How to Choose a
Birth Care Provider
That Supports Natural Birth
Your sister-in-law my say to you, "go and see Dr. Manybucks, he is the BEST!" but your sister-in-laws idea of "the best" may be a doctor who gives a standing order for an epidural. Take no ones advice in this department. You must be sure for yourself that this person is going to act according to your beliefs and desires, and not over ride your decisions when you have no energy to fight. Many doctors will preface a sentence with "I will let you if…" like for instance " I will let you labor over 24 hours if… your membranes are intact." This should send up a big ol’ red flag. He is already making assumptions that your body may fail you. You don’t need the pressure of living up to your doctor’s expectations while in labor. Even some midwives can be intervention-happy. Never assume that because she is a midwife she shares your views. I have heard of many midwives who will not let a VBAC labor for longer than 24 hours.
There are a few kinds of care providers you can choose from. Obstetrician, General Practitioner, Certified-nurse midwife, Certified Midwife practitioner, Direct Entry (Lay) Midwives or you may choose yourself as your provider. The definitions of these practitioners vary from country to country. I will attempt to give a concise description but it my not be completely correct for your area.
Dictionary definition: <specialist > A physician specialist expert in the delivery of total obstetrical care and the diagnosis and treatment of gynecological disease.
"An obstetrician attends the woman during labor and delivery and is trained to handle any complications that would endanger the mother and fetus. Throughout a pregnancy a woman may schedule eight to ten or more visits to her obstetrician, during which tests are performed, such as blood typing—in preparation for possible blood transfusion, and to determine if there are incompatibilities between the mother’s and baby’s blood—and screening for infectious diseases. Specialized tests to monitor the health of the fetus may be recommended, including ultrasound to visualize the fetus, and genetic testing to learn the risk for genetic diseases such as Down syndrome."
Obstetricians have a great deal of knowledge concerning the possible negative eventualities of birth. This is beneficial in cases of high-risk deliveries. However if a birth is not following a "text book" timetable these doctors tend to want to control the events. They control it by using the methods best known to them…medical intervention.
Another problem with employing an OB is that they generally do not attend home births.
Dictionary definition: (GP) a medically qualified doctor who practices general medicine as family practitioner. Some GPs are also qualified in specialized medicine.
Again because this person has been trained to think of childbirth as a dangerous event he is more likely to treat it as such. There are doctors who embrace natural birth, but consider that most spend much of their time diagnosing illness and prescribing medications. Doctors most often use skills that are second nature, doing nothing is not what doctors tend to be best at.
In many places it is illegal for a doctor to attend a homebirth. Therefore if you chose a doctor your hand is forced. Remember that even if you have a great doctor you will still have to contend with unknown nurses and are subject to hospital policy.
MANA definition: Certified Nurse-Midwives (CNMs) are educated in both nursing and midwifery. After attending an educational program accredited by the American College of Nurse Midwives Certification Council (ACC), they must pass the ACC examination and can be licensed in the individual states in which they practice, most often in hospitals and birth centers.
Often called MEDwives these women bridge the gap between doctors and midwives. Most of their training is still based on the medical model of birth. Although they tend to be much more in touch with the mother’s needs and will spend both your labor and delivery with you; they still often rely on interventions and preconceived ideas about birth.
This type of midwife rarely attends home births in the United States; they are more likely to practice in hospitals or birth centers.
MANA definition: Certified Professional Midwife is an independent practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwifery Model of Care. Certified Professional Midwives (CPMs) may gain their midwifery education through a variety of routes. They must have their midwifery skills and experience evaluated through the North American Registry of Midwives (NARM) certification process and pass the NARM Written Examination and Skills Assessment. The legal status of these nationally credential direct-entry midwives vary from state-to-state. In some of the states where they are also individually licensed midwives' services are reimbursable through Medicaid and private insurance carriers. 
Many schools have been founded in the last few decades that strive to teach aspiring midwives the Midwifery Model of Care. "The Midwifery Model of Care is based on the fact that pregnancy and birth are normal life events. The Midwifery Model of Care includes: monitoring the physical, psychological, and social well- being of the mother throughout the childbearing cycle; providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support; minimizing technological interventions; and identifying and referring women who require obstetrical attention. The application of this woman-centered model has been proven to reduce the incidence of birth injury, trauma, and cesarean section." These schools have allowed midwives the chance to learn their trade in an institutionalized setting without being tainted by medical dogmatism. CPM’s often attend home births.
Remember that even though a CPM has the education and experience necessary to understand you desire for a natural birth, nothing should be assumed, it is imperative that you interview you potential assistant to make certain you are compatible.
MANA definition: A Direct-Entry Midwife is an independent practitioner educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing. Direct-Entry Midwifes provide the Midwifery Model of Care to healthy women and newborns in out- of-hospital settings. Direct-entry midwives are not trained as nurses. The Midwifery Education and Accreditation Council is currently accrediting direct-entry midwifery educational programs and apprenticeships in the United States .
Direct-entry midwives legal status varies around the world. In many places they practice outside the law, and may face imprisonment if caught. Despite this, they remain strong in their convictions that birth is a safe and natural part of life and that the medical establishment, insurance companies nor the law should have a hand in it.
DEM’s practice almost exclusively at home although some do work in freestanding birthing centers. Ina May Gaskin the "Mother of Midwifery" who has long rallied for the rights of birthing mothers and newborns and woman in general is a direct entry midwife.
Bornfree definition: "In its most basic sense, unassisted childbirth can be defined as giving birth outside of a medical environment without the assistance of professional attendants. But, in reality, unassisted childbirth is much more than that. Women and couples who choose this option generally approach birth from a spiritual or emotional perspective rather than a medical one. Unassisted birthers rarely time contractions or measure dilation. Instead, they trust that a woman will give birth in her own time and in her own way. Therefore, no one acts as a midwife in an unassisted birth. Rather, the birthing woman looks within herself for support and direction." .
If you chose this option you have an intimate understanding of what your provider believes since it will be YOU! This decision carries huge responsibilities but you can be sure that no one will interfere. Unassisted Birth can be a safe option as long as it is planned and the mother has educated herself in all aspects of birth.
When seeking out a birthing care provider, an interview is a must. I can not stress this enough. Never assume that someone shares you views until you have talked with them about everything that is important to you.
You must go into the interview prepared. It is best to have a written list of questions so that you don’t forget. This is also a good test because if this person seems annoyed, or amused at your tactics they are probable uncomfortable with having their authority challenged. A few good questions to ask are:
Tell me a little about your practice and birth philosophy.
Why did you become a Midwife/Doctor?
Under what conditions would you want to transfer?
What kind of birth education do you recommend?
Are there any situations where you would be uncomfortable attending a home birth?
What kind of monitoring do you do during labor?
What kind of postpartum care do you provide?
When do you cut the cord?
What is your rate of Forceps/Vacuum/Cesarean section/Episiotomy?
How do you feel about water birth?
There are many more questions to ask but you must ultimately decide what is important to you. It is best to read about natural birth before interviewing any prospective caregivers. This will give you a clear idea of what is paramount in achieving the birth you desire. You may be asking, "What books should I read?" The next article in this series will cover what books to read and what not to read! Until then HAPPY GESTATING!
 Obstetrics," Microsoft® Encarta® Encyclopedia 99. © 1993-1998 Microsoft Corporation. All rights reserved.  Midwifes Alliance of North America(MANA)  Midwifes Alliance of North America(MANA)  Midwifes Alliance of North America(MANA)  Midwifes Alliance of North America(MANA)
 Bornfree: The Unassisted Childbirth Page