Decisions, Decisions, Decisions

 
After struggling with all of the considerations mentioned above and decided to conceive, there are a barrage of other decisions that the mother will need to face and debate. Some will be easier than others to make, and again the mother will likely face great doubt as they are very crucial to the eventual outcome of her pregnancy. These decisions include whether to continue working during pregnancy, finding a doctor and hospital suitable to the mother's liking and demands, selecting between home and hospital birth, and selecting the support and educational groups that are right. This section is designed to aid the mother in making these difficult decisions by better informing the mother of each choice.

Work and Pregnancy

Pregnancy raises many questions regarding the mother's work and career. While most women chose to continue working right up until their due date, this is not necessarily what is best for the mother. In deciding whether to take maternity leave, reduce hours, or continue to work as long as possible, there are a number of factors to consider. Firstly, the mother must ensure that her working environment does not put the mother at risk of being exposed to harmful substances such as chemicals, inhalants, solvents, and radiation. If the mother's job requires that she be around such substances, it is best that she take maternity leave, because this type of environment is detrimental to her health and the baby's. The U. S. Pregnancy Discrimination Act prohibits job discrimination of the basis of pregnancy or childbirth. If unable to continue work because the conditions are dangerous to the health of the mother and the baby, the mother should to be treated as any other employer who becomes disabled or has an illness whether it be physical or mental. The mother should be able to retain her job after a necessary leave of absence. Secondly, the mother must consider the types of benefits and/or insurance coverage her employer has for maternity leave. Thirdly, if the mother's job is strenuous or requires great amounts of heavy lifting, walking or standing, her doctor will tend to recommend that she reduce her hours, take time off, or stop working all together. Lastly, it is important to consider the mother's partners work and career status. It is possible that once she has given birth, he could take time off to take care of the new born.

Selecting a Physician and a Hospital

Selecting an Obstetrical Caregiver:

Ideally the mother will have chosen her doctor before pregnancy, and he/she may have been the mother's doctor for many years, making this decision much easier. Other women will have to find a doctor either because they do not have a regular caregiver, or their regular caregiver is not qualified in this area. This decision should be very important to the mother. The selected physician will become very familiar with the mother over the next nine months and thus she too should have a great level of comfort and ease around them.

In searching for a provider many women tend to interview numerous physicians so they can find the one they are most comfortable with and whom meets their needs. The mother's options maybe limited by the type of insurance coverage that she has but essentially she will have a choice of three different obstetrical caregivers: a family physician who delivers babies, an obstetrician, and a midwife. Each has their advantages and disadvantages, but all are essentially the same when it comes to delivery. A family physician and obstetrician give the mother more detailed care during pregnancy, whereas midwives are more focused on the labor aspect. Midwives are registered nurses who are specially trained to provide care to women during labor, birth, and postnatal periods.

Some women first select the hospital in which they would like to give birth and then chose a doctor that works at that hospital to provide care during pregnancy. For those who are actively seeking a healthcare provider there are a number of questions and concerns to raise when interviewing candidates. Some of the questions the mother may consider asking include:

- What is their bedside manner like?

- Is their office in a locale convenient to the mother's work and home?

- Does the doctor have hospital privileges at the hospital of the mother's choice?

- If not, is the hospital or birth center that they are affiliated with convenient to the mother and does it meet her standards?

- Will the doctor be made available for after hours care if necessary?

- What are his fees?

- How does the doctor respond to and deal with the mother's questions of concern?

Remember that this is a person that the mother will get to know intimately and will have to be with for at least 9 months so she must select carefully and ensure acceptable service. The mother should remember as well that when dealing with a doctor she is also dealing with their staff including nurses. The mother should be concerned with their presence as well. Making sure that she is comfortable with the staff as well as the doctor is essential. If the mother can, she should try to make sure that the physician and staff selected, have a philosophy regarding childcare and pregnancy related issues that is similar to her own. This will make the care process much easier.

Beyond the questions noted above, the mother may also find it important to question potential candidates for her care on how long they have been practicing and what their various pregnancy related statistics are. For instance, the mother may be interested in knowing how often the doctor opts for such labor procedures as episiotomies, cesarean sections, induction, and active labor management techniques. All of these could be very important in making her decision.

Selecting a Hospital:

Selecting a hospital to give birth at is just as important as selecting a physician to care for the mother during pregnancy. The mother may want to begin her search for a suitable hospital by speaking to friends and family and inquiring where they had their children and how they found the service and care at those facilities. The mother may then decide to contact the hospitals that she is interested in and ask for a tour of their prenatal and delivery unit facilities. This will give the mother a chance to see the maternity wards and care facilities first hand, and will provide the opportunity to speak to and question some of the nurses and doctors in the unit.

