Choosing a Caregiver

More information Professional caregivers Choosing a caregiver is the most important decision that you will make. Questions to ask It is quite acceptable to "shop around" for appropriate health care, and interviewing potential caregivers can be rewarding. Choosing a birth place The environment in which a woman labours and gives birth has a major effect on the birth.

There are usually a variety of health care options to consider for pregnancy care although not all of these services may be available in all communities. Your first step might be to take some time to investigate what is on offer locally and further afield. The earlier you start in the pregnancy the more time you will have time to evaluate the services available. Don't hurry these decisions. Weighing up the options and speaking to the relevant people will ultimately help you feel more comfortable about the decisions you've made. You always have the right to a second opinion and to change caregivers at any time.

What the research says

Studies undertaken in many countries show that the it is the attitude, practices and philosophy of the professional caregiver in charge of the birth (midwife or doctor) that has the greatest influence over the type of birth a woman experiences. This is because training and experience shape the way a professional caregiver thinks and many of them practise "what they have been taught" rather than what the research evidence demonstrates is "best practice". Habit and routine dominate the way many caregivers work, and many feel uncomfortable if there are asked to try something different, especially when the request comes from a pregnant woman.

In countries where the primary caregiver for birth is traditionally a midwife(for example The Netherlands, Denmark, Sweden, Norway) women and babies have the best outcomes: the number of caesarean sections is lower, the number of forceps or vacuum extractions is lower, the number of tears or episiotomies is lower and the rates of normal and uncomplicated births are higher than other western countries where doctors are in charge of most births (see Marsden Wagner's article "The Active Management of Labour"). Countries that have switched to community based midwifery care, such as New Zealand, have shown a marked improvement in birth outcomes since changing from a hospital based system (see Karen Guilliland's paper "Managing Change In Midwifery Practice")

In many countries, statistics are available for birth outcomes, often listed hospital by hospital. This information can form the basis for further investigation. (See www.drfoster.co.uk).

Research has also clearly demonstrated that birth outcomes is directly linked to the broad type of care chosen by women: women who can pay for a private obstetrician and a private hospital will have a poorer outcomes for themselves and their baby than women who have chosen care in a standard publicly funded hospital where midwives provide the majority of care. These outcomes are independent of the health status of the woman - in other words, women in higher income brackets should have better health than poorer women, yet they often end up with worse birth outcomes, despite starting labour in better general health.

Unnecessary intervention in birth adds considerably to the costs of maternity services for the community as a whole and to individual parents in particular, and ultimately may not result in a better birth outcome.