Deciding on your care

Depending upon where you live, your financial circumstances, how far through your pregnancy you are and you and your baby' health, you may have a range of options available to you when thinking about who should care for you during pregnancy and birth. This is an important decision to make as the person you choose to look after you will have the single greatest influence on the outcome of the birth. The more the attitudes and values of your doctor or midwife are aligned with your own, the easier it will be to build a trusting and effective partnership. Firstly, ask yourself what your own values and attitudes are and then ask your prospective doctor or midwife the same questions to see if they are the best 'fit' for you.

The person you choose to look after you during your pregnancy and labour will have the single biggest influence on how you give birth. Getting this decision right for you is therefore going to be important. 

The first step in the process is to work out what sort of care you are looking for during your pregnancy and what your hopes are for the birth of your baby. You might find it useful to work through the following questions to get really clear about your priorities. Spend some time with your partner or a support person to go through these questions and work out what is important to you.

Pregnancy

- Do you consider pregnancy and birth as natural life events?

- Are you healthy and expecting a normal pregnancy?

- Do you see pregnancy and birth as risky?

- Do you have health concerns which require specialist care?

- Is it important to you that your caregiver takes charge of making the decisions about your health during pregnancy?

- Do you want to take responsibility for making the decisions which affect you and your baby?

- Is it important that you avoid long waiting times for your antenatal appointments?

- Do you want to have the opportunity for discussion during your antenatal appointments?

- Do you want to be in and out of your antenatal appointments quickly?

- Do you want to see the same person for each antenatal visit?

- Is it important to you that your caregiver is easy to get to from home or work?

- Do you want your caregiver to be able to come to your home for antenatal appointments?

- Do you want to have a female caregiver?

- Is it important that your caregiver can support you with the emotional aspects of your pregnancy?

Birth

- Are you hoping for a 'normal' vaginal birth?

- Would you prefer to arrange to have your baby by caesarean section?

- Do you want to give birth in a hospital?

- Do you want to give birth at home or in a home-like setting?

- Do you want your baby to decide when it is time to be born?

- Would you prefer to know when you are going to go into labour and have your labour induced?

- Do you want to keep interventions to a minimum?

- Do you want access to an epidural?

- Do you want to avoid using drugs during labour?

- Do you want to be able to use water for pain relief in labour?

- Do you want to avoid perineal tearing or the need for an episiotomy?

- Do you want to give birth in deep water?

- Do you want your partner to be able to stay with you once you have had your baby?

- Do you want to sleep in your own bed after the birth?

- Do you want to be able to put your baby in the nursery after the birth?

- Do you want to stay in hospital for at least a couple of days once you have your baby?

- Do you want to leave hospital as soon as you have had your baby?

When you are clear about what you want from your antenatal care and what your hopes are for the birth, it is time to go shopping for a caregiver!

Finding the right care for you

The choices available to you for care during pregnancy and birth will be dependent upon where you live, what you are able and willing to spend on your maternity care, whether you have private health insurance and then sometimes, how quickly you are able to make the arrangements. Some options for care are very popular and the likelihood of being able to access them lessens, the longer you wait to book in.

What is important however, is that you are able to get a good match between what you have identified as being important to you and what your caregiver feels is important and their preferences for caring for pregnant women.

One way of finding out what a particular midwife or doctor thinks about these issues is to ask them questions. You could do this at a booking in appointment, or if you are considering making private care arrangements, you could make a specific appointment to ask questions before you make a decision. You might decide to ask them some of the same questions that you have just answered, or you might ask very specific questions such as:

- What are your preferences for 'managing' pregnancy and birth?

- Will you support me to have a normal birth / caesarean birth?

- How will you support me to make informed decisions?

- What is your normal birth rate / caesarean birth rate?

- What are your statistics for the use of episiotomy?

- When would your recommend inducing labour?

If you are working with a team of midwives, for example in the public health system, the answers to the questions that the clinic midwife will provide at an antenatal appointment will relate to hospital policies rather than her individual practice.

Birth Preferences Statement

Another useful tool to aid discusion with a potential caregiver, is a Birth Preferences Statement. This could involve simply writing down your answers to the above questions and working through these with the midwife or doctor as a discussion starter. Their responses to your preferences will help you get a feel for how much they might support you in your choices. You do not need your caregiver's approval for your informed choices, but the ideal situation is one where your midwife or doctor's attitudes and values around pregnancy and birth, match your own. This will make it much easier to build a trusting relationship with them. You are not using this statement to plan for the birth at this point, but rather to start a conversation with your caregiver to find out if you are going to be able to work well together.

Making decisions

When considering each possible option of care available to you, you will be balancing the pros and the cons in order to make the right choice for you. The BRAIN decision making tool can help. This is an acronym which stands for each element of information you might wish to include in considering your decision.

B – Benefits ‘What are the benefits of this model of care for me and my baby?’

R – Risk ‘Are there any risks or negative consequences associated with this model of care for me or my baby?’

A – Alternatives ‘What other options are available to me?’

I – Intuition ‘What sort of care do I want during pregnancy and what are my hopes for the birth of my baby?’

N – Nothing ‘If I do nothing and don't make this decision now, what might the consequences be?’

You probably apply this questioning process every time you make a decision. BRAIN provides you with a structure for your questions, so that you can be sure that you have covered all the relevant information required to support your decision making process.

You can find information to help with answering these questions in the sections about Midwife-led care, Obstetric Care, Shared Care and Where Can I Have My Baby?