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Choosing Your Care Provider

“But the wisdom from above is first pure, then peaceable, gentle, open to reason, full of mercy and good fruits, without uncertainty or insincerity.”— James 3:17

The choice of a care provider is one of the most important decisions you will make during pregnancy. Your choice of provider will affect where you will birth, how you will birth, the tests and interventions you are likely to receive, and your overall experience of pregnancy. It will also affect your treatment during birth, your feelings about that birth, and your confidence and trust in future births.

Two Different Philosophies of Birth

Providers typically subscribe to one of two distinct philosophies of birth.

The first philosophy views birth as a normal process for the female body, a process that, except in unusual circumstances, a woman is able to do quite well on her own. In this view, the design of the female body is seen as complete, meaning that most often a woman’s body does not need outside help to give birth. After all, women have been giving birth for millennia, and the human race has multiplied quite well thus far. Providers with this philosophy only seek to intervene appropriately when an anomaly or complication presents itself. These providers see their role more as a “lifeguard,” ready to intervene if necessary but trusting that the birth process is designed to work well. A well-trained provider using this method has witnessed birth many times, knows what is normal and what is not, and is skilled in knowing how to recognize anomalies and complications before they become dangerous. This philosophy has come to be referred to in the last several decades as the midwifery model of care.

The second philosophy is what some call the medical model of care. This approach views birth as urgent. It requires that a birth prove itself to be normal before assuming it is. In this view, birth is seen as risky, and interventions are taken whether the mother and child need them or not — just in case. Providers with this view believe that because complications do sometimes arise, it is safest to treat every woman accordingly. There is a standard “type” of birth considered normal and ideal, and women must not fall outside that norm. A provider in the medical model of care is trained to intervene and follow the same protocol for every woman. Many have never witnessed a birth without any intervention or some sort of management. If we consider our first provider the lifeguard, this provider is more like a swim instructor, hyper-vigilant and hands-on, requiring every swimmer in the pool to wear a life jacket regardless of circumstances.

These different philosophies can lead to quite different birth experiences. It’s important to know where a doctor or midwife falls on this spectrum and whether that provider’s beliefs about birth line up with yours. If you have had health problems in the past, you may find yourself less confident in your body’s ability to birth without outside help, so you may prefer the medical model. If you feel confident in your body and have a positive image of birth, or if you have developed a distrust of the medical system, you may find yourself more aligned with the midwifery model. Of course, if you know you have extenuating circumstances with your health, your history, or this specific pregnancy, that should impact your choice of provider.

On the whole, midwives tend to fall under the midwifery model of care (hence the name), and obstetricians fall under the medical model of care. However, there are certainly many individual exceptions to this, so it’s important to get to know an individual provider and his or her beliefs rather than assume. Midwives working as part of a group practice are often beholden to an obstetrician, or were themselves trained under the medical model, or have to follow hospital protocol regardless of their own personal preferences. And there are certainly obstetricians and family doctors that lean more toward a midwifery model of care in their work.

Which Model Is Right?

God designed our bodies beautifully. His design for opening the female body and birthing a baby works, and it works well. We know that, biologically and from research, when we follow that design as best as possible, things are ideal for mother and baby. However, because of original sin, we live in a world that is not always ideal. Complications arise, sickness exists, and pregnancy and birth are not easy. What was designed perfectly is now subject to the effects of sin, and outside interventions may indeed be needed.

We can trust that God designed our bodies well and expect our births to follow suit, but we can also recognize that sometimes complications arise. Expecting that birth will be complication-free, allowing it to happen according to its design, and making choices toward that end makes sense, but so does having an experienced, watchful provider with us, should intervention truly be needed. We can certainly see God’s hand in any necessary interventions to help a mother and baby stay healthy. We can even allow these unexpected difficulties and interventions to become redemptive, joining us with Christ and his work on the cross.

Making the Choice

You will need to decide for yourself what model resonates with you and your specific situation. Where would you feel more peaceful? Which philosophy most aligns itself with your experience, temperament, and faith? Which philosophy has better outcomes from a physical, emotional, mental, and spiritual standpoint? Are there health complications or anomalies with the current pregnancy that you need to consider? How does your history play into the decision? Are there women you know who have had great birth experiences? Whom do they use? There is no cut-and-dried answer. Every woman is unique, with a unique set of circumstances.

What we can say, though, is that you should choose the provider who best fits your beliefs, circumstances, and family. This means you should never be afraid to interview different providers, ask questions, and switch when necessary. If a provider is hesitant, dismissive, too busy, or doesn’t even know the answers to your questions, that can be an answer right there. You deserve to have a provider who takes the time to answer questions and concerns, and who sees the value in a mother being informed and “picky” about her provider.

