How to Choose a Pregnancy Provider
Whether this is your first pregnancy or you’ve been through this before, the first trimester of pregnancy is a special time that lays the foundation for a healthy maternal journey and good prenatal development. Our goal at Spora Mommas is to ensure that every birthing person is empowered to safely navigate their maternal journey, deliver with confidence, and make space to center their joy and appreciate the beauty of this stage of life.
Unfortunately, the facts are that if you are a woman of color, you are at higher risk for pregnancy complications due to implicit bias and shortcomings in our medical system, regardless of your education level, income, or location. That’s why it’s so important to have the right team supporting you throughout your pregnancy, delivery, and postpartum. Every birthing person should have a positive birthing experience and feel comfortable with and supported by your pregnancy providers. We’ll give you the information you need to choose the right people for you and work to build rapport and trust with them.
The Medicalization of Birth
Giving birth has changed a lot in the last 100 years. Starting in the early 1900’s, state governments began passing regulations to direct birthing mothers to physicians’ practices and hospitals instead of the more traditional use of home births and midwives. This has saved many lives, but the increase in the standardization of medical care has exposed women to unnecessary medical procedures and taken away their bodily autonomy.
According to the organization Listening to Mothers in California, 74% of California mothers agreed that childbirth should not be interfered with unless medically necessary, but only 5% gave birth with no major medical intervention. That means we aren’t listening to what women want. Even more 61% of people in labor were immobilized which can make labor longer, decrease the person’s comfort, and increase the likelihood of a cesarean birth which can increase risk for serious short and long term complications. Maternity care experts agree that many medical interventions are not necessary for a safe childbirth, and could increase risks for both mother and baby.
This medicalization of birth affects all birthing people, but it’s even more dangerous for people of color who die at a rate of 2.4 to 3.3 times that of white mothers. Black birthing women have always had a tumultuous relationship with the healthcare community, their bodies having served the medical community without consent or credit. We can look to Henrietta Lacks to the many enslaved women that Dr. Sims (the so-called father of obstetrics and gynecology) surgically experimented on without anesthesia. Additionally, slavery itself created structural racism that still exists today and perpetuates these disparities in Black maternal and infant health outcomes. The birthing experience of women of color within the medical system can be dangerous and fraught with implicit bias and racism. That’s why it’s important that you are able to feel confident in choosing your pregnancy support team.
Types of Medical Providers During Your Pregnancy
It’s important to be aware of the types of providers that are available during your pregnancy so that you are familiar with the choices that you have. Even better if you can find providers that are culturally aligned with your birth needs.
Obstetricians are medically trained, licensed doctors. Frequently referred to as an ‘OBGYNs’, they have completed another 4 years of medical school followed by 4 years of residency training in Obstetrics and Gynecology (hence OBGYN). OBs provide prenatal, labor and birth care. They can also manage high-risk pregnancies if a perinatologist (see below) is not part of your pregnancy team. They can also perform obstetric & gynecological surgeries.
Perinatologists or Maternal-Fetal Medicine Doctors (MFMs) complete 4 years of medical school, then 4 years of residency training in obstetrics and gynecology education like OBGYNs, plus they attend a fellowship of 3 additional years. Perinatologists provide prenatal, labor and birth care for high-risk mother and baby care to women that are 35 years+ and/or have underlying health issues. They can also diagnose and manage birth defects, heart problems, and blood disorders in a developing baby.
Perinatologists generally partner with multiple healthcare providers to consult, co-manage, or directly care for you and your baby before, during, and after pregnancy, though they are not typically associated with delivering your baby outside of high risk scenarios.
Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) are educated in graduate-level midwifery programs accredited by the Accreditation Commission for Midwifery Education (ACME). CNMs and CMs pass a national certification examination administered by the American Midwifery Certification Board (AMCB) to receive the professional designation of CNM (if they have an active RN at the time of the certification exam) or CM. There are other designations for midwives, which include the credential of Certified Professional Midwife at the national level, Licensed Midwife (LM), Direct-Entry Midwife and Lay Midwife.
Midwives have been found to be comparable and in some cases preferable to physician-led (MD) care in terms of mother and baby outcomes, efficiency in the use of healthcare resources, and in patient satisfaction. The World Health Organization recommends midwives as an evidence-based approach to reducing maternal mortality. Midwives do not deliver your baby and do not manage high risk pregnancies.
Support Team Members
In addition to your medical team members, you should consider having continuous support throughout your maternal journey.Throughout history, women have been cared for and supported by other women during labour, birth, and postpartum. The role of support team members is to care for you emotionally and in many ways physically as well, providing distractions when you are experiencing discomfort and/or helping to physically support you during the movements of labor. Additionally, support team members can help you make difficult decisions that occasionally arise. It’s always helpful to have supportive people in your corner who are familiar with you, your wishes and your birth plan. Evidence shows that continuous support can:
Lowers the risk of c-sections
Result in positive birth experiences
Reduce use of pain medication during labor
Doulas
The role of a doula is to provide continuous physical, emotional and informational support to you before, during and shortly after childbirth to help you achieve the healthiest, most satisfying experience possible. There are many benefits to receiving continuous support from a person who is not a member of your social network and is experienced in providing labor support. A doula is not a midwife and does not provide medical care, but experienced doulas can answer questions, help you create and advocate for your birth plans, and guide you through relaxation and breathing techniques..
