Choices For A Prenatal Care Provider


When determining who will be your care provider throughout pregnancy and birth, there are many factors you should consider. You will want to consider any risk factors that you may have as well as the type of experience that you wish to glean from birth. There are two major models of care when it comes to childbirth: Midwifery and Medical.

The Midwifery Model of Care has a woman-centered focus. Birth is considered a natural and normal process where the woman should be supported. A midwife will support a woman and the natural rhythm of her birth physically, emotionally, and spiritually. She will seek additional medical expertise and intervention when it is truly necessary. She will also allow plenty of time during prenatal appointments for discussion and will endeavor to develop a trusting relationship between you.

The Medical Model of Care has a pathological focus. This means that the doctor’s focus will be on preventing, diagnosing, and treating complications. Medical training involves the use of tests, distributing medication, use of medical interventions, and surgery. This model of care is also known for it’s “drive-by” style prenatal appointments.

Types of Midwives

  • Certified Nurse-Midwife (CNM)
    • In the United States this is the only type of Midwife that can legally practice in all 50 states
    • CNM’s are trained in the Nursing and Midwifery and is certified by the American Midwifery Certification Board. A CNM may have a bachelor’s degree in Nursing and a master’s degree in Midwifery
  • Certified Professional Midwife (CPM)
    • In the United States national certification is available for CPMs but licensure is given on a state level. Currently CPMs are legally authorized to practice in 28 states.
  • Certified Midwife (CM)
    • CMs are currently legally recognized to practice in New York, New Jersey, Rhode Island, Delaware, Maine and Missouri
    • CMs have a bachelor’s degree in a non-nursing field and a master’s degree in Midwifery. CMs are certified by the American College of Nurse-Midwives
  • Traditional/Community Midwife
    • A traditional midwife has chosen to become certified or licensed. There could be many reasons for this, but one is that there are some women (midwives and expectant mothers) who are simply uncomfortable of the certain care practices that are required for the midwife to maintain their licensure.  

Medical Practitioners

  • Family Practice Doctor
    • Your normal family doctor can care for you before, during, and after pregnancy as well as during delivery
    • Family Practitioners have completed medical school and a 4 year residency program in family medicine
  • Obstetrician-Gynecologist
    • An OB/GYN is a doctor that specializes in pregnancy, childbirth, and a woman’s reproductive system
    • An OB/GYN has completed medical school and a 4 year residency program in obstetrics and gynecology
  • Perinatologist
    • A Perinatologist is maternal-fetal medicine specialist and works with high-risk pregnancies
    • A Perinatologist has completed the same education as an OB/GYN plus 2-3 years in a maternal-fetal medicine fellowship program.

When choosing your healthcare provider you should be aware that many may sway somewhere in the middle of the the models of care. A midwife may take a more medicalized approach and an obstetrician may take a more woman-centered approach. That is why it’s important to interview individual care providers to know if they are a good match for you.

Some questions you may want to ask:

  • What are your general views on birth?
  • What is your c-section rate?
  • What hospitals/birth centers do you have privileges? Do you do home births?
  • What are your routine care practices? Why do you think they are necessary? Can I forgo any of them? To you provide alternatives?
  • Do you clients that wish to have a med-free birth typically succeed?
  • What is your stance on ultrasounds?
  • What is your stance on cervical checks?
  • How do you handle pregnancies that have gone “past due”?
  • Will I be seeing you at all my prenatal appointments? Who would be attending the birth if you are not available? Will I be able to meet them beforehand?


These questions are just a starting point to get the conversation flowing. Ask questions about what matters most to you and your situation. Try to find someone with a similar philosophy of birth as you do and who respects your decision. Simultaneously you should be considering where you want to give birth. I will delve into what your options are for that next week. Until then,

Have a blessed week,

Jaime Mackey

News Flash: A Hospital is a Business


As a country we seem to have forgotten that doctors and hospitals are running businesses. We see the doctor, they give us a diagnosis, and they tell us how they’ll treat it. Maybe we ask questions, maybe we don’t, but normally we go along with the “doctor’s orders” without much consideration. In western society we have deemed doctors the be-all-end-all of our healthcare. We, as a society, have forgotten that doctors and hospitals are providing a service and we are the customers. Instead, we give them higher rights to our bodies and care than we give to ourselves. As a laboring woman you may be admitted to the hospital and get hooked up to a bunch of machines without being told much of anything about what they are for or how they are supposed to benefit your care.

