Having an empowered birth depends on who you have in your corner. That’s why it’s so important to be really intentional about who will be a part of your birth team.
In “Overdue,” our maternal health series made in partnership with Un-ruly and Gerber, doula and registered nurse Ebony Harvey gives an overview of what goes into building your dream birth team.
To learn more about the types of people you’ll lean on during your birthing journey, and how to find them, keep reading. (You can also navigate to the section you want using the table of contents.)
Table of Contents
Who Will Be on My Birth Team?
Depending on your needs and preferences, your birth team can be as intimate as two people or as large as a whole village!
Size doesn’t matter: What’s most important is ensuring that the people on your team are going to give you the support that you need.
This support can be split across three categories: medical, emotional/physical, and postpartum.
Medical Support
When it comes to medical support, who you’ll have on your birth and labor support team will be based on where you give birth.
If you’re choosing to give birth at home or at a birthing center, you will most likely be under the care of a midwife. (Though there are some hospitals that offer midwifery care, too.) A midwife is a medical professional trained to provide contraceptive and reproductive help to birthing folks.
There are five types of midwives, according to the American Pregnancy Association:
- Certified Midwife (CM): A CM will have, at the minimum, a bachelor’s degree in midwifery from an accredited institution. They are all certified by the American College of Nurse-Midwives, and, according to Midwives Alliance North America, are only recognized in a few states: Delaware, Maine, Missouri, New Jersey, New York, and Rhode Island.
- Certified Nurse Midwife (CNM): These providers have a bachelors in nursing and a masters in midwifery. They also get their certification from the American College of Nurse-Midwives.
- Certified Professional Midwife (CPM): This type of midwife is someone who has trained in midwifery, but doesn’t necessarily have a bachelors or masters in the field. They must meet standards set by the North American Registry of Midwives.
- Direct-Entry Midwife (DEM): A DEM is someone who has received midwifery training, works independently, and is registered and/or licensed.
- Lay, Traditional or Community-Based Midwives: These providers are trained in midwifery, and have chosen to forgo certification or licensing.
Click here for more information on midwives and doulas.
Giving birth at a hospital? Your primary medical support will come from obstetricians (OBs) or obstetrician-gynecologists (OB-GYNS). Both are doctors focused on providing reproductive, pregnancy, and childbirth health care.
While the vast majority of OB-GYNs are generalists, there are a few specialists who may be a part of your birth team.
- Reproductive Endocrinologists: If you’ve been trying to conceive for six months (for those older than 35) to a year, you may find yourself working with a reproductive endocrinologist. They will conduct tests to determine a cause of infertility, and provide reproductive assistance through intrauterine insemination (IUI) and/or in-vitro fertilization (IVF). While they won’t deliver your baby, they’ll be critical in helping you get and stay pregnant.
- Maternal Fetal Medicine Specialists: These doctors work with folks experiencing high-risk pregnancies (and issues associated with them like preeclampsia or high blood pressure while pregnant) or are giving birth at an “advanced maternal age.” (We prefer AMA over another phrase you might hear: “geriatric pregnancy.”)
Rounding out the care you’ll get at a birthing center or hospital are labor and delivery nurses. They provide labor support and take care of you and your baby after you’ve given birth.
Emotional and Physical Support
Emotional and physical support can come from your partner, friends, and family.
But remember what we said about self-care during pregnancy. You need to surround yourself with as many low-stress people as possible. So make sure whoever you choose to provide that emotional support is someone you can trust and who isn’t judgmental. Depending on the role you’d like them to play, you’ll want someone who is aligned with your birth preferences.
Doulas are a great resource for this type of support. They are trained to provide continuous emotional and physical support and to answer any questions you have about the birth process. (They’ve also been found to improve birth outcomes!)
You can work with a birth doula, postpartum doula, a Trigger warning: Click to reveal text bereavement doula for infant loss, or a full-spectrum doula, who supports people from preconception to pregnancy to birth to postpartum!
Other folks who can offer emotional and/or physical support include:
- coworkers,
- therapists,
- acupuncturists,
- lactation consultants
- pelvic floor therapists,
- reiki healers, and
- physical therapists.
Postpartum Care
The support shouldn’t end once you give birth. You’ll need all the help you can get!
