Building Your Birth Dream Team: Who Belongs in Your Corner

Childbirth isn't a solo sport — it's a team effort. In this episode, Katie O'Brien breaks down every player who can join your birth "care team," from midwives and OBs to doulas, family, chiropractors, pediatricians, and even your birthing location itself. She unpacks the real differences between midwives and obstetricians, walks through the various midwifery certifications (CPM, CM, CNM), and explains why maternal-fetal medicine specialists get called in for higher-risk cases. Beyond providers, she dives into the emotional side of the equation — choosing the right support person, navigating family opinions, and communicating your needs clearly. Katie also compares hospitals, birth centers, and home birth, covering key questions to ask about C-section rates, NICU access, doula-friendliness, and transfer policies. The takeaway: whether you're just starting to build your team or reevaluating an existing one, trust and communication are the foundation of a birth experience that truly supports your goals.

Transcript

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Hi, my name's Katie O'Brien, and I'm your host of Calm, Collected, and Consented Childbirth. In this episode today, we are gonna talk about who is on your care team. A care team is including all the people that are gonna work together to have your birth experience be the best possible one the birth team is really important, and it's actually a lot larger than you might initially think So first we're gonna talk about who this care team is, and then we're gonna talk about how to make sure that you are picking the right care team or if you already have your care team, making sure that they are fitting your needs throughout prenatal care and then going forward into labor and delivery and postpartum Remember, this is not medical advice, but rather information to help you communicate effectively with your care team So let's get started. Okay, first thing is who is on this care team? So we're gonna talk about the members of this care team, but just to outline them, this is gonna be your,, midwife, OBs, maternal fetal medicine potentially, doulas, family members, friends, chiropractors, PT, massage therapists, acupuncturists, so that whole group potentially, pediatricians, and actually your birthing location. I consider, your birthing location part of that care team So let's start out with your midwife or obstetrician. Medical professionals are capable of being allies. We want to help, and we certainly go into this field hoping that we are helping everybody that we encounter. There is a lot of medical distrust in the United States right now, and we could go into a whole tangent on why there's medical distrust., It's understandable. Unfortunately, it doesn't always serve us well to have medical distrust. Medical distrust works best when it is helping us gain knowledge and make s- making sure that we understand enough about our own health to make informed decisions. But where it's not helpful is when things go not as planned, particularly quickly, and we don't have the information that we need at the time. So the first part of having a good experience through pregnancy and childbirth is gonna be making sure that you're picking the right care providers, particularly the right midwife or obstetrician. You need to make sure that their goals are gonna align with your goals because this is the leader of your care team. This is the person that's gonna help you bring your baby into the world, and manage things postpartum as well, Not every provider is right for every patient, and that's just the truth. And it's actually okay. But Communication is really key. If you feel that you are not able to communicate effectively with your provider, then that's not gonna be the right fit. Let's talk about the difference between obstetricians and midwives. The biggest difference from the very beginning that you can say in one sentence is midwives don't do surgery Great care teams often have both midwives and obstetricians on them. So midwives are trained, generally speaking, that things are normal until they're proven not normal. Obstetricians, on the other hand, are trained in abnormal. So an increasing number of hospitals are using both obstetricians and midwives on their floors. The midwives often are running the labor and delivery unit in the sense of doing the majority of all the vaginal deliveries Obstetricians go into obstetrics for a lot of different types of reasons. Some of them love surgery, and they're excellent at skills that midwives cannot have. So your care team could include both. If you are delivering out of the hospital, that provider is typically going to be a midwife. But if you're delivering in the hospital, you might see both providers But I do want to say that some obstetricians are very vaginal birth friendly, and you could have a midwife that strangely is not. So it is worth knowing as much as you can about the individual provider that you're going to be dealing with, particularly in the prenatal setting Obstetricians become obstetricians in generally the same way. They go through medical school, whether it's a DO program or an MD program, and then they go through a residency in obstetrics. Midwives can enter midwifery in a number of different ways, so let's talk about that for a minute So there's a couple of different ways to enter midwifery. You have certified professional midwives. Certified professional midwives are certified by NARM. It is under an apprenticeship or a training program, And this training program isn't conventional college. They are experienced and trained in out-of-hospital