Small Blessings Blog

The Process of Choosing a Health Care Provider

Jai Ram Kaur Hergo - Friday, July 11, 2014


Very likely you are reading this because you are pregnant. And perhaps you are thinking of joining pregnancy yoga classes with me. Have you already thought about who will be your care providers for your pregnancy and birth? Or are they already chosen?


In this post I would like to share some things with you that may help you a.) in choosing where and with whom you would like to give birth or b.) in building a relationship of trust with the care providers you have already chosen.


But first, why is this important? If this is your first pregnancy, where everything is new and you have no measure from past experience, even the context that gives rise to this question might not be clear. So here I will try to help you into a place from where you are more aware of what is informing your choices and how you may be able to influence outer circumstances to make them most conducive to what you want, which is a healthy, happy baby and a healthy, happy you.


Many of you reading this will I suppose also be intending to have a birth with minimum to no medical intervention, so I would like to support you in this. There is much that can be done from WITHIN yourself, to help create the context where this becomes more possible, and this is what we practice in my pregnancy yoga classes. Ultimately, so much is OUT of our control, so the best thing you can do is to prepare for the unexpected and develop attitudes and skills that will help you, NO MATTER WHAT. AND there is also a lot that can be done on an external level to help create an environment where a birth in which you are aware and present and peaceful becomes simply more likely.


By the time women come to my classes they have most often already chosen a health care provider and where they will birth (waiting lists are often long and you have to move fast!). So hopefully here I will catch some women who have not yet chosen.. as well as, as I said before, giving some tips as to how to maximise the good in the relationships if there are no other alternatives.


For many women, birth will happen in a hospital. It's a good idea to visit the hospital and take the tour. Get a feeling for the place and the staff. You can then ask your questions. In general, hospitals are systems which operate according to procedures and schedules. This by nature puts the hospital as institution at cross purposes with the process of birth. In her great book, Mindful Birthing – Training the Mind, Body and Heart for Childbirth and Beyond, Nancy Bardacke highlights the difference between Institutional Time, which hospitals follow, and Horticultural Time, the time inhabited by a pregnant woman and her baby. Horticultural Time has its own inner logic. It is nature-driven. A seed is planted and if the ground is fertile and the conditions are right it will grow. 9 months that seed is nourished into a plant in your womb. Nature ripens in its own time and eventually when the fruit is ready it will drop from the tree. This is not a process that can be manipulated or pushed, any more than nature can be pushed. We are learning on a global level what happens when nature is pushed.


In the process of pregnancy and birth we are asked to approach the experience in a certain way – to be patient, humble and allowing. Each fruit (baby) has its own time, a result of a multitude of visible and invisible factors. (In this analogy the sunshine comes from the love from your heart and the other hearts that shine on this baby.. a topic for another day!).


The hospital system will try to influence nature with various interventions. This is not to say that medically trained people do not have the well being of you and your baby at heart. They do. But just as we are likely to go into auto pilot mode and do things just because we haven't considered alternatives or whether that thing is really the right thing at the time, so do they tend to go on auto pilot. An intervention applied just because it is procedure can have negative effects on the process. Just as an intervention applied as a result of a mindful and considered choice, that is applied with wisdom, has the potential to very positively influence the process. It is never the case of one thing is good and another bad. There is no substitute for mindfulness in each moment, as each moment has never happened before. This is what systems and institutions by their nature do not have programmed into them.


So when you go on your hospital tour, you will want to find out how much you can influence the process.


  • For example, asking what the caesarian rate is in the hospital is important. The World Health Organisation says 15% of births as caesarian is reasonable. In many hospitals in Australia, one third and sometimes higher is more likely.


  • Ask about induction and when the policy is to induce. These days women are increasingly being induced before term. Studies clearly show that babies born when they are ready to do so suffer from many less problems, particularly respiratory, during and after birth. Also, induced labours are twice as likely to end in caesarian.

  • Also ask about the use of sintocinon, the synthetic oxytocin used to “speed up” labour.
  • I have written another post on the relationship between sintocinon and epidural and the natural hormone cocktail in birth. Some hospitals use sintocinon as a procedure. Used wisely, it can help speed up a stuck or slow labour. It can also cause stress for mother and baby, bringing sharper contractions and therefore increasing the likelihood of the need for epidural. So it is good to ask how the hospital views the use of it.

  • Also ask about foetal monitoring. If you are permanently hooked up to a machine this will limit your mobility, and in labour being upright and able to move is working with gravity and ensures a rich blood and oxytocin supply to your baby and womb. It can also be distressing to feel stuck. Can you be monitored intermittently, using a Doppler? This is a hand held device for hearing a baby's heartbeat as it responds to contractions or rushes or surges.