While there aren’t any educational requirements to be a doula, some doulas take labor support training courses. Certification is not required, however there are many benefits to obtaining a doula certification.
A Support Person
Support can also come from a family member, partner, friend, or anyone that you have agreed to trust with supporting your birth plans and wishes. Your support person, selected by you, should be flexible, asserting, trustworthy and committed to being helpful to you. When selecting a support person make sure to consider:
If that person will be available around the time of your due date to help you ( +/- 1 week before and after your due date).
If they are aligned with honoring your birth beliefs, plans and expectations, despite their own beliefs.
that they are not expected to make any decisions for, unless you have directed them to.
Nurses
Nurses can also be valuable parts of your pregnancy and birth support team. A licensed professional nurse has a 2-4 year degree in nursing. They operate under medical provider orders, initiate the administering of medications and some labor and delivery procedures. Nurses provide some supportive care during delivery, but they simply CANNOT provide adequate continuous support throughout the delivery phase. Nurses have many responsibilities to tend to while you are in labor and during your delivery. Also, while the nurse may be nice and willing to help, you cannot guarantee their thoughts and beliefs will be aligned with your birth plans. You do not want to rely on the nurse to remind you of the things that you said were important to you for your birth experience.
Choosing the Right Maternal Team
Now that you are familiar with your options it’s time to choose the right people for your team. This process will be highly personalized to what is important to you, your birth plan, and circumstances, but we recommend you consider the following:
Insurance coverage: If you are insured, start with finding providers that are covered by your insurance.
Location: Determine if the location of their office and where they deliver is close enough to you to be convenient. Providers and delivery facilities that are too far away or difficult for you to get to could impact your ability to get care.
Your health history: Do you have any chronic illnesses (such as high blood pressure or diabetes) or previous complications (such as preterm labor or preeclampsia) that may require special care? If so, ask the provider you're considering what experience they have in caring for patients like you.
What matters to you?: This may take a little reflection, but ask yourself what is important to you in a provider, prenatal care, and in your labor and delivery? Are you more comfortable with a female or male doctor, or does gender not matter? Assess what’s important to you.
The provider’s reaction and attitude: Once you decide what’s important to you in your maternal journey it should be discussed with your provider. How do they react? Are they building trust with you? Yes, they are the medical professionals, but it’s your body and child, so what you want should be respected and valued. How supportive are they if you want to prioritize having an unmedicated vaginal delivery? They will be a vital part of your team and it’s important you feel comfortable communicating with them about your needs and boundaries.
Finding Compatibility with Your Provider
Once you’ve chosen the right providers and support team for your pregnancy journey, you’ll want to begin the process of building trust and comfort with them. Like most relationships, compatibility and comfort can build over time. Do your best to intentionally communicate with your provider and evaluate things like:
How comfortable do you feel with them? This isn’t always immediate, but you shouldn’t have to feel uncomfortable, disrespected, or unsafe. Ever. Period.
Do you find it easy to ask them questions? Many patients aren't comfortable asking questions, and if that’s you, it can be helpful to let your provider know in advance. They may be able to check in with you more regularly or pause before moving on.
Do they explain things clearly and completely? The job of your provider is to make sure that you understand what’s going on with your body and baby. If anything is unclear or confusing, let them know.
Do they seem interested in you personally? Your maternal journey is really personal and your provider will play an important role in your experience. They are part of it and it shouldn’t feel like you are a number or being rushed through a visit. Getting to know you better will help them better understand your needs.
Additionally, because the risk of pregnancy complications and maternal and infant mortality are higher for women of color, it’s ok to ask your provider how familiar they are with that problem and how you can work together to combat that risk. Hopefully, you’ve found a provider that is sensitive and responsive to your concerns, but there may still be issues that arise. If you feel you can, try to talk to the provider about your concerns. If your concerns aren't addressed, don't hesitate to change doctors to someone who is a better fit for you.
Resources to find culturally competent OBGYNs:
Don’t stress about trying to predict every specific need you will have during your pregnancy, but you should be able to leave your first set of appointments with a provider and have an idea of their general approach to care and how it will feel to be supported by them.
Getting Support from Spora Mommas
We are Spora Mommas, an arm of Spora Health, a primary care system built for people of color. Mommas is a digital experience that was designed to make the maternal journey better for Black people and to center their joy. We understand that there is a lot to think about as you set out on your maternity journey, especially as people of color, and our goal is to empower you to more confidently navigate everything from pregnancy through early parenthood. Spora Mommas will ensure that you are prepared for everything from pregnancy to earlier parenthood with the support of a virtual childbirth education course led by a doula, a community of other Mommas for support, connection, and fellowship, and a registered nurse and doula available one-on-one.
We are currently looking for people in their first trimester of pregnancy to join Spora Mommas. Interested in having us support your maternal journey?