Choosing a provider is not the time to be soft and passive. Many women find themselves afraid to ask questions or express their preferences for fear of annoying their provider. Others may know in their heart they want to switch, but don’t want to make waves or risk offending anyone. Many women may begin to see red flags as their pregnancy progresses, but think it is “too late” to switch, or they have idealistic hopes that, somehow, they will be the exception. It is important for your health and the health of your baby, as well as your growth in confidence as a mother, that you view yourself as the authority. You are the one making decisions, and it is important for you to find strength and confidence in that. Your provider is offering a service for you, not the other way around.

I’m thankful we sought out all the information we could. We felt confident in our relationship with our midwife and trusted her completely. We interviewed a number of midwives. The one we chose was upfront [in saying] that she prays for all of her clients and even included an outline of sorts of what we could pray for each week as the baby developed. I loved the extra care I received from the midwife, compared with the medical doctor I had with my first [child]. We talked about stress, diet, exercise, and other aspects of pregnancy. I wasn’t a number; I was a pregnant mom in her care whom she knew and was praying for.

— Cherie L., mom to four on Earth, one in eternity

A good provider will offer choices rather than telling you what will be done to you. A good provider will have an open conversation about options and will want you to have a birth that respects your role as the mother of your baby. While they may have recommendations and protocol, they will make sure that you are informed and have as much a say as possible in everything that happens. They will make sure you know the benefits and risks of each choice, encourage you to do your own research, and respect your intelligence and free will to make your own choice.

When choosing a provider, it’s critically important to note whether the provider is part of a group practice. If a provider is part of a group practice, it’s very important to know if every member of the group views birth and practices the same way. As part of a group practice, the provider you’ve chosen may not actually be the one who attends your birth! Even within the same practice, different doctors or midwives may have different protocols and opinions. You may agree with your primary provider, but the person who shows up on call at your birth may view things differently.

You, mom, have the right and obligation to pick a provider who is truly going to serve you and your baby well, with dignified and evidence-based care, and who will be there when it is time to birth. This person will be with you during one of the most important, emotional, and vulnerable moments of your life. Birth is messy, naked, and requires a tremendous amount of trust and vulnerability between you and the people in the room. Choosing a provider with whom you can be all of these things is not only important for your emotional satisfaction and care, but, as we’ve seen, can also play a huge role in the actual birth itself. A provider who offers you an atmosphere of safety and comfort, without shame or embarrassment, is profoundly important.

Picking the top name on your insurance company’s provider list is not the best way to find a provider. Nor is doing a Google search for providers in your area. One of the best ways to begin your search is by word of mouth. Find other women who have been happy not just with the providers’ demeanor but with their own actual births, and ask them for advice. If you have friends who haven’t been happy with their care, take note of who not to use. Ask local doulas for recommendations. If you are on Facebook, find a local moms’ or birth group and inquire there (but be sure to state what kind of provider and birth you hope to have). When you make appointments to meet with a doctor or midwife, do so with the understanding, even if only in your head, that this is an interview and you are not committed to using him or her. Your first commitment is to your baby and your care, not to a receptionist or to a provider. Find your voice with the nurses and doctors and let them know you are trying to find the provider who fits you best. Do not be afraid to ask questions. Consider bringing a notebook with you to jot down responses.

Below is a list of questions that may help you decide if a provider is right for you, offering you insight into a provider’s practices:

• Where do you attend births (what hospitals, birthing center, home)?

• How long do my prenatal appointments last? How long will I see you?

• Do you work with other providers? Who will be at my birth?

• How many/what percentage of your clients end up with a natural/medicated birth?

• Do you provide care for the baby after birth, or is that transferred to someone else?

• What is your cesarean rate?

• What birth classes do you recommend or provide?

• How do you feel about a doula attending the birth?

• What tests do you typically require during pregnancy?

• Do you routinely use IVs or pharmaceuticals in a normal labor?

• Do you perform episiotomies?

• What is your policy on artificial induction of labor?

• What are your recommendations for a healthy pregnancy?

• Will you respect my beliefs and refusal of artificial contraception?

• Do you perform, prescribe, or refer for abortions?

Here are a few things to ask yourself or reflect upon after meeting with a provider:

• How did I feel during the appointment? Rushed? At peace? Cared for? Important?

• Did the provider look me in the eye?

• Is it important to me that my provider is a male or female?

• How much time did I have with him or her?

• Did answers to my questions satisfy me?

• Did I feel comfortable expressing my opinion or asking questions? Did the provider ask me my opinion?