birth, so they are not able to deliver in the hospital setting. Some birth centers will have certified professional midwives, but that depends a lot on the state. And in general, the state's gonna play a lot into what a certified professional midwife is able to do but certified professional midwives do have training in the out-of-hospital birth, and they are capable of doing prenatal care, the birth itself, taking care of the newborn, and also postpartum care There's also certified midwives and certified nurse midwives. Both are certified through ACMB, and both are trained through an extensive specialized graduate or doctorial program that's specific to midwifery. Nurse midwives have a bachelor's in nursing and go through a nursing track, whereas certified midwives, do not specifically go through nursing. The big thing you're gonna see difference-wise is that certified nurse midwives are accepted in all 50 states. They're able to practice in all 50 states full scope. Certified midwives have limited states they're able to practice in. But as far as the practice itself, it's gonna look very similar Certified nurse midwives and certified midwives are able to deliver babies in both the hospital and out-of-hospital settings, including birth centers Okay, so the next care team member we're gonna talk about is maternal fetal medicine, also known as perinatologists. So these are obstetricians that have further training in high-risk pregnancy and ultrasound surveillance. If you have any aspect of your care that requires a more detailed ultrasound or maybe a look at it from a more high-risk angle, they are going to have you see a maternal fetal medicine specialist. There are some places where pretty much everybody sees a maternal fetal medicine specialist for their anatomy scan, that super detailed scan around 20 weeks, but there are other places where they just don't have a lot of maternal fetal medicine specialists, and you're only gonna see them if it's a particularly high-risk scenario. They're gonna play in mostly if your care plan deviates and they're talking about delivery that's early, that's potentially preterm, or that they're really worried about the growth of your baby or any kind of abnormality Another care member is a doula. So doulas are trained professionals who provide continuous physical and emotional information and support. They do not provide medical care. I like to kind of define it as they are there for you and your pain and your, wellbeing, but they're not there as a, medical provider. So they're not gonna take vitals, check your cervix, estimate the size of your baby, catch the baby, or actually they shouldn't be making medical decisions for you either. The other thing that doulas should not be doing is taking over as the only support person. So a doula that is a really great doula is gonna help your partner, or for partners listening, help you help the pregnant person. So the goal is that, they're facilitating the team between the pregnant person and the support person Excellent doulas are gonna help you help them basically some insurances do cover doulas, but it can be spotty as to who's covering and what they're covering. And then there are doulas that will not accept insurance because the coverage is not good. So it's definitely worth looking into a doula early if you're gonna have a doula on your care team to figure out the insurance and how you can go about paying for this service if needed. Another, care team member is family members. So the first member of the care team is gonna be your support person. Support people, I'm also talking to you. You are the first member of that care team. This is a team sport. It works best when there is communication and there is support there. Can a woman deliver a baby by herself in the hospital without a support person there, get through postpartum, then take care of the baby? Well, technically, yes. Does that usually go well? No A support person cannot be replaced. There's a reason paternity leave is starting to be a thing. It should be, and we need to be using that and understanding the importance of that role in helping that mom and baby So the interesting thing is family members and friends can be really wonderful, and at the same time they can also sometimes have opinions that maybe you don't want to hear. So how involved people get is, is up to you, and it's really, really good as a partnership, to, and as a couple to determine how involved you want the other members of your life to be. It was really interesting. During COVID, a lot of places went down to limited people being in the delivery rooms, and one of the things that surprised me was how many mothers of patients were the other support person. It was not always the fathers of the baby. And in most all cases, this was a decision made by the care team, meaning the, pregnant woman, her significant other, and the mother So it's really important to evaluate the relationship you have with the other people in your life and how good they're gonna be at being your support person. In some cases, the f- father of the baby or your partner might not be the person that's going to be able to be your best support. But as long as you have talked about this and you're in agreement, it shouldn't be a problem. I'm gonna give you an example. I was taking over a couple's care from a midwife in the hospital setting, and the midwife had seen this patient throughout the pregnancy, and the partner was really supportive during the pregnancy. And so she, when she was giving me a report on this, patient, she said, "You know, it's really interesting, Katie. Her partner's not really that present. He's on the