Full text of DOI:10.1046/j.1523-536x.2000.00141.x

BIRTH 27:2 June 2000
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A CONSUMER VIEWPOINT
Looking for an Obstetrical Caregiver in the United
States: One Woman’s Experience
Alison Barrows Ronn
When I first found I was pregnant, I asked a friend if
she could recommend a doctor and I made an appoint-
ment. I had not done much reading before my first
appointment, but I did have a general idea of what I
wanted—as intervention-free a birth as I could handle.
I wanted to be able to look back on the birth and say,
‘‘That was really hard, but I did it!’’
I had my first appointment when I was two months’
pregnant. My first contact at the obstetric practice was
a brusque woman whose title I never caught. She took
me through a bunch of material, for instance, asking
me if I was going to have the AFP (alpha-fetoprotein)
test and if I was going to breastfeed, but she did not
educate me about my choices. I was discouraged at
the lack of information and guidance.
On the same visit I found I liked the obstetrician
that my friend had recommended. We did not discuss
many issues, but I did have some questions. When I
asked her about positions for childbirth, she said I
could try other positions, but that most women gave
birth on their backs, and this was the easiest position
for the doctor to deliver the baby. From what I had
read, this is the worst position for most delivering
women. Obviously I was not going to be encouraged
to find an alternative position to give birth that worked
for me.
to have. Much of what I read, even in the up-to-date
pregnancy and nursing books, made me angry. It
seemed that many procedures which have been proved
ineffective in most cases are still used, and that many
which have been proved effective are not used. For
instance, routine episiotomies, augmenting labor with
Pitocin, constant electronic fetal monitoring, and feed-
ing on a schedule are all still common, whereas encour-
aging movement and changes of position (including
for delivery), providing support and comfort for the
laboring mother, and use of bathtubs or Jacuzzis and
other nonpharmacological methods of pain manage-
ment are not.
And I heard enough from friends who had recently
delivered to make me believe that these ineffective
practices occurred in our local hospitals. For instance,
although one friend had decided to breastfeed, her
baby was given a bottle in the nursery in the middle
of the night. Perhaps she would have had problems
anyway, but she ended up pumping and bottle-feeding
for about a week before the baby would successfully
nurse.
Another friend had arrived at the hospital 7 cm
dilated—she said she thought she was home free.
When she arrived, the labor and delivery nurses
strapped an electronic fetal monitor on her and never
took it off. Consequently, she was stuck in bed for the
duration of her labor and in retrospect wished she
and her husband had been better prepared to assert
themselves. All the reading I have done so far indicates
that continuous electronic fetal monitoring can be un-
comfortable for the laboring mother, and that in low-
risk births does not lead to better outcomes and may, in
fact, lead to unnecessary interventions. It also focuses
attention on the machine rather than on the laboring
mother.
During the next few months of my pregnancy I read
a lot and thought about the kind of care I would like
Alison Barrows Ronn is a freelance technical writer who lives in
Boylston, Massachusetts.
The first part of this paper is modified from an article in the
Massachusetts Friends of Midwives Report, Fall, 1999, and was
written when she and her husband were awaiting the birth of their
first baby. Their son, Parker, was born at the BirthPlace in Wellesley,
Massachusetts, on 9 November, 1999.
I began to worry about a ‘‘routine’’ delivery at our
local, highly recommended hospital. My reading had
made me believe that my best chance for a birth with
few or no interventions was to be well supported and
Address correspondence to Alison Barrows Ronn, 60 E. Temple
Street, Boylston, MA 01505.
᭧ 2000 Blackwell Science, Inc.