We would like to think that these medical procedures are done in order to give us the best care possible, but evidence indicates that some of the procedures are done more for the sake of convenience. And, in the case of for-profit hospitals, to protect the bottom line.

In our microwave society we have a severe lack of patience and a desire for convenience. While non-induced vaginal deliveries occur at a pretty steady rate at all hours of day and night, c-sections and inductions have caused an increase of babies born during regular daytime hours. [1] Beyond the convenience for the doctors, when you are able to schedule and manipulate when the majority of the births will occur you can reduce the amount of staff you have on hand during the other hours. That’s a pretty good business plan, right?

Cesarean sections are also occurring at much higher rates than what should be necessary. The World Health Organization states that C-Section rates above 10%-15% do not improve fetal or maternal outcomes.[2] So why is it that the United States has an overall c-section rate of 32%?[3] There are some theories floating around out there that it’s because of women waiting until later in life to have children, obesity, and diabetes rates. These theories may be able to account for some of the increase, but not all. A California Watch analysis determined that women were 17% more likely to receive a c-section at a for-profit hospital than a non-profit. Any business person would say that it makes perfect sense when you consider that a c-section produces twice the revenue of a vaginal birth while taking 88% less time. [4]

So, the main question here is: As a birthing woman, how can I use this information to have a better birthing experience? My number one answer to that is to keep in mind that a doctor is there to give you advice and possibly perform a service. But you have the final say on your care. You can maintain control of that right by being careful in choosing a prenatal care provider and birthing location. Ask questions, find out their policies, and remain open to switching providers if you begin to think that they are not going to provide the kind of care that you want or need.

Second, be sure to have someone with you during labor that will be your advocate. It is unlikely that you will be able to think clearly or concentrate on decision making between the waves of contractions, have someone there that knows your desires for birth and will be able to ask all the questions that you can’t seem to remember to ask during your vacations into Labor Land. This advocate can be anyone from your spouse to a family member to a doula, just make sure it’s someone you trust to have your best interests at heart.

Lastly, stand your ground. You are paying them. They work for you. You have the final say in your care and what is done to your body. You are a strong, informed, and  empowered woman and nobody gets to bully you into having a medical procedure done that you do not want or need.

Look for tips on choosing a prenatal care provider and birthing location in the coming weeks.

Have a blessed week,
Jaime Mackey

All Women Have Childbearing Hips

There were many times before and during the early days of my pregnancy with Michael that people voiced their concerns of someone with my build being able to birth a baby without complications. Being tall and slim these people thought that my hips were just too narrow. Once, I was even told that I would possibly need my hips broken.

Though a lot of these comments stopped as I got further into pregnancy and my hips began to spread, the more I learned about birth, the more I realized these concerns were completely unfounded. staff. “Blausen gallery 2014“. Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762. – Own work, CC BY 3.0,

When many people think of the pelvis, they think of it as this solid immovable mass, but that is not the case. The pelvis is made up of four bones: the scrotum, the coccyx, and two hip bones; which are held together by several ligaments. During pregnancy the placenta releases a hormone called relaxin. This hormone is believed to cause the ligaments in the pelvis to relax and soften, allowing for more movement of the pelvic bones during childbirth.

This fear that a woman may not be able to birth a baby on her own, may be the result of the positioning of women during the labor process. In traditional hospital settings a woman would give birth lying down or in a semi-upright position. These positions are known to reduce the size of the pelvic opening . They are more beneficial to the doctor attending the birth, allowing for easier access to the birth canal, than they are to the birthing mother.

Research has shown that when women birth in upright positions such as squatting, hand and knees, kneeling, or sitting on a birth stool; they are 23% less likely to have a forceps or vacuum assisted delivery. Being able to work with gravity, may be part of what makes these positions more beneficial.

Baby’s Head

A newborn’s head is also not a fixed size and shape. The skull of a newborn is composed of soft plates of bone. When the babies head moves through the birth canal these plates can shift and even overlap each other. This is why newborns can have odd shaped heads for a while after birth.

