When I was first thinking through the reasons to have a home birth, back when I was pregnant with my daughter, prenatal care was pretty low on the list. Prenatal care wasn’t that big a deal to me. As long as you get the basic minimum of prenatal care, that’s all that matters, right? But after I switched from an obstetrician to a home birth midwife, I discovered what a difference really good prenatal care can make. It’s not just about taking your vitamins and checking your urine. Prenatal care is about building a relationship with the person who’s going to be with you during one of the most emotional and powerful events of your life. An event during which your emotional state has a huge impact on whether the process goes smoothly or not. Stress during labor can stall labor, so if you’re not comfortable with your care provider, then you’re at a much higher risk of having problems and needing interventions. If you want a natural childbirth, then having a good, comfortable relationship with your care provider isn’t just a luxury–it’s essential.
And that relationship is built through prenatal care.
Now, I realize that those of us who see home birth midwives are spoiled. I’ve never heard of an obstetrician that schedules hour-long appointments with every patient (and often goes over that time limit). I don’t think there are many midwives who attend hospital births who also visit your home for prenatals. There aren’t many obstetricians who have annual bonfires at their own homes for all their previous and current clients. However. I do think that there’s a minimum level of care and respect that you should expect during your prenatal visits (and from all your doctors, really, if it come to that). Now that I’m experienced midwifery care, here’s the minimum that I think every birth care provider should do for you.
1. Remember you. Look, my midwife has a lot fewer clients than most obstetricians, so it’s easier for her to remember the names of everyone in my family. But even the busiest doctors can take a minute to look things up in your chart before they meet with you. But what I love about my midwife is that she remembers things that aren’t in my chart. She remembers the projects I’m working on, the plans I have for Thanksgiving, and that weird dream I had about the baby. Even a really busy obstetrician should at least know my daughter’s name and how old she is.
2. Listen to you and care about your concerns. I think most care providers do this–but I’ve certainly heard stories of some that didn’t. If a care provider brushes off your question or assures you that something you’re worried about is “no big deal” without explaining why, that’s a red flag. It doesn’t matter if it really isn’t a big deal. It was a big enough deal to you to bring it up, so it deserves a conversation.
3. Ask you questions. What I love most about my midwife is that she asks me lots of questions that have nothing to do with being pregnant. This is probably just because I’m an extravert and I love to talk. But seriously, when I was pregnant the first time, seeing my midwife was like going to therapy. I would tell her everything. And she actually cared (or she faked it really well, which is just as good). I told her all about every detail of preparing for the baby, every weird dream I had, every parenting-related conversation with my husband. And at the next visit, she would remember those things and ask follow-up questions. It was awesome. Of course, she also has her litany of pregnancy-related questions that she asks at every visit (any swelling? any unusual discharge? how’s your diet? are you exercising? are you taking all your vitamins?), but those always come at the end.
4. Like you. Ok, I guess this doesn’t really matter too much, as long as she can at least fake liking you. But at the very least, you should sincerely like her. A lot. Again, this person is going to share an incredibly intimate experience with you. Don’t invite anyone into that experience that you don’t like. There are a lot of care providers in Atlanta; if you don’t like yours, find a new one.
5. Be nice to your older kids and offer an environment that’s kid-friendly. Of course I didn’t care about this–or even notice it, really–during my first pregnancy. But it goes without saying that people who are pregnant are people who are having kids. Plenty of us have older kids. Sometimes those kids come with us to prenatal visits. If your care provider doesn’t offer an environment that’s kid-friendly, this can be a real pain. My midwife has several baskets of toys for kids, as well as some beautiful birth dolls that my daughter adores. But the real reason my daughter loves to visit my midwife is because she has a basket of sample-sized Luna bars that everyone can help themselves to.