Your postpartum support team can include:
- family and friends
- postpartum doulas, who support your physical recovery and provide evidence-based insight on infant care;
- night nurses, who take care of baby at night so you can sleep;
- lactation educators and specialists if you’re breastfeeding or chestfeeding;
- pelvic floor coaches; and
- your baby’s pediatrician.
How Do I Find (and Pay for) My Birth Team?
Now that you know who can be on your birth team, it’s time to find them!
You can start by asking your community for recommendations. Who were their providers? What was their experience like? If you’re the first of your friend group to have a baby, don’t worry! You can join an online group for moms to ask this question.
There are also a number of ways to find Black and brown birth workers online. Here are a few:
- Health In Her Hue, an app and digital platform that “connects women of color to culturally competent and sensitive healthcare providers”;
- Hued, an online directory of providers who are devoted to providing inclusive and equitable healthcare to Black, Latinx, and Indigenous communities;
- Sista Midwife, an online directory of midwives and doulas around the country;
- Frontline Doulas, an organization with a doula hotline;
- Antonia & Grace, a maternal health concierge service providing education and support specifically for BIPOC people; and
- Robyn, a platform that has a directory of wellness specialists like nutritionists and massage therapists.
- ZocDoc, an online directory of healthcare providers
You can also use apps. Wolomi offers pregnancy group support, Poppy Seed Health is a 24/7 telehealth service, and Irth lets Black and brown birthing people share their experiences with healthcare providers and hospitals for others to read.
If you have insurance or Medicaid, make sure you’re checking to see that the doctors you find through recommendations or these aforementioned platforms take your plan.
What if they don’t take your insurance? You have a few options.
You can check what your out-of-network coverage is and talk to your insurance company about the policy if you have any questions. For example, what is your out-of-network deductible and your out-of-pocket maximum? (The latter is the amount, which, after you hit it, your insurance company may pay the cost of treatment)
If you move forward with working with the out-of-network provider, ask their billing department if they can provide you with billing statements featuring medical codes. This can make submitting claims to your insurance company for reimbursement easier.
Working with a midwife? Some may be open to bartering as a way to pay down the cost of care.
You can also ask the provider for their self-pay rates, or, as Quartz explains it, “the price a patient without insurance is asked to pay.” You may be surprised to find that self-pay rates can be lower than what you would pay with insurance.
And there’s always the option of asking your community for help. Consider crowdfunding as a way to raise the money needed to pay your provider, or creating a fund on your registry for family and friends to chip in toward your care.
What Questions Should I Ask Medical Providers?
Now that you know where to find providers, you have to figure out if they’re your people. Interviewing prospective care providers can give you a sense of whether or not this is someone you want on your team.
We think trust and an ability to communicate are among the top criteria to look for in a healthcare provider. Both are going to be core to your ability to make fully informed decisions on your care throughout your pregnancy. You want to be able to believe that what this person tells you is the whole truth. And you want someone who has a communication style that makes you feel respected.
Deciding if you trust a provider is a mix of intuition and insight that comes from asking some specific questions.
Patient-Centered Care Questions
There are two concepts that can lead to truly supportive birthing experiences: informed consent and patient-centered care. The definition of informed consent from the American College of Obstetricians and Gynecologists (ACOG) can be applied to other providers.
“Informed consent requires that an obstetrician-gynecologist gives the patient adequate, accurate, and understandable information,” ACOG states, “and requires that the patient has the ability to understand and reason through this information and is free to ask questions and to make an intentional and voluntary choice, which may include refusal of care or treatment.”
Patient-centered care has been defined as care that is “respectful of, and responsive to, women’s preferences, needs, and values.”
To put it simply, you want your birth team to know that they’re not the most important people on the team. Who is? You and your baby. Your providers are working for the both of you.
With your birth plan in hand, have a conversation with prospective providers.
As Ebony points out in the video, these conversations require boldness. You’re not asking for their permission to have the birth you want. You’re telling providers what you want, and asking questions to help you gauge their ability to partner with you.
In fact, the way a provider responds to you even having a birth plan is really telling. If they scoff or ignore it, they’re probably not going to be as attentive as you need. You’ve built a birth plan that is flexible to respond to how unpredictable birth can be. You want a provider who isn’t dismissive of your initial desires, and who doesn’t press for your worst-case scenario as the only option available.
But if they’re open, here are some examples of patient-centered care questions you can ask.
I’ll be working with a doula. What is your experience with collaborating with doulas in a patient’s care?
