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The first step in choosing a caregiver is to decide what
your priorities are. Imagine what you would like your birth to be
like. What are the top three or four priorities for you? Different families
will have different priorities. Some may want to avoid episiotomy. Some may
want to ensure medical pain relief is available immediately on request. Some
may want to go into labor spontaneously (instead of having an induction).
Some may want a high level of medical supervision. Some may want to give
birth off the bed. You might want ALL these things, or something completely different.
Your doula can assist you as you get to know your options and identify your
priorities.
Styles of care
The caregiver you choose provides you with professional
medical care and expertise, but the person who is ultimately responsible for
your care, and your baby's care, is you. One of the most surprising
things to learn is that medicine is as much a skilled art as it is a
science. And the "art" part means that for most things relating to pregnancy
and birth, there are differences of opinion on what you might do.
Safety is top priority for everyone involved in birth, but there can be
different opinions on how to be safe!
There are all sorts of practitioners who care for pregnant
women, including obstetricians, family doctors (general practitioners),
nurse-midwives, direct-entry midwives, registered midwives, and lay midwives. Each caregiver
will have his or her own way of working and approach to birth. Not all
doctors, or midwives, are the same or have the same views! Most of the time,
they will fall into one of two camps.
Active Management
The first approach is called "active management."
Practitioners of this style generally believe the safest way to handle birth
is to be "active" -- to use medical methods of controlling the process to
try to prevent problems from arising. Active management uses routine
procedures for all women -- sort of like a "set menu" in a restaurant where
everyone eats the set meal the chef is skilled at preparing. Some women feel
very safe and cared for with this approach, which relies heavily on the
caregiver to make decisions.
Expectant Management
The other approach is called "expectant management."
Practitioners of this style generally believe the safest way to handle birth
is to observe carefully, but to "do" as little as possible, unless there's a
specific problem arising in an individual woman. Little is done routinely,
because routine interventions are recognized to introduce their own risks.
Expectant management is like a full a la carte menu -- you can choose from a
range of different dishes depending on what you like and avoiding foods that
don't agree with you.
Now that you've decided what your priorities are, and you
understand the range of possibilities caregivers may offer, you can ask
friends for recommendations. Keep in mind to consider whether your
friends had the same or very different priorities from you! Did they prefer
the set meal or the a la carte menu? Once you have some names to consider,
try meeting with two or three caregivers, or even more, to decide who you
feel most comfortable with.
Making a choice
Remember, the key is a good match. Your priorities, or
a caregiver's approach, are not "good" or "bad" in themselves. They are
what's right for you, and what's right for him or her. What's important is
making a good match between what you want and what your caregiver
will feel comfortable providing. Don't expect to go to an Italian restaurant
and ask for Japanese food!
It can be hard work to find a supportive caregiver. But doing
the work before your birth can avoid stressful tensions arising in late
pregnancy or during your labor. Remember, your doula can help you through
this process. That's what she's there for! See also:
Questions to ask your caregiver
Choosing a place of birth
Writing a birth plan
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