couch. He's really not facing her. And this is very strange because during prenatal care, they seemed really cohesive, on the same page. He was really supportive." And that had been night shift, so that, that's always interesting, you know, the differences between daytime and nighttime and how support people are able to support. But I went in there, and over time, throughout the day, I learned that he actually was very medically scared. He had a lot of medical anxiety and did not like hospitals. And interestingly, the couple had already decided that they wanted him to be present for the birth, but that it was understood that he would not be actually directly supporting her. He was gonna be at the delivery, but not necessarily actively supporting her. Now, she had an epidural, and she was comfortable and happy and fine. And,, the goal was just that he was in the room, whether or not he was even watching. And they were totally okay with this. This was a plan they made, and they were okay with it. And that has always stuck in my head as a great example of how, as long as there's communication ahead of time, there doesn't have to be a role that's exactly defined Now had this patient wanted to go natural, it would've been important for her to have somebody else in the room that was actively helping manage her pain naturally. But in her case, that was not what the goal was, so their arrangement worked out really, really well There are definitely times when you as a couple might pick to do something that's gonna be against what your family members have been historically doing. For example, breastfeeding rates have really gone up, in the last probably 20 years. Prior to that, there w- the breastfeeding rates were not as high, so you could have parents that for generations nobody was breastfeeding, and so these family members that don't have any exposure to breastfeeding might not be very breastfeeding friendly. They might say things that you find as a couple are not supportive of your decision-making. We're gonna spend a lot of time in this podcast talking about how to incorporate your family members in a positive way so that your whole family can feel positive about welcoming a baby another member of the care team could be chiropractors, physical therapists, massage therapists, acupuncturists, basically providers in the naturopathic world. This could be a counselor, They can be very helpful in helping you manage pregnancy pains, discomforts,, even anxiety. These other health professionals can be really useful in helping you through pregnancy. Your midwife or obstetrician could be a really great place to start and ask if you're having pains like, sciatica, pubic symphysis pain, carpal tunnel, if these other specialties can help with that A pediatrician becomes a very important part of your team, obviously, as the baby's born. But you're gonna start looking into pediatricians before the baby comes, ideally. So getting information from family, friends, and your providers about pediatricians in the area and pediatricians that might be good for you to take your baby to. It's important for you as a couple to start talking about what you want in a pediatrician Some family practice doctors and nurse practitioners also see babies, so do you want to take your baby to a family practice, or do you want to take them to pediatric services? What's in your area? And then it comes down to what you're hoping your pediatric care looks like. Are you hoping that this provider's gonna be okay with delayed vaccinations? Are you hoping that they're gonna be okay with breastfeeding or formula feeding or any number of things that come up in a child's life? It's a good idea to meet with potential providers before you have the baby so that you can start communicating your needs and make sure that you're in alignment on what you're hoping for out of their care services. The last care team member that I'm gonna talk about is the birthing location. The birthing location matters a lot, probably more than most people even realize, and it's not always so easy to just look at the location from the standard of what others have experienced, like say other people in your life, or other specialties. So maybe that hospital is really great at heart care, for example. They have great cardiologists on staff. They do a lot of surgeries and procedures, and they're really known for that. Their obstetric floor might not be as well reviewed. Things that matter a lot, in a hospital setting would be their C-section rate, their breastfeeding rates, the acceptance of doula care, what kind of practitioners they have there, what types of pain medication or, pain alternatives are offered, and their NICU services. So let's get a little bit more into each of those. So if you really want a vaginal delivery, like that is a huge goal of yours, C-section rate is gonna matter a lot. You could be in an area where you don't have any hospitals, in which case you're not going to be able to look for a hospital that has a lower C-section rate. You might only have one that you could possibly go to. But let's say you're in an area that has multiple locations, C-section rate is going to matter. If they are routinely having a forty-plus C-section rate, your likelihood of having a C-section is gonna be higher than if you go somewhere that the C-section rate is thirty percent or under. This leads into a little bit of what type of providers they have there too. Generally speaking, hospitals that have midwives on staff doing a lot of the care are going to have lower C-section rates Some hospitals have moved to laborist or hospitalist programs where the obstetricians and midwives that