Congrats! You’re pregnant or planning to be in the future!

You may have already chosen your care provider and your place of birth. Will you give birth at a hospital? Birth center? Home? Most births in the U.S take place in a hospital setting. We typically have a clear image of what a hospital birth looks like based on media depictions. (But SURPRISE! It is almost never like you’ve ever seen depicted in movies! hint: it’s far less dramatic). Many feel most comfortable giving birth in a hospital with access to pain management drugs, an OR down the hall and a team of medical professionals on standby should anything go awry. If a hospital birth feels best for you, take a tour of your area hospital(s) and see if it is the right place for you. Different hospitals may have different policies, procedures and amenities available.

Some areas have birth centers as an option. These can may attached to a hospital or free standing. They offer a more home like environment but with access to more medical care if the need arises. In NYC, our birth center choices have become more limited as of late. There is the freestanding Brooklyn Birth Center. Mount Sinai West has a birth center, with 3 rooms, that is scheduled to close December 31, 2018. NY Presbyterian Downtown technically has a birth center, with 1 room but it is free unavailable due to overflow from labor and delivery or postpartum. Birth centers may offer options like birth tubs to labor or give birth in (in NYC, delivery in a tub at a birth center is not allowed), nitrous oxide for pain management, birth position choices beyond being on your back, and fewer interventions. Most often, the room you give birth is on the room you will recover in with your baby (and partner, if applicable). The beds tend to be larger and not the typical narrow hospital bed.  Some people chose a birth center when a hospital feels too medical but a home birth does not feel medical enough.

More and more people are choosing to give birth in the comfort of their home with a midwife. For those who give birth at home there is often more freedom of movement, no or limited access to pain management drugs, the ability to eat and drink while laboring and fewer interventions. If you give birth at home you may have as many or as few people attend your birth as you wish. Some people want to give birth surrounded by their closest family and friends while others prefer just their birth attendant and midwife. This differs from a hospital where you are often allowed 2 support people and may have a revolving door of medical professionals and hospital staff in an dout or your room.

In addition to the location you plan to deliver you have a choice of who will care for your and your growing baby throughout your pregnancy and birth. You may chose to give birth, like many other pregnant people, with an Obstetrician. You also have the choice of a Midwife. Depending on your state and licensing requirements they may be a Certified Nurse Midwife or a Certified Practicing Midwife. Both are educated and qualified (a very common misconception) but have gone about their certification in different way, as state mandated.

So what are the primary differences between obstetric care and midwifery care? Again, depending on your state, OBs tend to deliver babies strictly in a hospital setting. Midwives may practice in hospitals, birth centers or home births. Some work in various settings while others only work in one. Many midwifery practices offer a more holistic approach to pregnancy and birth. From my personal experience, each prenatal visit with my midwives was 1 hour long (rather than the usual 5-15 minutes for most OB visits). We spent time discussing pregnancy, parenting, life, wellness, and options. Every prenatal test was optional as well as a discussion to the pros and cons but ultimately my decision to do it or not. We truly got to know one another and get comfortable with each other. Birth is an incredibly intimate experience and you want to feel completely at ease and safe with your care provider.

No matter your choice of type of care provider there are a few questions you may wish to ask as you interview potential providers.

• Do you take my insurance? Birth can be expensive! $10,000-50,000+ in NYC!

• Are you available at my due time?

• What hospital/ birth center do you deliver at?

• How many providers are in the practice? Will I get to meet them all?

• What is your policy/ recommendation on induction? Do you practice routine induction at a certain point?

• What is your cesarean rate?

• What percentage of your practice is high risk? (This may influence their cesarean rate. Not all care providers work with a high risk population and this will inherently decrease their cesarean rate)

• What percentage of your patients receive an epidural? Are you comfortable if I chose an unmedicated birth? (This is entirely up to you!)

• Do you perform routine episiotomies? In what situation would you recommend an episiotomy? (Episiotomies are no longer recommended as a routine intervention. This is often a procedure that makes expecting clients of mine very nervous so ask ahead of time!)

• May I chose a position that feels best to me at the time to give birth to my baby? (Research shows that upright positions create a more open pelvis, making it easier to birth your baby. The traditional lithotomy position is not the only way you can birth your baby)

• How much time do you typically spend with your patients at prenatal visits?

• Are any tests and procedures optional?

• Are you ok if I hire a doula? (Some providers are very supportive, while others are not. You may wish to ask why or why not)

• If you have any health concerns you may wish to speak to your potential provider to see if they have experience working with pregnant people with this health concern and how it is typically handled in their practice.

Over all, the biggest thing you need to decide is where and with whom do you feel safest and most comfortable? No one else gets to decide this for you. Do some research, meet people, ask people who have given birth with that care provider or in that location what their experience was like and then go with your gut. Cause you’ve got this mama!!