You’re pregnant…Maybe you’ve been trying for a while. Maybe there have been treatments as a part of your journey. Maybe there is another person involved in this process with you. Maybe this is your first or your fourth pregnancy; maybe they have resulted in children, miscarriages, abortions. Maybe you are nervous, excited, unsure, joyful beyond belief!
Or maybe none of those things.
Either way, this post aims to help you to make decisions on who will be on your care team.
The most important thing during this time is to take care of you! You and the baby you are growing. And this team of people, both personal and professional, will help in that.
At the beginning you certainly don’t have to know who will be holding your hand through birthing or while the baby is crowning or in the operating room; and exploring our supportive relationships and relying on them during this beginning time and into the end has the potential to lead to a smoother and happier experience.
First, who to tell?
This decision depends on who you are, what your relationships are like, what your job situation is like, and what your past experiences have held.
When someone has experienced a miscarriage or multiple miscarriages, they may be more hesitant to share their pregnancy until a certain point passes. Or, if you are unsure how this pregnancy may affect you or your relationships, it’s OK to wait and figure it out. Or, maybe you are bursting to tell everyone! Either option or any in between are just fine. Whatever the reasons, whatever you decide is the right decision at the moment.
If you are currently working, telling your employer depends on where you work and what kind of arrangements they make with pregnant people. It is good to start planning your job situation out early though – especially if your job includes physical considerations. You can begin by talking to trusted supervisors and then HR. While it is illegal to discriminate against someone in a job setting based on their pregnancy status , you still may find resistance to accommodations and fair pay or hours. Hopefully, this is not the case and if it is, see who can advocate for you alongside yourself. Depending on where you work, it may be helpful to find out what your maternity leave will be like towards to beginning to start planning – is it paid; how long does it last; will my job be held? If you work for yourself, it will be up to you to decide how to handle your finances and your work load during the different stages of pregnancy and postpartum – planning still required!
Then, what provider(s)?
A major decision, that is never set in stone but is quite influential, is the decision of who medically to trust with your and your baby’s care.
Choosing a medical care team that fits with your needs, your desires and prioritizes what you find to be the most important can make a big difference in how you experience your pregnancy and birth, leading into infant care and beyond.
Generally, it breaks down like this:
Midwives – “A midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy and birth, offering expert individualized care, education, counseling, and support to a woman and her newborn throughout the childbearing cycle .” While midwives practice with a similar model, there are several different styles of midwives to choose from: home birth midwives, birth center midwives and hospital midwives. Each state has different regulations – do your research. While highly trained, midwives are not doctors and they have a doctor as a back-up for higher risk situations. Midwives are more well-known for being best for non-medicated or low intervention births, with lower c-section rates – and while all of that is possible with midwives, they can have access to pain relief medication (when in the hospital) and definitely to hospital-based care if needed or desired.
Family doctors – Family doctors are just how they sound – they not only do maternity care and birth, they also can continue to care for you, the baby and your whole family. They are trained to provide care to adults, children, pregnant women, newborns and seniors. According to familydoctor.org, “In addition to diagnosing and treating acute and chronic illnesses, your family physician provides routine health screenings and counseling on lifestyle changes in an effort to prevent illnesses before they develop. And, if a health condition arises that requires care from another specialist, your family physician will be there to guide you and to coordinate all aspects of your care .” This set up is preferred by people who potentially want that continuity of care over a lifetime for themselves and their children.
Obstetricians (OBs) or Obstetrician Gynecologist (OB/GYN) – Obs are doctors specifically trained to focus on the pregnant, birth and postpartum period. They are also surgeons and can perform c-sections. OB/GYNs are doctors who “provide medical and surgical care to women and has particular expertise in pregnancy, childbirth, and disorders of the reproductive system. This includes preventative care, prenatal care, detection of sexually transmitted diseases, Pap test screening, family planning, etc .”