  • How about vaginal examinations? Having someone roughly investigate how dilated you are can actually cause your cervix to contract as a reaction, so enquire how often they are deemed necessary. Experienced midwives can tell how dilated a woman is by other signs. If the hospital will not err from policy on this, you (your partner or assistant) can ask the examiner during the birth to be very gentle and breathe expanding breaths during the exam, visualising an opening and softening happening at the same time.

  • What is the policy on eating and drinking in labour? Sometimes a hospital will forbid it, so that you will have an empty stomach in case you need to have a caesarian. However, being able to eat if you're hungry – something light and easy to digest like fruit or light soup – will keep your strength up. And drinking liquids is also very important. Having fluids through a drip will also limit your mobility.

  • How about after the birth? These days it is more widely understood, as it was in the further back past, that waiting for the cord to stop pulsating before cutting it delivers precious blood, nutrients and antibodies to the baby. What is the policy on this and if it differs to your own view, is there flexibility? How about skin to skin contact? The sense of touch being the first language of a baby, how precious it is for your baby to feel on its skin your skin, feel your warmth, hear your familiar heartbeat. Putting your baby to the breast for the first time within the hour after birth significantly increases the chances of you having no problems with breastfeeding and is a strong factor in that first bonding between you. Is the hospital prepared to wait before doing tests, giving injections etc. Also, find out what exactly the procedure is here, so you can research what these things are, in order to ask yourself if they are really necessary or if there are alternatives.

It must seem like a lot! And a lot of work. It is certainly possible to have a wonderful birth with minimum to no intervention in a hospital, with good relationships with staff, but to look at it very honestly: this is work you will need to do, energy you will need to expend, to make it possible. There are many factors and evidence to strongly suggest that it will not happen by default. That's just the reality. This is nobody's fault, and no need to get angry or upset about it. We are all humans in this together, each on our own particular journey. AND there is also no need to give over the power of choice. There are other possibilities.


You may as a result of a visit to the hospital (or conversation with your obstetrician) find that there is too much of a mismatch for your satisfaction. Pay attention to your feelings during these conversations. If you feel comfortable in asking the questions, if you feel heard and welcome, this is a good sign for you. If you feel concerned or anxious that your views will not have a place in this setting, or that there may be no room for negotiation, go home and take time to consider whether there are alternatives. There is no right or wrong. Only by listening to yourself will you find the right way FOR YOU.


If you do feel that there is too much of a mismatch between you and the hospital, there are alternatives. There is in Perth the Family Birthing Centre, which provides midwife led care. If you are not in Perth find out if there are birthing centres in your area. In general the midwifery model of care is more Horticultural. It sees the woman in the centre of the process and is THERE for her, in her process. It emphasises the BEING over DOING way. BEING there for the process and giving it the TIME it needs, rather than thinking what needs to be DONE to move it along to fit into the procedural framework.

Here in Perth there is also Community Midwifery Centre, which provides midwife support for home birth and also a Domino programme, where your midwife accompanies you to the hospital.


Or there is the option of having a Doula – a trained birth assistant (not medically trained as a midwife, but aux fait with hospital procedures). She will be with you all through the birth and serve as an advocate for you in interface with medical staff, so you don't have to worry about this. She can also keep a close eye on you so that if an intervention might be wisely applied at any given time, she is in a position to recognise this and pose it to you so that you can decide together. In a hospital you will likely not have this kind of continuous care, as shift midwives will come and go. Evidence shows that women who have one person continuously there to support them (aside from the partner, who is mostly not trained) are much more likely to come through the birth without intervention.


A Doula can also be there for you after the birth, visiting you in hospital and at home and supporting you with breastfeeding. Simply knowing someone is at your side can be immensely helpful. She is definitely someone who follows the Horticultural Time way of thinking and is probably a strong advocate for this, since she has chosen this path for herself.


On a last note, my wish is that all this empowers you. I have come to see the whole process of preparing for birth as a kind of a modern rite of passage. Collectively, historically, we humans have come away from the view and experience of womanhood and motherhood as something natural, wholesome, divine and powerful. We women have contributed to this too. So going through this process CONSCIOUSLY and choosing consciously can for some women be a kind of reawakening to their own sensitivity, intuition, inner strength and capability to influence events. Not control events, but influence them. In fact, a huge lesson seems to be to learn that we are not in control. So much can happen in birth that is out of our control. So it is about creating as much of a conducive environment as possible, without it needing to be perfect.. and then letting go.


And this is where your own inner experience comes in. This is perhaps THE most valuable lesson of all: when you learn that no matter what, you can choose where and how to focus, when you learn that through your breath you influence your body and your mind, that you can find peace and calm in the midst of a storm, that happiness is your natural condition, no matter what... you have conquered your mind. And when you conquer your mind, you conquer the world. Not in a dominating way, but in the way of mastery. And this, dear women, is the highest skill you can take into life in general, and into parenting in particular, where emotions will run high, things WILL get irrational, and you will be challenged. To be able to breathe, find your centre, be strong and at the same time let go. In this way, birth is a training for life.

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