Pizza or Tacos: The most important decision you make during pregnancy
When people find out they are pregnant for the first time, there are many decisions to make. Where will the baby sleep? What is the best stroller to use? Do we need to move? All of these questions are valid, but there is plenty of time and many resources to help figure out these logistics.
The most important decision you will make during your pregnancy is choosing your care provider.
Your care provider (either an OB or midwife) is directing your care throughout your pregnancy. They are making calls that affect your health and that of your baby long-term, and may even potentially perform emergency surgery on you. This is not a decision to take lightly!
In my experience, if/when the unexpected or emergencies arise during pregnancy or labor, people who like and trust their care provider feel much more satisfied with the outcome, while clients who have had difficult relationships with their care providers, or did not trust them, have had more to process and harder recoveries. For example, someone who had an emergency cesarean felt more at peace with their birth story due to a wonderful provider than someone who had a routine induction they didn’t want with a provider they felt bullied by.
If the thought of choosing a provider, or a new provider, feels overwhelming, I completely understand. Scheduling appointments, dealing with insurance, getting to the office during a pandemic - not at all easy, but definitely worth it.
How to choose the best provider for you
Pizza or Tacos?
First, you must understand the different ways of approaching birth. There is a great analogy (I’ve heard attributed to the lovely Tanya Wills of Manhattan Birth) about choosing your provider based on your philosophy. If you are hungry and craving tacos, you won’t go to a pizza spot and expect to get tacos. Similarly, if you hope to have a low intervention birth, it doesn’t make sense to choose a care provider with a high intervention rate. There isn’t a right or wrong option here, but it is important to clarify what you want in order to have a chance at the experience you desire.
There is a spectrum of providing care for pregnancy and birth. On one end we have the view that birth is a safe and natural process that sometimes needs interventions when medically indicated. The midwifery model of care tends to fall closer to this end, homebirth midwives especially. On the other end, the obstetrics model of care views birth as a pathological process that needs routine interventions in order to be safe. Now, of course, individual providers can fall at any point on the spectrum—there are certainly OBs who support physiological birth and midwives who have a much more conservative approach—which is why it is important to interview potential providers to learn about how they work. This scale simply gives an idea of how their training might influence their philosophy.
Why does this matter?
Let’s build on our pizza vs. taco analogy. Here are three potential scenarios that could happen, along with how they translate to pregnancy and birth.
Scenario 1: You really want a taco, but you find yourself at the pizza shop out of convenience. You get lucky and a sweet new cashier is working who really wants to help you find something to eat that they can provide. The cashier asks you questions about what you like, listens to you, and is able to make a satisfying suggestion for a calzone. It wasn’t the taco that you hoped for, but you felt supported and you are no longer hungry, so it’s all good!
Translation: You have a care provider who raises some red flags, or you may have a team practice where you don’t know who will deliver your baby. They may suggest interventions you don’t want, but the timing works out for you to go into labor spontaneously. Everything aligns and the doctor on duty the day of your delivery has a great bedside manner and a gentle, evidence-based approach. You and baby are happy and healthy and it all worked out!
In my experience, most people giving birth for the first time think that they are going to have an experience similar to this first scenario if they are classified as low risk. They might not love the provider they are with, or maybe are working with a practice with several providers that they hardly know. But they usually have a baseline assumption that all care providers offer evidence-based care and that as long as a true emergency doesn’t come up, patient preferences will be accounted for and they will be supported, especially if they hire a doula.
However, most people who don’t choose a provider that aligns with their views end up with something more like scenario 2:
Scenario 2: You arrive at the pizza shop, still craving tacos, but instead of the lovely cashier behind the counter, the cranky old proprietor is there. Rather than listening to you, they insist that you get a certain pizza because they have been doing this for many years and they are the pizza expert, so they certainly know better than you. Obviously, you have the option to leave, but at this point you are hangry so you just get the pizza. It’s not what you wanted, you don’t feel taken care of, and even though you aren’t hungry anymore, you still want tacos.
Translation: You have a care provider who raises some red flags, or you may have a team practice where you don’t know who will deliver your baby. They suggest routine interventions you don’t want, but you advocate for yourself to buy more time. You end up being induced anyway because you are tired of negotiating your care and ready to not be pregnant anymore. The day of your delivery, the doctor on duty is pushy and condescending and you have to constantly advocate for agency and evidence-based care while you are trying to labor. Even though you are thrilled to meet your baby, you feel exhausted from the stress of labor and a nagging disappointment about the experience.
People are often bullied into interventions they don’t want that are not necessarily evidence-based. If a provider routinely (as in not just because something is medically indicated) uses interventions, it is because that is how they were trained to see birth and you.will.not.be.the.exception to this. I cannot stress this enough. Out of the almost 40 births I have supported, I have had only one client have an intervention-free birth with a practice that regularly uses interventions and it was because the stars aligned that day: water didn’t break prior to labor starting, it was before the estimated due date, and they were able to labor at home long enough to just go into the hospital to have the baby. In most cases, there are myriad opportunities to intervene starting with weekly non-stress tests, and if your practice routinely uses interventions, they will be suggested (or potentially pushed on you).
Scenario 3: You are craving tacos. You head to your favorite taco shop where you are a regular. They don’t have your usual, but they know you there and make a suggestion for a delicious alternative. It wasn’t exactly what you thought you would get, but you ate some delicious tacos, you are no longer hungry, and you feel very supported by your taco shop team!
Translation: You get the sense that the care provider you have does not align with your views for pregnancy & birth, so you find another care provider who you like and trust. They spend time listening to you, answering your questions and getting to know you. On the day of your delivery, they offer compassionate, informed consent and take the time to honor your preferences and answer your questions, even when something unexpected comes up. You and baby are happy and healthy and you feel empowered by your birth experience!
Again, I want to emphasize that only you know what kind of care makes you feel safe and supported and interventions are not inherently bad. But make no mistake: if you are hoping to avoid unnecessary interventions, the only way to do this is to make sure that your provider agrees with you.
Have your tacos and eat them too: Birth is wild, and the unexpected will definitely happen. However, if you have a care provider you trust, who listens to you, and who actually practices informed consent, it makes all the difference in terms of how you can feel about your pregnancy and birth — even when it’s not what you expected or wanted initially.
