregnant person rather than an OB’s style.

If you’re looking for the latest technology to support your birth, who usually has an ultrasound machine and technician in the office, someone who can perform surgery in case of an emergency, access to medications for intervention, augmentation, or pain management, who is well-trained in abnormal, urgent and emergent situations, and can refer you to other specialists, if needed, you’ll want an obstetrician, or OB/Gyn. They are regulated by the state where they practice, and the hospital they work in. They’re surgeons, and often see birth as something to be managed.

If you want someone who sees birth more as a physiological and normal process instead of one that needs medical management, who can perform ultrasounds, has access to several interventions and pain medicine, has hospital privileges and access to an OB in case of an emergency, you’ll want a CNM that works with OBs and in hospitals. They are regulated by the state and by both the OB office they work with and the hospital they work in and are reviewed by their peers annually.

A birthing center or homebirth midwife that is a CNM or CPM will be regulated by the state they received their licensure and has to be reviewed by their peers annually. They will also see most births as natural and normal, not something that needs to be managed. You choose the position and place you birth your baby, but you have someone there who has been trained in how to detect if something needs intervening. However, with state regulations they may or may not be able to attend a birth if you have other “conditions” that stop them from attending. 1) Your age, 2) previous births, 3) your weight, 4) and your medical history. The birthing center may have hospital privileges and the ability to order ultrasounds and lab work. Unless the homebirth midwife works with an OB, they can’t specifically order lab work or ultrasounds.

A lay midwife will have full autonomy for a homebirth, but, like other homebirth midwives, they have no hospital privileges. All tests you opt into will need to be ordered by either yourself, or through another provider overseeing your pregnancy. You will still want to find a care provider whose personality fits yours, and who trusts in you and in your decisions. Regardless of whom you choose, they need to be the right fit in all ways: personality, beliefs, trust factors, and desired outcomes. “Happy birther, happy baby,” or “Healthy mama, healthy baby” … These things matter!

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