I want to have a vaginal delivery after cesarean. Do you have experience with those types of deliveries?
How many times will I get to see you postpartum, before the six-week mark? (You can read more about this in our article on postpartum recovery.)
These experience questions are valuable. Let’s say you’d like a gentle C-section, but the provider you’re speaking to has never heard of them. Then, once you explain it, you get the sense they think it’s silly or they flat out say they won’t do it. That’s your cue to go to the next person on your list.
Black Maternal Health Crisis Questions
You want to make sure that not only are the people you work with aware that there’s a Black maternal health crisis, but that they’re personally invested in addressing it.
What are they personally doing to ensure birth equity? Have they attended any seminars on the topic? Have they and other members of their practice who you may work with done any implicit bias training? Is there a maternal birth equity initiative at the hospital?
Working with someone who has awareness of the crisis, and what’s more, is taking concerted steps toward improving birth experiences for Black moms can build trust that you will be treated with care.
Asking this question from The New York Times’ guide on how Black mothers can protect their births gets to the heart of the matter:
“I recently read that Black women like me have a much higher chance of death related to pregnancy and childbirth than white women. That’s really scary. What do you think about these statistics, and how we can work together to prevent that from happening?”
“A provider who touches Black bodies should know about the Black maternal health crisis,” says Ebony, “and [they should] be able and willing to answer questions.”
Medical Bias Questions
Medical bias is just one of the many factors that have led to the Black maternal mortality crisis. Similar to what we talked about above, you’ll want to ask questions that address it head on. The provider’s answers should make you feel safe with them and/or their team.
For example, a number of studies have found that physicians believe Black patients feel less pain than white ones. And thanks to that biased belief, Black people routinely receive less pain treatment from doctors than their white counterparts who report the same level of pain.
So as a Black person about to give birth, it’s fair to ask your provider:
“How will you make sure my pain is appropriately addressed?”
Asking questions about other ways medical bias can affect your birth experience (e.g. being encouraged to have a C-section despite being a low-risk first-time mom) can give you insight into your care.
Also if your identity includes other marginalized communities (e.g. you’re queer, trans, deaf, blind, overweight, and/or have mental health issues), talk to your provider about the ways implicit bias have affected your healthcare in the past and your concerns about how it could affect your birth experience. Then gauge if the potential provider has enough experience or empathy to be able to take care of all of you.
If the provider gets defensive or is dismissive instead of answering your question with a plan, then they’re what? Not for you, boo.
Hospital Practice Questions
Where you’re giving birth has just as much of an impact on your birthing experience as who is taking care of you and your baby.
So you should be intentional about vetting the facility you’re giving birth in up front.
Are you planning a home birth or birthing at a birthing center? You’ll want to plan for the possibility for an emergency transfer to the nearest hospital should you need one. Ask them “How does the hospital handle complex medical emergencies?” advises Ebony.
What could that potentially look like for you? Ask follow-up questions so you have a clear sense of what will happen if the unthinkable occurs.
Let’s say your birth plan is to not have a C-section, but you know you should have a plan just in case you may need one.
Ask providers what happens in the lead up to them deciding to do a C-section. (Get a clear picture of what is going on: “Are moms having long, extended labors? Are they going over term or are they preterm?” Ebony adds.)
Ask for a tour of the facilities. Does the staff look diverse? Does the Labor and Delivery floor feel comforting, or does it look like a pit stop to the operating room? If it feels like you’re being prepared to go to surgery, it can affect your ability to labor without interventions, says Ebony. It may also hint at the hospital’s policies.
“They [may not be] open to allowing the development of a natural, physiologic birth,” she says.
Now that you have an understanding of who can be on your birth team, how to find them, and what questions to ask, you’re all set to get the labor support and postpartum care that you deserve!
While there is no way to guarantee a stress-free birth, having people you trust in your corner is essential to feeling empowered during your pregnancy and birth.
Jalan, a pediatrician and mom who opted to have a home birth for her last baby, told us that she held a conference call with her birth team. Her husband, postpartum therapist, obstetrician, midwife, and doula were all on the call.
Jalan’s therapist asked the birth team to tell Jalan what they were committing to do to support her and her birth plan. Come labor day, they all had her back exactly the way they said they would.
“This is my last baby,” Jalan said, “and damn it, it’s going to be what I want it to be!”
You deserve that same kind of energy and autonomy. Finding the right birth team will help you get there.
