One of the first, and arguably most important, decisions you'll make during your pregnancy is who your provider will be. Usually, that means a choice between an OB-GYN and midwife. If you go with the latter, you'll have some specific considerations (and possibly some explaining to do to people who just don't get it). There are more than a few essential conversations you'll want to have with your midwife, too, although I think you'll find that many of them apply if you have an OB.
For my first pregnancy, I saw a team of certified nurse midwives. If a woman isn't high risk, my medical practice automatically puts her in that program. As a result of my placement, I saw whoever was available, and then the midwife on call would be the one to help me deliver my baby when I went into labor. I ended up absolutely loving the program and the individual attention I received. I'm pregnant again, and even though I'm on a different insurance plan the program is much the same, with the exception that I can pretty much see the same person each time (minus delivery). I see my midwife every four to five weeks now, and the frequency of those visits will increase as I progress. I appreciate that she makes time for me and my questions because, well, there's a lot to discuss.
If you're pregnant, and staring a seeming endless amount of visits square in the face, you'll probably have plenty of opportunities to talk about all your concerns. Make sure these are on your list:
Any provider you see should be well-versed in your medical history, and that's never more true than when you're pregnant. Your midwife will want to know your, your partner's, and your family's medical history as it pertains to genetic problems and pregnancy health conditions.
She'll also ask what kinds of medications, supplements, and vitamins you're on, as these can affect baby.
Sufficient weight gain is essential to a healthy pregnancy. According to Rose Midwifery, both inadequate and excessive weight gain pose risks for mom and baby. Your midwife will likely give you a recommendation for total weight gain based on BMI.
It's really important that you tell your midwife about your pregnancy symptoms, particularly if you have any sense that they might not be normal. If she doesn't know that your nausea is affecting your ability to function, or that you're spotting when you go for a run, she can't help you.
I had terrible thrombosed hemorrhoids during the last trimester of my first pregnancy that had to be excised at urgent care. At my midwifery appointment a few days later, I was a little embarrassed, but I told her they still didn't feel better. I was right, and she got me into general surgery the next day.
There are a few things that are just plain not OK to consume during pregnancy, no matter what kind of provider you see. For example, most anyone will tell you that you mustn't drink alcohol or smoke.
Other things, however, might be negotiable. Travel or certain types of exercise, for example. With all the talk about limiting caffeine, I was surprised when my midwife suggested that I drink a Coke to help with my second trimester migraines.
Available Screenings & Tests
Different providers require and recommend different tests. Find out which screenings are available and when and how often you'll have an ultrasound. Most tests for genetic and chromosomal abnormalities are optional, so you'll want to talk to your midwife about risks and benefits, as well as what's available through her practice.
For this pregnancy, I was offered a blood test that detects fetal chromosomal abnormalities on account of my advanced maternal age. My midwife was great about giving my partner and me the information, but remaining neutral, and we opted in.
One major assumption that people make about midwifery is that you must be having your baby at home. Many midwives do perform home births, making them a great choice for moms who want to go that route. However, just as many midwives (mine included) deliver in hospitals. If a water birth is what you're looking for, you need to find out if that's something your midwife does, but it could be an option in your home as well as some birthing suites at a center or hospital.
I ended up being really glad I delivered in a hospital because my baby came out with a compound hand. I needed a vacuum-assisted delivery, and there was an OB-GYN right there to do it.
Another misconception about midwifery is that all births are done unmedicated. While many practices certainly center around so-called "natural" childbirth, that's not always the case. True, most midwives will coach you in alternative pain relief, like breathing techniques and massage, but just because she's a midwife doesn't mean she's necessarily against medical interventions.
I was pleasantly surprised when my midwife told my I could have an epidural if I wanted. "You're the mom, and you make the decisions," she told me. I gave birth in a hospital anyway, so I had access to an anesthesiologist. With a 29-hour labor, I was glad to take advantage of that option.
When Labor Begins
Wherever you're giving birth, you need to know where to be and when. Your midwife should go over the classic signs of labor, how to time your contractions, and when to call her.
My water broke at 4:00 a.m. when I had my daughter. It was a slow leak, so I called the midwife. She told me she wanted me to labor at home for 12 hours before I headed into the hospital. I was happy to, too, because the last thing I wanted was to be turned away because I hadn't progressed enough.
Every pregnancy and birth is unique, so you'll want to know where your midwife stands when it comes to complications and specific procedures. You'll want to find out how she handles breech births, vaginal births after C-sections (VBACs), whether or not she performs episiotomies, and her views on delayed cord clamping... just to name a few.
Although these procedures occur much later in your pregnancy, you should have the conversation early so you're both on the same page. You don't want to be shopping for a new provider right before your due date. Trust me.
It's a really good idea to have a plan for how you're going to feed your baby before they make their entrance. Most practitioners will promote breastfeeding, and midwives are no exception. If you intend to nurse, your midwife can be an excellent resource for you. My midwife was a great comfort to me when she assured me that my small breasts would not affect my ability to breastfeed.
Whatever your plans, that conversation, and all conversations for that matter, should be free of judgment and pressure.
Check out Romper's new video series, Bearing The Motherload, where disagreeing parents from different sides of an issue sit down with a mediator and talk about how to support (and not judge) each other’s parenting perspectives. New episodes air Mondays on Facebook.