Most people see pregnancy as a time to prepare for the baby.  I see early pregnancy as a time to figure out what you want before you even go to your first appointment.  A lot of women don’t even think about the actual birth until a few months or weeks before the baby is born!  It can be difficult to make a change that late in the game.  You should choose the provider who has the same philosophy as you instead of hoping to change them by the end of the pregnancy.

Tips for choosing a birth attendant

• Think about your core birthing philosophy.  Do you feel that birth is a natural physiological process?  If so, a midwife is your best bet.  Do you have physical issues that dictate that there could be a potential problem?  Do you see birth as dangerous with lots of opportunities for things to go wrong?  Then an OB might be your preferred provider.
• Visit The Birth Survey, a consumer reporting site dedicated to birth.  Go to rate your OB, midwife, and place of birth.  As of now the site is just up and running and they should have formulated the results by Fall of 08
• Get recomendations from people who share your birthing point of view, visit online forums (like mothering.com) and ask questions.
• Interview your potential care provider.  Remember, they are working for you, not the other way around.  Related posts:  Interviewing your OB, Interviewing your Midwife, and Interviewing your Place of Birth
• Create a birth plan well before your second or third trimester.  Going to your provider interview with a birth plan or at least an idea of what you want can help you ask the right questions.  Just make sure to not be negative or badger the doctor!
• How much one-on-one, hands-on support do you want during pregnancy? Midwives generally treat the whole woman:  mentally, physically, socially, psychologically, spiritually.  Prenatal appointments generally last about an hour and they are usually there for the majority of labor and birth.  OBs on the other hand are primarily surgical specialists who have a prenatal appointment time of about five minutes and generally just come in at the end to catch the baby.
• How much involvement do you want in your pregnancy and birth? Many times in midwifery practices the mom gets to do her own urine dip and weigh herself at her appointments.  The midwife tries to explain things to her and tries to get her to interact during her visits.  An OB visit is more in-and-out with the nurses doing everything behind the scenes.
• Where do you want to give birth? Some women just go to an OB because they think they’re supposed to and then realize late in pregnancy that they want a home birth!  Where you give birth automatically dictates who will be there.  For example in Colorado at this time, OBs work in the hospital, only Certified Nurse Midwives (CNM) can work at a birth center, and Certified Professional Midwives (CPM) and CNMs can do home births.  Most CNMs (90-95%) work with doctors in the hospital.
• Do you want to have a waterbirth? Some hospitals allow it, some do not.  If you have to give birth in a hospital and want to fight a policy that does not allow waterbirth, having a provider who supports it can go a long way.  Yes, it is possible to change hospital policy!  In Gentle Birth Choices Barbara Harper talks about how to do this.
• Choose someone you’re comfortable with. If you’re not comfortable with your provider there is no way you can let your body open up and relax enough to have a baby.
• If a provider or place (like home or birthing center) is out of your insurance network, talk to your insurance provider.  Also, often times a home birth or birthing center is cheaper even though you have to pay in full.  For example, in Colorado a typical, no-intervention birth in a hospital usually costs around $12,000-13,000.  In an insurance plan where you pay 10% of hospital and doctor’s costs you’re looking at a few thousand dollars.  A home birth or birth center birth usually costs around that if you’re paying in full.
• Do you feel more comfortable with a male or female doctor?  Remember that just because a doctor is female doesn’t mean she believes in the same birthing philosophy as you do.