Tuesday, 3 April 2012

Guest post: A doula's path through pregnancy/birth (Part 1: Prenatal Care and Education)

This post begins the series written by my friend and fellow doula, Chris. You can see the intro to the series, one of Chris' doula stories, here. She's now getting to see pregnancy and birth from the other side, and is writing a series of guests posts on her experiences. Stay tuned for more!

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Working as a full-time doula and childbirth/breastfeeding educator for a year (straight out of college) means that I am probably one of the most over-educated first time moms ever. Not only have I read the books, I have seen firsthand what the books are talking about, and I’ve had the chance to form some pretty firm opinions about labor, delivery, and newborn care in a hospital setting. It also means that I have a lot of intuition to rely on when it comes to making choices. Having a well-considered philosophy of birth means that I can rule out a lot of the noise that surrounds birth and focus on finding local resources that can support me through a healthy pregnancy and delivery. It’s pretty exciting to have a chance to put my ideas into action in the first person, and it’s interesting to see what has changed in the years since I left doula work to be a high school teacher.

When it comes to making decisions regarding prenatal care providers and a birth setting, I was lucky to have the benefit of first-hand experience to guide me. My experience with midwives through AmeriCorps was varied and quite educational. On one end, we had our former boss Barb, who is probably the image of what everyone thinks of as a midwife--earthy, friendly, competent, easy to talk to, and a very vocal proponent of women’s ability to make the best choices for our bodies. At the other end we met CNMs who seemed to need to prove their “legitimacy” to the medical establishment at the hospital and were just as interventionist as any of their MD colleagues. Having met Barb and other similar midwives, I knew that having a wonderful midwife provide my prenatal care and attend my delivery was non-negotiable to me, but I also knew I needed to be careful--not all midwives are created equal.

I actually chose my prenatal care well before getting pregnant. My husband Kevin and I moved to Athens, GA about 4 years ago, and I had to find a new place for my annual GYN care. Though we weren’t even discussing having kids yet, it made sense to me to find a practice that I might like to stay with straight through (instead of having to find a different prenatal care provider). Since I didn’t have many Athens friends yet, I started with the Internet, where searches for “midwives Athens Georgia” turned up the same practice time and time again: the midwifery clinic associated with Athens Regional Medical Center (a hospital). I made an appointment for a Pap and met an absolutely wonderful midwife. My next three annual exams were performed by different midwives but were just as wonderful (yes, I am using that adjective to describe appointments including Pap smears and internal exams). So when I had my IUD removed last summer, I had no intention of switching practices if we were to become pregnant. I liked this place.

After I had already gone to my first prenatal visit, I read Rebecca’s post on "what every first time mom should know" (particularly the section on “information to gather and questions to ask about a care provider/setting”), and my type-A side all of a sudden hit the panic button. I hadn’t asked any of those questions! I hadn’t even thought about it! Good moms-to-be and good feminist pregnant women who take charge of their bodies should be asking those questions!! I should have asked those questions before choosing a provider!

Then I slowed down and thought about why I hadn’t felt the need to do so (I am normally NOT the person who fails to ask questions or probe for reasons/answers), and this is what I realized: I liked the Athens Regional midwifery clinic and trusted their care because it felt familiar to me--it felt like the clinic where I worked with AmeriCorps, which had a very open-minded, forward thinking attitude towards pregnancy and birth (largely due to the aforementioned Barb). I hadn’t felt the need to quiz my midwives because they gave me “that good midwife-y feeling like Barb did.” What I love about midwifery care is that it feels like a partnership. A great midwife values your input and listens to your observations while still sharing her expertise, and you leave the appointment feeling good about your body, what it’s capable of, and what you’re built to do. A great midwife normalizes the process of pregnancy and birth and builds your confidence about what you’re experiencing. And a great midwife helps you extend those feelings to your birth by supporting your childbirth decisions and creating a mother-centered experience. A wonderful OB/GYN can give you the same feeling, but patient-centered care with an emphasis on education is a hallmark of the midwifery model. It’s also one of my favorite parts of working with a midwife.

The clinic had other signs that reassured me it was the kind of place I wanted for my prenatal care. It offers Centering Pregnancy (which I learned about through Barb and AmeriCorps, and thought was totally cool). Centering combines regular checkups with prenatal education as well as support from a group of women who are due around the same time as you. Centering is great from my perspective as a pregnant woman because I’m excited to make some pregnant friends, and it’s also recommended over individual prenatal care by the American College of Nurse Midwives. Science and Sensibility has a useful post on the structure and benefits of group care (and they do a cool WellBabies group care program that I’d love to see come to my area). Now that my centering classes have started, I like it even more than anticipated. It’s a great feeling of support and camaraderie, and the midwife who facilitates the group does a wonderful job. Even more fun is the fact that Kevin is enjoying it as much as I am.

I also like that the clinic isn’t exclusive or private-pay only, which makes for an interesting demographic mix. They accept Medicaid (and in fact were one of the only public-health prenatal practices in Athens for a long time). Also, a lot of the people who go there speak Spanish, and some of the midwives and all of the support staff speak excellent Spanish as well. To me, that feels comfortable and progressive. Because after all, a supported, educated birth should be a right for all women, not just ones with private insurance or the right immigration documents.

However, even with all of those reassuring signs, I’ve done my fair share of question-asking regarding the practice and what I can expect from a delivery at Athens Regional through the midwifery practice. I’ve asked everyone I bump into with experience with the A.R. midwives--women who have given birth with them, doulas, childbirth educators, a student nurse midwife--and the responses have been unanimously positive. I even talked to one woman who switched to this midwifery practice from an MD’s office halfway through her first pregnancy, and she described the experience as “amazing.” I feel like that’s a pretty solid endorsement.

All in all, having prior experience as a doula doesn’t exempt me from doing my research or from thinking carefully about my choices in care providers. It just means that I have a place to start from and that it’s easier to weed out the non-helpful stuff (from outdated advice to scary books to unnecessary testing), since I have a pretty clear idea of what I’m NOT looking for. I means I am already developing confidence in my choices and learning to trust that “woman’s intuition” that you hear about. But it should definitely be said that you can accomplish all that without experience as a doula! Rebecca’s friend Mollie sure did, and she had a beautiful birth experience. I have a ton of respect for the research and effort she put into her preparation. The point is this: no matter which angle you approach from, the more you know and the more you ask, the more confident you are. The more confident you are, the better your chances for having a satisfying, positive birth experience. That kind of birth is what I wish for all women, no matter how, where, or when you deliver.