Since both Mom’s pelvis and Baby’s head are flexible objects, fear of a interventions due to a woman’s body type is unnecessary. Whether petite or pear-shaped, all women have childbearing hips.

Have a blessed week,

Jaime Mackey

Michael’s Birth Story

A Natural Hospital Birth


On Monday, February 9th, 2015 I woke up around 6AM with the pressing need to pee. This wasn’t unusual, this had become a routine over the past few weeks. When you’re 9 months pregnant you have to pee a lot. At first, this day didn’t feel any different from any other day. I was disappointed that I hadn’t gone into labor during the night. I had been experiencing pre-labor contractions for two weeks, I ended up taking all of the previous week off work because I was so uncomfortable and I had been sure that the baby would come. But he hadn’t, and I couldn’t use up any more vacation time or I wouldn’t have what I needed for my actual maternity leave.

On my way back to bed from the bathroom I thought the contractions were a bit stronger than they had been. I laid down in bed and timed a few of them. They were 12 minutes apart. Not overly close, but more consistent than they had been. I thought maybe something could happen today, but I wasn’t getting my hopes up. I had a little bit of time before I’d have to get up for work so I tried to get some more sleep.

I woke up again after about an hour. I think it was a contraction that woke me. I timed them at less than 10 minutes apart now. It seemed like things may really be getting started. I nudged Johnqwell, my husband, awake to let him know what was going on. We decided it was time to let people know that we thought labor had started. My family had a 3 hour trip to make in order to be there for the birth so we wanted to let them know as soon as possible.

We both let our jobs know we wouldn’t be coming in to work. Then it was time to play the waiting game. We settled in for a movie to try to pass time while we waited for labor to progress enough to head to the hospital. I was jittery, excited for things to be happening. I started walking around the living room, hoping to speed up the process. When I wasn’t able to walk during the contractions anymore I called the midwife’s office. It was time to head to the hospital. My family was on the way to our apartment, so we called them to let them know that they needed to meet us at the hospital instead.

It was 2PM when we got to a triage room at the hospital. My family arrived around the same time. The nurse checked my dilation and I was at 3cm. She asked me to walk around the hallways and she would check me again in an hour. So we all walked in circles around IMG_0405the unit. When I felt a contraction coming I would stop and lean on
Johnqwell, wrapping my arms around his neck and focus on my breathing as I let the surge flow over me.

My dad thought it was all great fun. He kept running to the end of the hall, slapping his hands against his thighs and saying “Common Jaime, common”, like I was a dog. It was terribly annoying. Not to mention distracting. After a few times of this I whispered into Johnqwell’s ear as I leaned on him, “I think I’m going to murder him.” Thankfully, we made it through the hour without bloodshed.

When we went back into triage I was checked again. I was 4 cm, they were going to admit me. Once they got me into a labor and delivery room the nurses there proceeded to ask me a bunch of questions that I had already been asked in triage. I was annoyed, I was trying to have a baby here and they were taking my attention away from that for all these unnecessary questions. They also had me sitting in the bed, which was making the contractions harder to handle.

When they were done with their questions I told them that I wanted to get up. They told me that I could walk around the hallways some more. I didn’t really want to walk anymore, I just wanted to stand. But I knew that walking would make labor move faster, so I headed into the hallway.

My instincts had been right. Before we could even make one lap around the unit the contractions were so consuming that I needed the time between them to relax and regroup, walking was not happening. We slowly made our way back to the room. I was feeling nauseous and I told the nurse. She told me that she could start me on fluids and that it sometimes helped with the nausea. At the time, I didn’t know the effects that could have on breastfeeding, so I told her yes. Luckily, my midwife knew better. When she arrived shortly afterwards she had them take the IV out.

I was so grateful for my midwife. She immediately went to work making sure I was comfortable. She tied my hair back and helped to prepare a bath. As I got into the bath I stopped in a squatting position. In this position I felt my body open up and it felt right. I labored in this position for a while, until the contractions were taking all of my energy and concentration. I felt the need to rest my legs so I laid back in the tub. I felt my body relax in the water. I let my eyes close as I focused on my breathing and let all other thoughts drift away. I heard my midwife move into the room, telling my parents that I was falling asleep between contractions. I smiled to myself. I wasn’t sleeping… I was in Labor Land.

