(Originally posted on October 26, 2016, updated on July 13, 2020)

Two of the most important decisions are often made early in a person’s pregnancy journey: where to give birth, and who will attend. In the Madison area, there are basically three choices for places to birth your baby: SSM Health St. Mary's, UnityPoint Health Meriter, or at home. Sometimes insurance coverage plays a part, and often location and choice of provider go hand in hand. The good news is, in my opinion, all three locations are great options, and there are lots of fantastic providers to choose from. Here are some differences you may find helpful as you consider your choices, as well as a few tips to keep in mind.

St. Mary's:

Tubs for laboring in every room, including 1 room with a large birthing tub (though water births not currently allowed)
Family suites include double sized, memory foam beds that can also accommodate your partner, as well as walk-in showers with a massaging shower head and bench

Meriter:

Tubs in every room, including 2 rooms with large birthing tubs
Water birth is allowed

Home:

You have complete control over the environment and who is present
Midwife-led home births in the US are considered as safe or safer than hospital birth for low risk pregnancies

Birth location is truly a personal choice. I think it comes down to what your goals are and where you will feel safest and most comfortable while birthing your baby. Some women feel safer knowing high risk OB care and excellent NICU staff are immediately available, should they become necessary. Others feel safer in their home environment, where the risk of unnecessary intervention is lowest, and hospital transfer is available for emergencies. A case can be made for either, and wonderful birth experiences can happen regardless of location. Perhaps a bigger piece of the puzzle in determining overall birth experience is your chosen care provider. We are very lucky in Madison in that both hospitals allow for very patient centered care, and with the right team it can still feel like a very calm, non-medical event if that’s your goal.

Considerations When Choosing a Care Provider

Type of Provider:

Many people don't know that they have options in terms of the type of provider they will have for maternity care and the delivery of their baby. Here are the main four options:

OB/GYN- An obstetrician and gynecologist (OB/GYN) has earned a bachelor's degree, finished medical school and completed a residency program before they obtained their medical license. OB/GYNs tend to women's health concerns, such as pregnancy and reproductive issues. Most OB/GYNs are generalists and see a variety of medical conditions in the office, perform surgery, and manage labor and delivery.

Family Medicine Provider- Family care practitioners are primary care doctors, usually with three years of training beyond medical school. They care for a wide variety of conditions, but some choose to emphasize obstetrics and undergo additional training in this area.

Certified Nurse Midwife- Nurse-midwives are educated and licensed as nurses first, and then complete additional education in midwifery. CNMs are licensed to practice in all 50 states. They are usually licensed in individual states as Nurse Practitioners (NPs).

Direct Entry Midwife (CPM or CM)-The legal status and requirements for direct-entry (non-nurse) midwives vary from state. They are usually licensed in individual states as Licensed Midwives (LMs) or Registered Midwives (RMs). The Midwives Alliance of North America tracks the laws and regulations in each state for direct-entry midwives.

Again, choosing which type of provider is right for you is really dependent upon your preference (unless you have a high risk pregnancy, in which case you may need a specialist). Some families appreciate knowing that their OB is highly trained in surgery or interventions that may be needed somewhere down the line. Some prefer to go with a family practice provider or midwife that is used to seeing healthy, low risk patients, knowing their care will need to be transferred to a specialist if things become complicated or they require surgery. Also, it's best not to generalize about philosophy, as some OB/GYNs are very supportive of low-intervention birth, and some nurse-midwives are fairly medicalized in their approach. Your provider's credentials may not be as important as their philosophy when it comes to their style of care.

Philosophy:

The key to feeling well supported by your provider is to determine what your provider's philosophy on birth is ahead of time, and whether that closely aligns with your own. Just because a provider says you can have a low intervention birth or the VBAC you are aiming for as long as things go well, doesn't mean they are well accustomed to these types of births, or are fully in support of them. When the time comes to determine which interventions are necessary, and how quickly they need to be administered, you'll want to trust that your doctor is in agreement with you on evidence based care if that is important to you.

Model of Care: Midwifery vs. Medical

As mentioned, there are doctors providing care based on the midwifery model, and midwives who practice more according to the medical model. Take a look at the below comparison to see what resonates more with you.

Midwifery Model of Care

Birth is a social event, a normal part of a woman's life
Birth is the work of the woman and her family
The woman is a person experiencing a life-transforming event
See birth as a holistic process
Shared decision-making between caregivers and birthing woman

Medical Model of Care

Childbirth is a potentially pathological process
Birth is the work of doctors, nurses, midwives and other experts
The woman is a patient
Trained to focus on the medical aspects of birth
"Professional" care that is more authoritarian in nature

In addition to discussing basic philosophy and model of care, if you are looking for a specific type of birth (e.g. low-intervention or VBAC) don't be afraid to ask how many of these types of births they've attended lately. You may ask how many of these resulted in the intended outcome, and reasons for any that did not. You'll be able to determine a lot simply by the way these questions are answered, and hopefully you'll end up feeling even more confident about who you've chosen to attend your birth. Then, fingers crossed, they'll be the one there when the time comes!

Call Schedule:

One last critical piece to the puzzle of lining up a provider is taking into consideration how their call schedule works. For this reason alone, a lot of women will choose a small practice where they are sure they will either get their provider the day they go into labor, or a back-up that they've met and also trust. For others, they are comfortable knowing that the larger practice they've chosen is up to their standards, and find comfort in knowing that their chosen doula will be there for the entire process, even if staff changes shifts or their provider doesn't end up being the one to attend their birth.

See additional posts in this series: Birth Preferences (Part 1): The Importance of Informed Consent and the "Overdue" Baby, Birth Preferences (Part 2): Vaginal Exams, and stay tuned for upcoming posts in this series: Birth Preferences (Part 4): Labor Coping Strategies, and Birth Preferences (Part 5): Fetal Monitoring.

Written by Angie Traska, coordinator of Align Doula Services, providing intuitive, attentive doula support that aligns with you. Serving Madison, WI and the surrounding areas.

Want to meet a few excellent doulas, learn more about Align’s classes or other services? Please join us for our complimentary doula info meeting on August 5th to learn more, or shoot us a message to line up a private consultation!

Disclaimer: The content found on this blog is meant only to provide general information and is not a substitute for professional medical advice.

Birth Preferences (Part 3): Birthing Environment and Choosing a Care Provider