And there was a place I visited recently–I won’t be specific because I don’t want to criticize; this place has great reviews and I’m sure it’s wonderful in many ways–but let me just say that it was a place that caters to pregnant women. A lot of the pregnant women I saw there (including me) had older kids with them. But when I sat down in the lobby and offered my daughter a snack, the receptionist told me that food wasn’t allowed in the lobby. I was literally speechless (and for me, that takes a lot). No food?!? We’re talking about a place full of toddlers and pregnant women, and they don’t want us to eat our own food? Seriously? Not cool.
There weren’t any toys there, either. Luckily my daughter was entertained by the wonderful view from the big windows. But I was not impressed. In fact, I was seriously pissed off. Probably because I was hungry.
6. Ask your permission. This goes during labor too. I hate it when women talk about whether their care provider will “allow” them to do something. You’re not this person’s servant, ladies. You’re a client. You’re paying them. You allow them to do things, not the other way around. Yes, you should want their advice, and you should feel like you can trust it, but that’s different. You shouldn’t feel like you need to ask their permission–they should ask yours.
Last week we were still trying to decide whether to make the trek to Virginia for Thanksgiving or not, and I asked my midwife her opinion. There was a part of me that kind of wanted her to give me permission or not, that wanted her to say, “yes, it’s fine if you go, and you certainly won’t have the baby there,” or to say, “no, you really shouldn’t go; you’re too close to the end of pregnancy.” But she didn’t say either of those things. She said, “If you went into labor there then you’d have to go to the hospital. So you just need to decide how terrible it would be for you to have a hospital birth in Virginia vs. how terrible it would be to miss this family event. And then consider the likelihood of you going into labor while you’re gone (not very likely).” She helped me consider the issues, and she left the decision to me. I loved that.
We decided not to go, but really it was mostly because we didn’t want to spend the money on a rental car, and I decided I didn’t feel like sitting still for a ten-hour drive.
7. Challenge you in a positive way. My midwife is a good influence on me. I’ll never forget the conversation I had with her when I was interviewing her as a potential care provider, when I was first considering a home birth for my daughter. I asked her in what situations I wouldn’t be allowed to have a home birth (wrong question, but I was still thinking in permission mode). She said she was comfortable attending many different types of births at home: twins, breech, no problem. “But,” she said–and she looked me firmly in the eyes–“if I’m not happy with your diet I will kick you out of my practice and you will have to go to the hospital.” She put the fear of chocolate into me. Every time I had an urge for ice cream or a cookie, I heard her voice in my head–I will kick you out of my practice!–and I’d hastily reach for a salad instead.
8. Educate you. It almost goes without saying that home birthing moms need to be highly educated about birth, because you really do need to be able to make a lot of decisions and factor risks that hospital birthing moms may not need to think about. (Although I think there are a lot more dangers in hospitals, and you should be educated about those too, but that’s a different issue.) In either case, it’s important that your care provider help you think through all sides of an issue and weigh the options for yourself. It’s not enough for them to say, “I recommend this.” They should explain why.
My midwife did this for me yesterday through a lengthy conversation about this prodromal labor thing. She told me the easiest way for me to know if it’s really labor is for me to check my cervix to see if it’s dilating. I protested that I have never been able to find my cervix, ever, to which she replied, “If you can’t find it, it’s probably not dilating.” She then explained in detail what it feels like. All this made me feel a lot better about how I’m going to figure out whether I’m actually in labor or not.
9. Support your choices. No matter what. If you’ve hung around the home birth community at all, then you’ve probably heard plenty of stories of obstetricians (and nurse midwives, too) who aren’t supportive of a woman’s desire for natural birth. But this goes the other way, too. A home birth midwife should be supportive of a woman who feels like she needs to transfer. I’ve heard stories of women who felt that their midwife’s desire for them to have natural home birth overrode safety considerations. Your midwife shouldn’t have an agenda for your birth. And you should talk to her about what circumstances might make you want to transfer.
10. Fan and massage you while telling you you’re the most important and wonderful person in the whole world. Isn’t that a regular part of everyone’s prenatal visits? No? Oh, I guess it’s just me, then.