• How did her or she talk about the baby? Was my baby referred to at all? Would I feel comfortable with this person holding my baby?

• Does this provider make me second-guess myself or my ability to give birth?

• If this was a first visit, did the provider just assume his or her role, and respect that I hadn’t decided on a provider yet?

• If he was there, did the provider respect my husband and include him in the discussion and appointment?

Pope Pius XII actually addressed the topic, and his words are equally applicable to any kind of birth provider: “Undoubtedly nature’s voice speaks in [the mother] and places in her heart the desire, joy, courage, love and will to care for the child; but to overcome the suggestions of fearfulness in all its forms, that voice must be strengthened and take on, so to say, a supernatural accent. It is your duty to cause the young mother to enjoy, less by your words than by your whole manner of acting, the greatness, beauty and nobility of that life which begins, is formed and lives in her womb, that child which she bears in her arms and suckles at her breast; to make shine in her eyes and heart the great gift of God’s love for her and her child.”⁶⁵

What a beautiful thought! Does the provider you are considering have this deferential and reverent attitude toward your motherhood? Does this person recognize the sacred privilege of being with you during this physical, emotional, spiritual journey into mothering this new child?

Once you have selected a provider, remember that you are not beholden to him or her to continue care. If that provider is not right for you, don’t let the fear of offending or going through the process of finding a new provider scare you. It’s better to be a bit uncomfortable now than to live with the regret of knowing you ignored warning signs that then played out in your birth. Find peace in knowing that there is the right provider out there for you and that finding him or her is invaluable. If you are having trouble finding a provider or making peace with the options available, consider praying to Saint Brigid, patroness of midwives; Saint Raymond Nonnatus, patron of midwives; or Saint Gianna Molla, patroness of physicians, to help you find the right person. Pray with your husband and include his input in your decision.

Whatever your decision on a provider, know that, no matter what, you are the mother God gave to this particular child. You are the one entrusted with making the decisions for your baby, and God will give you the grace needed to do so in your particular circumstances.

With my first pregnancy, I saw a family practitioner who also attended births. I didn’t have a very good experience with her, and I felt she wasn’t very knowledgeable, so I knew for the next I wanted an OB-GYN. Between my first and second pregnancies, I experienced five years of infertility. I saw two different gynecologists, trying to get answers and help, both of whom offered me the pill. Around this time I was talking with a woman at my parish whose daughter saw a Catholic OB-GYN who specialized in NFP, infertility, and did not give out birth control. I was intrigued. I found out that his office was about forty minutes from my house, but the drive was worth it. I showed him my fertility charts, and he gave me some excellent advice. Why hadn’t anyone else offered this advice instead of simply pushing the pill?! It turns out, miraculously, I was actually already pregnant on my first visit with him (naturally after five years!), even though it was too early to tell at the visit. I was so glad that God had led me to him even though I was already pregnant. He even prayed during my birth along with a recording of the Rosary I had playing. He and his partner were absolutely amazing, kind, and smart throughout both that pregnancy and my following pregnancy.

— Amanda D., mom to four

Should I Choose a Catholic Provider?

Some women don’t have the option of choosing a faithful Catholic midwife or obstetrician, but in some areas there are practices or individual providers who practice from a Catholic mindset. They don’t prescribe artificial birth control or perform sterilizations, don’t participate in immoral or unethical fertility practices, and will never refer for or be complicit in an abortion. Often they are versed in or at least respect natural family planning methods and will not pressure patients into limiting their family size. These providers are a great asset to the Church and the community.

However, simply because a provider identifies as Catholic is not enough for a woman to choose that person for prenatal and birth care. The provider should still practice evidence-based care when it comes to birth and respect the rights of the woman to make informed choices for her birth. Part of living the Catholic faith is acknowledging the dignity of the mother and her rights over her body and her God-given authority over her baby.

A Catholic provider, especially, should never coerce or manipulate a woman into birth choices based on his or her ease and schedule. He or she should always ask before intervening in any way and respect the natural design of God for labor and birth. He or she should always speak respectfully to patients and recognize the mystery and beauty of the act of birth, and reverence and respect the mother in her God-given role.

There is no requirement by the Church to choose a Catholic provider, and every woman needs to choose the provider who gives her and her baby the best, most dignified, evidence-based care for her unique situation.

When I finally understood the sacredness of this vocation and knew without a doubt the inherent dignity of motherhood, I was able to find the confidence to seek out providers that upheld my dignity and my baby’s. They weren’t always Catholic or in a hospital setting, but they were out there.

— Angie W., mom to four