provide care are actually part of the hospital staff. They do not represent independent practices. And in fact, that hospital might not have privileges for places that are offering prenatal care. So your prenatal providers might be totally different than your providers in labor. That is worth finding out about too. Now, the laborist model where you have midwives and obstetricians employed by the hospital do have good C-section rate numbers generally. So I like to say it's more romantic in concept, that you have the same provider for prenatal care th- as you do for delivery than it actually is gonna change the rates likely of your ability to have a vaginal birth. But it is worth knowing that. And if that's really important to you, potentially selecting another hospital that does have the prenatal care and ob- and obstetric care done all by one person, though I would say that is increasingly hard to find. Acceptance of doula care in a hospital is something that is worth looking into if you're hoping to have an unmedicated delivery. Some hospitals are better at working with doulas than other hospitals, and in fact, a doula might be able to tell you how well the hospitals have worked with them Breastfeeding rates are important. Most hospitals will say they're breastfeeding friendly, but there is something called a baby-friendly hospital distinction, and hospitals can get that. It is hard to get, and those are hospitals that have really worked very, very hard to make their entire process breastfeeding friendly. That's gonna matter in babies being breastfed, immediately after delivery within that first hour of life, having lactation consultants on the floor regularly, having all the staff trained in breastfeeding. The type of medications available to you is another good question. Some hospitals have started to have nitrous oxide, which is basically laughing gas. That has been used very regularly outside of the United States, but we have not used it as much here. But it is a good option if it is available for somebody that does not want an epidural Some places do not have, anesthesia as readily available, and so epidurals can be delayed, so that's worth finding out about. Then there's the issue of the NICU. Some hospitals have NICUs and some don't. So this is a neonatal intensive care unit, and this is gonna be something that becomes important if you're potentially gonna be delivering, early, preterm, or with a baby that has potentially known complications, or perhaps with twins. NICU's gonna be really important to have at the hospital so that the baby or babies don't get transferred to another facility that has a NICU and you're left at the hospital that does not So that covers hospital services as your care team. But let's talk about birth centers or home birth. So birth centers are places that are staffed by midwives and are generally not in a hospital. Now, sometimes hospitals have a birth center within the area of their, campus, but it is not generally hospital-owned. Midwives staff birth centers, and you might see all three types of midwives staffing a birth center depending upon the state. Some important things to know about birth centers is they do not have the capability to give you an epidural, and they are for low-risk pregnancy scenarios. When you go to find out if a birth center is right for you, you want to ask some questions, and the questions you wanna ask are, what is their transfer rate, both prenatally and in labor? Meaning, what's the chance that you're gonna get transferred out of their care during pregnancy because you have a condition that will keep you from being able to be in their care, we might be talking about gestational diabetes. Maybe they allow you to be-- to have gestational diabetes, but only if it's controlled under diet or hypertension issues. Those are two easy examples. And then in labor, what's their transfer rate out to the hospital to deliver? and why are they commonly having to transfer patients both prenatally and labor-wise. Then you can take a look at yourself and see what your goals are and what it looks like your medical history is going to lead to, and whether or not that is going to be a high likelihood that you get transferred or a very low likelihood that you get transferred. Another question for a birth center is do the midwives follow you to the hospital if you do get transferred in labor? Some midwives that work at birth centers also have privileges at the hospital that their patients are gonna get sent to if they need to get sent to the hospital during labor. Some reasons that that might happen is that you stop progressing naturally on your own, and you might need Pitocin to augment your labor, or if you decide you need pain medication, like an epidural, because a lot of birth centers are able to give IV narcotics for pain or nitrous oxide. By the way, those are also things to ask the birth center. And also let's say you get to, like, eight centimeters and you just stay there. Sometimes that would be a reason to transfer, or fetal heart tones are not reassuring. So some midwives will be able to also go to the hospital with you and manage your care there, but there are other practices that the midwives do not follow you, and that you would get a new care team once you were transferred to the hospital. It's good to know what hospital the birth center's potentially going to transfer to. Often a birth center will have a hospital that they are specifically transferring to, and so it's good to know what hospital that is and to maybe even take a tour of that hospital in case, in the off chance that you end up there And then going back to the pain management options, what