Of course
there is no way of knowing for sure. One of the
exciting, and scary, things about having a baby is that
so much of it is a surprise! Your choice of caregiver
though will affect the choices available to you and may
affect the sort of birth experience that you have.
There are
two types of care - we will call one routine, and one
personalised.
Routine:
Routine care is the most common form of care in most
Western countries. It is called "Active Management" by
the medical profession. Routine care involves having
routine procedures and protocols that are applied to all
pregnant women. For example, an obstetrician may give
all pregnant women iron tablets, regardless of whether
they have iron-deficiency anemia or not. The reason for
this is that the caregiver is taking a "just in case"
approach. This can seem very reassuring. However, it
also means that the unique and individual needs of you
and your baby are not being taken into account. It also
means that you will be exposed to a number of
interventions that are not medically necessary but are
routine.
Personalised: Personalised care is more commonly
provided by midwives although many obstetricians do take
this approach as well. It is called "Expectant
Management" by the medical community. In this approach
nothing is routine, with protocols and hospital policies
being less significant. Rather than treating all
pregnant women the same, each woman is looked at
individually. If she is showing signs of iron deficiency
anemia for example, the caregiver might prescribe iron
tablets. The interesting thing is that the research
shows that mothers and babies are just as healthy with
this approach as they are with routine care. The benefit
is that you and your baby are being treated as unique
individuals with unique needs, you will be exposed to
less interventions, and have more choices available to
you.
How can
you tell if your caregiver is routine or personalised?
It can be
really difficult to know which type of caregiver you
have at the moment, especially if this is your first
baby. If you have a routine caregiver there are a few
clear signs though which include:
-
Your
antenatal appointments are generally short, often no
more than 5 minutes
-
Your
caregiver always checks the baby using ultrasound
rather than his/her hands on your belly and a tape
measure
-
You may
have been having vaginal examinations throughout
pregnancy and will probably be having them every
appointment from 38 weeks
-
Your
caregiver may be reluctant to talk about a birth
plan or tells you not to worry about anything and
let them take care of it all
It can be
helpful to have a few simple questions to ask your
caregiver to get a clear idea on where they stand and
then to be able to identify whether or not you have
similar beliefs. The B'LIEFS tool can be helpful for
this:
B - Bed
(how do you feel about me being in positions off the bed for labour?)
L - how
Long?
(what sort of time limits do you have for first stage or pushing?)
I -
Induction
(under what circumstances would you induce labour?)
E -
Episiotomy
(how often do you find it is necessary to do an episiotomy?)
F - Food
(how do you feel about me eating and drinking during labour?)
S -
Supporters
(what are your thoughts on me having a doula or additional supporter)
Even if you
decide that you are comfortable with having routine
care, asking these questions helps you to identify what
is important to you and whether you and your caregiver
are on the same page. Your doula or antenatal teacher
can help you to practice these and similar questions and
how to explore your options if you decide you would like
a different approach from the one you currently have.
This article
is reprinted with permission from
Childbirth International