A while later the contractions changed again. They were sharper. I was have a hard time keeping relaxed when they peaked. I was struggling to keep my vocalizations at a low moan, they started to raise in pitch and I wasn’t sure how to get through them anymore. My midwife noticed the change. She figured that I must be reaching the transition stage and thought that I should move back into the room.

Getting out of that bathtub was one of the hardest things I had ever
had to do. When I stood up everything became so overwhelming. The contractions rushed over me. I leaned on Johnqwell. It was too much. I was losing my focus and I began to feel labor pains in my back. When I made it back to the bed my midwife encouraged me to lean over the bed and move my hips, but with each movement was a biting pain. I wanted to stop. Next she helped me to get in the bed and lay on IMG_0407my side. In this position I was able to regain my focus.

My parents made their way over to my bed. I guess my vocalizations were worrying them. They both looked concerned. I shut my eyes to block it all out. I needed to concentrate. Someone began to stroke my hair. It was distracting. I wanted it to stop. I looked to see who was doing it. Later, my dad told me that I had given him a death stare. My midwife asked if I wanted him to stop. I nodded.

It wasn’t long after that when my midwife decided that it was time to kick everyone out that I didn’t want in there during the birth. I only wanted my husband, everyone else was becoming a distraction.

When my midwife checked me next I was just shy of 10 cm. She suggested that I could try pushing to move things along. With the next contraction she directed me in pushing while she checked my cervix. I had read that many women found pushing to be a relief. This was absolutely not the case for me. Having her check me while mid-contraction was extremely uncomfortable as well. Right when I had reached my limit, when I was on the verge of telling her to get her hand out of my vagina, I felt a pop and a sudden release of pressure as fluid rushed out of me. That’s when the midwife said, “That’s it, she’s at 10 cm.”

It was all a bit of a blur after that. The nurses were setting things up. I had one or two directed pushing contractions. Then someone said that they could see his head, that’s when the urge to push set in. My midwife said to wait, but it was too late for that. My body was pushing this baby out whether I wanted it to or not. Later, Johnqwell told me that he was thrown a pair of gloves too small for him, but Michael was coming too fast for him get the right size. He pulled them on the best he could just in time to catch him. The whole pushing stage has lasted maybe 10 minutes. He was born at 8:35pm.

Later on, a nurse mentioned that Michael had come out crying. But I don’t remember that. All that I remember is seeing my baby, he was perfect. As he was handed to me, he urinated, anointing me into motherhood. I told a nurse, I figured that they liked to keep track of these things. He was on my chest and a nurse covered us both with a blanket. Johnqwell and I looked at him with awe, he was beautiful and amazing, and we had made him.

After a few minutes a nurse asked me if I wanted to try breastfeeding him. I shifted him over to my breast and he latched on immediately. Everything had turned out exactly how I wanted. A beautiful natural birth. And most importantly, were a family now…


Thank you for taking the time to read about my journey into motherhood. I hope to have you back next week with more information and support for a natural birth experience.

Have a blessed week,

Why Choose a Natural Birth?


    When I was growing up I never really wanted kids. Even with that being the case, I knew from an early age that if I ever did decide to have kids, I wanted a natural birth.  Back then I had no clue of the bountiful reasons to say “No” to the epidural, but even with my limited knowledge of birth it seemed wrong to try to take a shortcut through labor. When I found out that I was pregnant with my son, Michael, I set out to do all the research I could on birth. Everything I found strengthened my resolve to let my body give birth the way God designed it to.

    During my pregnancy and afterwards, I encountered many people who just couldn’t comprehend why I would choose to “put myself through that.” The issue of how our culture portrays birth is a topic I can cover later, but for now, I thought I’d share a list of some of the reasons that I chose to have an unmedicated birth. This is just a subset of some of the many reasons that a woman might choose to say “No” to the drugs and any that are not mentioned are still perfectly valid and should be respected.

