3. Consider a midwife
If your pregnancy is low-risk, consider using a certified midwife, a health professional who can provide a range of women’s health care during pregnancy, childbirth, and the postpartum period. Certified nurse midwives (CNMs) and certfied midwives (CMs) have graduate degrees, have completed an accredited education program, and must pass a national certification exam. CNMs also have a nursing degree. Certified professional midwives (CPMs) have special training in delivering babies outside of hospitals.
Midwives practice in diverse settings—including homes, hospitals, and birthing clinics—and provide many of the same services as physicians, including prescribing medication and ordering tests. The care that midwives provide is based on the philosophy of not intervening unless there is a current or potential health problem. That approach has several benefits, according to a 2009 review of 11 studies involving more than 12,000 women. Women who used midwives were more likely to be cared for in delivery by their primary provider (rather than whoever was on call) and were more likely to have a spontaneous vaginal birth without the need for an epidural, forceps, or vacuum extraction. They are also more likely to report feeling in control during their birth experience and to initiate breast-feeding.
Most health insurance plans cover midwife care and include some in their list of covered providers. The American College of Nurse-Midwives maintains a list of CNMs and CMs. Make sure the midwife you’re considering is licensed to practice in your state. CNMs are licensed in every state, but CPMs and CMs are not.
4. Reduce the risks of an early delivery
Women who have a history of spontaneous premature delivery can reduce the risk of another preterm birth by about one-third by taking a special form of progesterone weekly starting at 16 to 20 weeks. In addition, women with a significant risk of delivering their baby early—due to their water breaking, for example—and who are between 23 and 34 weeks pregnant can reduce risks to the baby by taking corticosteroids such as betamethasone and dexamethasone. If your doctor doesn’t prescribe those medications ask why not, and get a second opinion if necessary.
5. Ask if a breech baby can be turned
Because a baby delivered buttocks- or feet-first can be in danger, many practitioners recommend a C-section when the baby is not coming out head first. But by using a technique called external version, a skilled practitioner can often turn a breech baby in the last weeks of pregnancy. Because it carries some risk—membranes might rupture, for example, or in rare cases the baby can become tangled in the umbilical cord—it should be done in a hospital, where both mother and baby can be monitored closely. With the increasing use of C-sections, some practitioners have little training or experience with the external version procedure. If yours is not, consider asking for a referral to someone who is.
6. Stay at home during early labor
Discuss with your provider at what point in labor you should go to the hospital or maternity center. Don’t be disappointed, though, if the staff checks you and sends you home. “Until a woman’s cervix is dilated to 3 or 4 centimeters, she usually doesn’t need to be in the hospital setting,” Main says. “She’ll usually be more comfortable and labor will even progress more smoothly at home.”
7. Be patient
Mothers are likely to be in labor longer than their grandmothers were, recent research suggests. That may be because they tend to be heavier or older when they give birth, or it may be a side effect of epidural anesthesia. In any case, most doctors learned about the course of labor from timetables set in the 1950s. “Obstetricians may be too quick to intervene because they think labor is not progressing as quickly as it should,” Main says. Talk with your practitioner as well as anyone who will be supporting you in advance about your desire to allow your labor to progress on its own.
8. Get labor support
Women who receive continuous support are in labor for shorter periods and are less likely to need intervention. The most effective support comes from someone who is not a member of the hospital staff and is not in your social network—a doula, or trained birth assistant, for example—according to a systematic review of 21 studies involving more than 15,000 women in a range of circumstances and settings. Ask your provider for a referral, and see if your insurance company will cover doula care.