Improving your epidural birth: Hire wisely

August 17, 2010 at 9:13 pm

A former college roommate and beloved friend came into town this past weekend and stayed with us Saturday night. As we chatted late into the night, she made a request. Could I created some more basic posts for women like her who don’t spend all their free time devouring birth-related media… women who aren’t sold on the “natural” bit (at least not yet)… women who plan to get epidurals but still want to improve their birth experiences? I thought that was a great idea. I think I’ll call this series: “Improving your epidural birth.” And here’s the first installment…

The first, and perhaps most important, tip I would offer to pregnant women (whether they want epidurals or not) is this:

Hire your care provider wisely.


Penny Simkin is a physical therapist, childbirth educator, and one of the trailblazers of the modern doula profession. Back in the early nineties, she published her findings from a study, Just another day in a woman’s life? Women’s long-term perceptions of their first birth experience. What she found was that positive birth memories had little to do with whether a woman’s birth was medicated or unmedicated, long or short, or even how many interventions she experienced. Instead:

The women with positive feelings today recall being well cared for and supported by the doctor and nurse, whereas those with negative feelings today tend to recall negative interactions with staff.

There are so many factors we cannot control as we give birth: the baby’s position, the rate of cervical dilation, unexpected complications, etc. But we can choose who will oversee our care. As I shared in blogpost on my old blog:

The people we invite or allow to be with us can make or break our birth experiences. I recently encountered a 2005 study indicating that there is a strong correlation between patient satisfaction with care provider and lower cesarean rates. . . . I can’t stress enough how important it is to choose the right provider—someone who will support and respect your birth preferences and shares your personal philosophy of birthing. You’ll know you’ve found the right provider when you know you don’t need to give them a copy of your birth plan when they arrive to catch your baby. Birth plans, at their best, aren’t for labor day, they’re for doctor/midwife interviews. Unfortunately, most women don’t approach the doctor/midwife selection process this way. Hence, there are far too many battles in the labor room where peace and joy should prevail and far too many cruel jokes among doctors and nurses about “those women” with birth plans.


There are many ways to approach the selection of our maternity care providers. One of the most common is to ask friends and family members whom they recommend. Others scan the list of providers who accept their insurance and choose the closest one. These methods can work well, but they are just as likely to result in frustrating incompatibilities. When we choose a doctor or midwife, we are entrusting our lives and our babies’ lives to their skills and expertise. But we are also choosing the person whose words and actions have the potential to impact us for the rest of our lives.

One of the sections I’m writing for the book project I’m collaborating on is called “Unity With Providers of Care.” In that section, I urge women to put even greater thought and research into choosing a maternity care provider than many of us put into purchasing a house or vehicle. In his book, Creating Your Birth Plan, Dr. Marsden Wagner urges:

Talk to the midwives and doctors available to you. Interview them at length, watching to see if they get restless or uncomfortable. . . . Are they condescending and do they seem to resent your questions? Or do they encourage you to take responsibility for your own pregnancy and birth? Don’t be afraid to change care providers if after a few visits you don’t like how one is caring (or not caring) for you. . . . If the doctor resists giving you the data or doesn’t know his or her intervention rates, watch out. Beware of any tendency to patronize you and suggest that you cannot possibly understand technical information about childbirth. . . . ‘Be a smart shopper.’ (p. 65-67)

To close, I will echo Marsden Wagner again: “A woman giving birth to a baby thrives when she’s at the center of a circle of love” (Creating Your Birth Plan, p. 176). Yes, we need to ensure that our maternity care providers are skilled, experienced, and competent, but we also deserve to be treated with respect and kindness and common decency. Unfortunately, respect, kindness, and common decency aren’t givens in the labor room. Don’t settle! Seek out and hire a doctor or midwife who gives you the best of both worlds: competency AND kindness. If the nurse assigned to you when you’re admitted to the hospital makes you feel uncomfortable or degraded, ask for another nurse. You deserve to be surrounded with true providers of care.

Stellar support team for my second birth

And, if you find yourself at the tail end of your pregnancy with a less-than-ideal midwife or doctor and you don’t feel comfortable changing care providers last-minute, I strongly suggest finding a doula to serve as the guardian and buffer in your birth space… but that’s a post for another day.

Hire wisely, my friends!