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BIRTH 27:2 June 2000
well coached. I wanted to have someone with me who
was working to make me comfortable and had a great
deal of experience to draw on. However, I was begin-
ning to be afraid that I would not find the support I
wanted at the hospital. In fact, I began to think I might
feel antagonistic toward policies I encountered there.
To have the best chance at a natural birth, I wanted
to feel relaxed and supported during my labor, and
not be fighting the hospital system or expecting my
husband to do so.
In my fourth month I began to look into birthing
with a midwife—someone who was trained to see
pregnancy and birth as a natural process rather than
as a problem to be treated. But I found that midwives no
longer attend births at our local hospital. I remembered
reading about these cutbacks—little did I know they
would affect me so soon!
I considered hiring an experienced doula who could
provide support and coaching. However, a doula would
have no authority in the hospital, so we still might end
up arguing with hospital policies, which would not
help my labor at all.
I continued looking into options and found a free-
standing birth center about 35 miles from our house,
where I could give birth in a homelike setting with a
midwife in attendance and lots of support for natural
pain management, including a Jacuzzi tub. I decided
to change caregivers with the goal of having my baby
at the birth center. If I have any risk factors, I will
have my baby at the hospital near the birth center with
a midwife in attendance.
If our local hospital had midwives, I think I would
have my baby there. I would want to be at this hospital
if anything went wrong with the delivery, or if the
baby had any problems. But I have to plan for a normal
birth—I am low risk, and most births do happen with-
out serious complications. Also, I feel far more confi-
dent that the midwives at the birth center will help me
and support me through a normal labor and birth and
that their support will minimize my chances of needing
medical intervention and the complications that can
occur with interventions. I regret having to give up
the convenience (our local hospital is 10 minutes
away—the birth center is 40) and the medical excel-
lence at our local hospital, but I strongly believe that
for a low-risk birth where the parents want minimal
medical intervention, midwife attendance is the right
choice.
through changes of position before giving birth in a
queen-sized bed. Parker never left the room I was in,
and nursed within an hour after birth.
The sources I have read say that women have better
births when they are confident and supported. My birth
environment provided that for me. I was confident that
my caregivers would not suggest unnecessary interven-
tions, yet I was also confident that they would take
the best care possible of my baby and me. And whether
because of that, or just because I was lucky, I had a
relatively quick and easy birth.
I would like to see more practitioners approach
prenatal care as a partnership. Usually, no one cares
more about the health of the baby than the pregnant
woman and her partner. A doctor or midwife can offer
expertise and even opinions on care and procedures
during pregnancy, labor, and delivery, while leaving
most decisions up to the expectant parents. In addition,
when the practitioner understands that there are differ-
ent approaches to prenatal care, it would allow the
practitioner to present his or her approach honestly,
and allow the pregnant women to choose the prac-
titioner and the approach that most closely matches
her own.
At the same time, it is important to offer real educa-
tion about tests and procedures that may be used during
pregnancy, labor, and delivery. This includes a clear
explanation of any negatives in addition to the posi-
tives. Including opinions can certainly be useful when
the woman is trying to make a decision. If she has
chosen a practitioner with an approach that she desires,
an opinion can be extra guidance—especially when it
is clear that it is an opinion. There seems to be an
assumption that women know about the pros and cons
of tests and procedures already, but I think that is the
exception rather than the rule.
I would like prenatal practitioners to offer informa-
tion on the benefits of a low-intervention birth, includ-
ing the physical benefits to the baby and the emotional
benefits to the mother. Parenting is a hard job. What
better way to start than knowing you did your best in
probably the hardest physical task of your life, and
that in that personal success you also did the best for
your baby?
I think it is important to offer education about the
benefits of breastfeeding to mother and baby. I think
many practitioners believe that women already know
about it, or they are eager to offer women the choice
between formula and breastfeeding. Facts can be pro-
vided about breastfeeding as they are about any medi-
cal procedure, without pushing a decision one way or
another.
Postscript
Parker was born on 9 November, 1999, at 5:12 AM.
He was 9 pounds 7 ounces. His birth was intervention
free. I arrived at the birth center about three hours
before he was born, used the Jacuzzi, and was coached
Although some interventions are clearly necessary
and can save lives, many practitioners seem to have
a mindset that interventions equal success because they

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143
allow you to care for the laboring woman. A laboring
woman can be cared for without medical interventions.
Instead, they should offer support and coaching based
on solid experience with labor and birth—experience
that most laboring women and their husbands or part-
ners lack.
I searched for the care that was right for me, and I
had a good birth. However, I did not find everything
I wanted in one place—I had to make compromises,
and I had to look hard to find what I wanted. Perhaps
by the time I am ready to have another baby, finding
the care I want will be a little easier.