options do they have at the birth center for pain management outside of natural methods? As far as home birth is concerned, this is gonna involve a home birth midwife, and once again, that could be any three of the midwife options such as certified midwives, certified nurse midwives, or certified professional midwives. You could find a practice that has multiple midwives that could be the option for the home birth, but oftentimes with home birth, it's one midwife that you have throughout the whole journey. Good questions to ask the home birth midwife are gonna be some of the same questions you'd be thinking of in a birth center. What's the transfer rate out both prenatally and in labor? Where are you gonna get transferred to? Unlike a birth center, which is usually established with a particular hospital to go to, often with home birth, it's based on where you live. Particularly if you're in a city and you have multiple options near you, you could get transferred by ambulance to whichever the closest hospital is. What are the common reasons that this midwife usually transfers out for? W- will this midwife be able to follow you to the hospital? Once again, if it's a certified professional midwife, they cannot have privileges in the hospital, but maybe they follow you as a doula, like in a doula role. Certified midwives and certified nurse midwives could have privileges at a hospital, but it's worth knowing if that would even be an option. And what are the pain management options that you have at home? Some midwives are able to give, IV narcotics at home and/or do nitrous oxide. And then, of course, with both birth centers and home birth, is water birth an option? It usually is, and in fact, sometimes water birth can be an option even in a hospital setting. I know for my first six years of my career, we were at a practice that was very similar to a birth center, but not technically a birth center, and we would do in-hospital water birth So that ends the who is your care team part of this. So let's talk about is the team right for you? So if you haven't picked a team already, how do you do it? Well, start interviewing people and places based on the above that we've discussed. Go out and talk to your midwife, your obstetrician, It's often helpful to consider making a birth plan and going over that birth plan with your obstetrician and midwife and making sure that they're going to be able to honor those things that are very important to you If it seems that the place you have selected to birth is not continuing to serve you, you might wanna look at your other options As a couple, it really helps to communicate about what you're hoping for out of your delivery. Are you hoping to be at home or at a birth center or a hospital? Are you hoping for an epidural? Are you hoping to use a doula? Who are you hoping to have at delivery? Figuring out these things can start helping you prepare adequately for how you're going to approach this. There is no right or wrong look for you as a couple. It's good to evaluate what you're each bringing to this experience Do hospitals make you very anxious? Are you needle phobic? Do you have trust issues? Are you concerned about your provider being female or male? It's important to get on the same page and to be open and honest. I did not find out that my husband had extreme anxiety regarding hospitals till well after we had children. It would have shaped our preparation more if I had known that ahead of time. And just like that couple I referred to earlier in this podcast, it's okay if your agreed arrangement doesn't look like your friend's agreed arrangement or your family's or how other people have birth. This is you as a couple. This is your way And as long as you are both on the same page about it, it is okay Some support people wanna be really actively involved and have a lot of opinions about a lot of this, and there are others that don't and have a lot of anxiety If you can get to a place where you are open and honest with each other and sharing your concerns, you're gonna be able to prepare for it better If you've already picked out a care team and you are well into the pregnancy, it's important to always be evaluating if it's still serving you. And if it is, great, keep going. But if it's not, consider trying to work towards something that maybe is gonna fit you better. Many practices accept patients as transfers pretty far into the pregnancy. So even if you're around 32 weeks, you might still be able to pivot and choose a different provider especially if it feels like the place that you're going to have to birth is not in align with your goals Throughout the remaining episodes of this podcast, we're gonna talk about a lot of these things and how we can finesse the conversation. But I wanted to give a good overview of a good place to start for childbirth preparation, and the best place to start is making sure you have a solid care team. Even if you have medical distrust, if you trust your providers and you trust your birthing facility, you're going to be at such an advantage having trust in your birthing place and in your care team is essential It's the first step to having the birth experience that you're hoping for. And even if things go not according to plan, you're going to feel a lot better if from the gate you have chosen people and surrounded yourself with people and places that support your goals Thank you for listening to this episode of Calm, Collected, and Consented Childbirth If you would like to learn more about Mindful Midwifery, please follow us on Facebook, Instagram, or check out our website at www.mindfulmidwifery.net I look forward to our next episode