Regardless of who you choose, it will most often be that your practitioner will be working in a team of other practitioners and you will be rotated through them at your visits and at your actual birth you will be treated by whomever is on call. This is the reason they try and get you to see multiple people during pregnancy – so you have at least some contact with the person who may be present at your birth. This can be a non-issue for some people, who feel flexible and/or who like everyone they’ve come in contact with, or a real concern for others, in the unpredictability and/or if they are not as fond of some of the care team. Another consideration is the gender of the doctor. If you have a strong preference or need from personal experience or religious practices, start this conversation early to make sure you can get your need met with this practice. The reasons they do this is to both provide the best care they can (minimizing the chance an exhausted and distracted person will be at your birth!) and so they can have personal lives and predictability with their own families. Please talk about your concerns with your practitioners and ask questions.
To keep in mind: the window to switch practices closes eventually – both for continuity of care and just in terms of scheduling. Different practices may have different time lines, and starting in your 32-34th week, you may see this window closing. If you start to feel a conviction to change practices, explore this option before it may be too late. There is also the option to show up at the hospital in labor and ask for a doctor, midwife or laborist (a doctor or midwife who is at the hospital for assisting in labors) on call – for the hospital, not for your practice – if you indeed do not want or do not feel safe with the practice you initially chose. Discuss this option with your people and even call the hospital, to make sure of how this could work.
People also give birth at home, unassisted by medical professionals. This happens both by choice and by accident (i.e. the baby comes faster than expected). If by choice, it is typically made with a lot of thought by people who feel safe in their homes. It is not technically illegal to birth at home, yet it is not protected legally either so do your research . If chosen or not chosen don’t hesitate to call for support or 911 if anything feels unsure or unsafe.
Other supportive roles:
Doulas – A doula is an emotional, physical and informational support advocate who is non-medical. A doula may help you write a birth plan, listen to and validate you, research options with you, practice comfort techniques and more! A doula’s role is to support YOU and your choices – that is their motivation and their care is individualized to you. Individual and groups of doulas work differently and the cost varies. There may be a program in your area that covers doula services for people in certain situations. Or your insurance may provide reimbursement – make sure to call them and ask.
Social Workers – Social workers can help to link you to other services to meet your needs. While hospital settings most always include access to social workers, you won’t necessarily be automatically linked to a social worker so make sure to ask if you feel you need one or want to explore the use of one. If not in a hospital, still ask! If a social worker isn’t available, ask whom you can speak with to find out about more resources.
Programs – There are often many free programs to help with health, education and materials throughout pregnancy, birth and early childhood. A social worker is a great person to ask about the various programs in your area.
Therapists – The emotional aspect of pregnancy is not to be ignored. Your body is going through vast changes and your mind and heart are as well! Not only are hormones surging through your body, helping to create new and more intense emotions, it is also often true that your life may change drastically with the birth of this new child/children. Paying attention to your emotional health is just as important as your physical and a therapist can assist. There are therapists who specialize in pregnancy related care. Above all, the connection you make with this person will be the most important. Many insurance programs cover at least part of the cost of seeing a therapist – you can call you insurance agency to find out.
Support groups – For information and connection, a support group may be right up your alley. Support groups are either group run or run by a facilitator (a point person who helps make it happen, helps the flow of the group and often has additional information to share). Check them out! Any group that relates to what you may be experiencing has the potential to be helpful – pregnancy specific or not. Support groups have all different topics and affinities. And many people find support groups especially useful after they give birth…but that is for another post.
That was a lot of information!
We ask you to remember to make decisions with your intuition and with all the relevant information.
Take time, take it in.
And take good care!
 Pregnancy Discrimination, EEOC –
 What is a Midwife – http://www.pamidwivesalliance.org
 What is a Family Doctor – http://familydoctor.org/familydoctor/en/healthcare-management/working-with-your-doctor/what-is-a-family-doctor.html
 OB/GYN – http://www.healthcommunities.com/pregnancy/what-is-obgyn.shtml
 Unassisted Home Birth – http://www.naturalbirthandbabycare.com/state-laws-for-unassisted-home-birth/