In the mother's search, there are a number of important questions to ask. For instance, does the hospitals policy on intervention during labor match the mother's needs and wishes? Does the hospital provide Mother-Baby care and rooming in? Mother-baby care is when the hospital takes care of both mother and baby in the postpartum period. Rooming in is a policy that allows the baby to stay in the same room as the mother while in the hospital rather than in the hospitals nursery with other babies. In researching possible hospitals to give birth at, the mother may also want to inquire as to whether or not it is a teaching hospital, if there are private postpartum rooms available, how many nurses there are per patient, how many people can be in the delivery room, what is the postpartum visitation policy, and what other services does the hospital provide which make it attractive to expectant mothers.

Home versus Hospital Births

Over the past two decades there has been a trend among pregnant women and women in general, towards taking greater control of their own health and well-being. This independence is greatly expressed and reflected in the many choices women now have during the labor and postpartum processes. Women now have the choice of a natural birth or a managed birth and can typically have either one in their home or at a hospital. They also have greater control over who is present and participating in the birth, and what procedures and birthing techniques will be used. Women also have the choice of using a birthing pool, which is supposed to be a more natural and welcoming way to bring a baby into the world.

With the increasing independence and greater choices available, it can be difficult to decide what is best. One of the hardest choices is whether to give birth in the comforts of home or with the increased safety of a hospital.

Hospital Birth:

The vast majority of babies are born in hospitals. Most physicians recommend and encourage women to give birth in a hospital to ensure that they are in an environment capable of handling rare and unforeseen complications. Hospital births can be more stressful to some women because of the unfamiliarity of the surroundings and the strict rules and procedures that some hospitals ask their pregnant patients to follow in labor. Remember, the labor procedure and accompanying rules typically differ between hospitals so ensure that the mother selected one that meets her needs and does not require anything of the mother that she is uncomfortable with.

There are many advantages to hospital births. Perhaps the greatest advantage is that it offers the strongest chance of a healthy and successful birth. Hospitals are prepared to deal with unforeseen emergencies and mothers with chronic conditions that may play a role in labor. Hospital care after birth also offers the advantage of allowing the mother to rest more fully as opposed to being at home where she may feel obligated to help with the newborn or house work when she should rightfully be resting.

Hospital births do have their disadvantages. The atmosphere can sometimes be less inviting and more stressful to a laboring woman. Also, hospitals typically have set rules and routines that must be followed during labor. Thus, the mother's freedom is limited. She may not be allowed to eat or walk around and this may make labor a more uncomfortable process. As well, the mother's birthing partner may feel more detached from the labor process in a hospital.

For a more detailed account of labor and hospital births refer to the LABOR AND BIRTH section.

Home Birth:

The most significant difference between a hospital birth and a home birth is that at home the control of the birth is with the mother and she can and can control what happens. This is the reason that more and more women are choosing to have home births. There are numerous advantages to a home birth. Women tend to feel more emotionally secure and comfortable at home making labor much more enjoyable. Also, at home the mother's partner it able to play a more hands on role in the birth and the mother can decide how many people and who will be present for the birth. Home births also allow the mother to avoid procedures that she may feel forced into and uncomfortable with in hospitals. Many hospital procedures during labor are questioned for their value and purpose, including: enemas, shaving pubic hair, limiting the number of support people and family present during birth, the encouragement of the use of pain drugs, refusing food, and having numerous and often many medical staff examine the labor process. As well, home births prevent cross-infection between patients from medical staff, which is a common occurrence in hospitals.

There are also some disadvantages to home births. The greatest disadvantage is that if something unforeseen and potentially dangerous does occur during labor, help may be too far away. Problems are however rare and most can be handled by midwives who typically attend home births. Most women chose to have a midwife attend and deliver the child. Some women do however decide to have no doctor or professional in attendance, and they manage their own labor.

Birth Center Alternative:

In an effort to bring the best of home and hospital births together, birth centers have proven to be a popular alternative. They are non-hospital facilities structured to provide a family oriented birth and care for women with a low risk of obstetric complications. They have become quite popular because of their more support-based, less technologically inclined maternity care and births. The woman is able to design and control her birth as if at home and emergency care is available in case of complications during birth. Birth centers stress a one-on-one relationship between the healthcare provider and mother, and encourage family participation in birth. Most major health care providers cover births at birth centers and their rates are typically lower.

Education and Support Groups

Childbirth classes can be very beneficial to both the mother and her partner. This is not to say that they are essential when pregnant; they merely offer information and support that aids in coping with and managing pregnancy and labor. The people that attend the class with the mother are experiencing the same things that she is and can be of great support and relief. There are a number of different classes that the mother may be interested in attending to help deal with pregnancy, prepare for labor, learn to exercise while pregnant, and educate herself on parenting. The mother will need to decide which, if any, of these classes are right and suit her needs. The mother may also want to take advice from her doctor regarding which classes may be of some importance.

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