  1.  To avoid the cascade of interventions. If you haven’t heard this term before, this is when you interrupt the natural course of labor, causing issues that need to be solved with further interventions, setting off a domino effect of intervention. There are many things that can set this into motion, such as:
    1.  Sweeping of membranes. This can weaken your membranes, causing your water to break prematurely, as well as increase your risk of infection. If an infection forms you may be given antibiotics during labor, which is just a whole other can of worms.
    2. Synthetic oxytocin to start or augment labor. This usually results in contractions that are much stronger than what would have been if labor would have started spontaneously. Sometimes these contractions can be so strong that they actually cause the uterus to rupture. They can also cause more stress on the baby, so electronic fetal monitoring is required. More intense contractions and limited movement increases the likelihood that the mother will choose to get pain medication.
    3. Breaking the water bags. The biggest issue this can cause is cord prolapse (which is cause for an emergency C-section). Many moms may have more intense contractions after their water breaks and that cushion between the baby and her cervix is gone. There is also an increased risk of infection. Since the barrier between the baby and the outside world is gone care providers will put a time limit on her labor. If it takes too long for labor to start or for the baby to be born, other interventions have to be used.
    4. Confinement to bed. Not being able to move and get into different positions makes it harder to cope with contractions and work with the baby to move him/her down the birth canal. This can cause labor to stall, the mother might not be able to get into an effective pushing position.
    5. Pain medication. Pain medication can interrupt the natural flow of hormones, which can really screw everything up in birth. An epidural numbs the entire lower part of your body, your legs can’t be trusted to support your weight, so you are typically confined to bed. And epidural also requires an IV to combat a drop in blood pressure, electronic fetal monitoring, a catheter. The medication can also make you and baby groggy.
  2. A faster recovery period. Women who choose to forego the epidural typically have a faster recovery period. There are many reasons for this. For one thing, with a natural birth, once the baby is out, you’re pretty much done with the pain (if you had any at all). Many women with epidurals complain of pain from the site of the epidural and spinal headaches, sometimes for years afterwards. Also allowing for the natural progression of hormones during a natural childbirth leaves you with a high that makes you very alert and energetic. After my natural birth in the hospital’s birthing center I got many compliments from the nurses on how easy of a patient I was.
  3. To be more alert during the critical bonding period. The first few hours after birth are a very critical period for bonding and initiating the breastfeeding relationship. When both mom and baby are groggy from drugs, it can make it much harder to bond.
  4. To increase chances of a successful breastfeeding relationship. Along the same vein as the previous point, a groggy baby may have a harder time latching on to the breast and may even take longer to even be interested in nursing. Some of the other ways an epidural can affect breastfeeding go back to the cascade of interventions. An epidural often causes the woman’s blood pressure to drop, so the woman is given fluids to counteract this side effect. This often bloats both mom and baby. The extra fluids in mom may cause her breasts to swell, distorting the shape of the nipple, making it harder for the baby to latch. The extra fluids in the baby can lead to a bloated birth weight; the baby will shed that extra water weight, but when the baby doesn’t reach his/her “birth weight” fast enough, the pediatrician may suggest that the woman begin supplementing with formula, sabotaging her milk supply, and the breastfeeding relationship.
  5. Fear of the needle. Needles give a lot of people the heebie-jeebies and that is one huge needle. And we’ve all heard the stories of the woman who had to get stabbed with the needle several times before they could get it in correctly. I have scoliosis with a very high degree of curvature. I figured, if anyone got their epidural placement screwed up, it would definitely happen to me.
  6. Freedom of movement. Sometimes the stories from the previous point go on to say the epidural didn’t even work, or the mother was only half numb. Then you are confined to the bed which severely limits your movements, which can make if very difficult to work with and cope with contractions. Pushing positions are also limited, which can make it much more difficult to push the baby out effectively, and then we’re back to the cascade of interventions.
  7. The experience. This isn’t some masochistic desire for pain. The idea that childbirth is inherently painful is something that irritates me to no end and a subject that I plan on covering in a future post. What this is about is the natural high that comes when the physiological birth goes uninhibited and your hormones are flowing naturally. There is all this oxytocin flowing through you, actually filling the room! Then there’s these feelings of strength and accomplishment. You have a new understanding of your body, as well a huge amount of respect for it.
  8. Stubbornness. Okay, so this probably isn’t a reason that many women would admit to, but this is probably the initial reason I wanted a natural childbirth. The way I viewed it was: natural childbirth is a challenge, a mountain to climb, an athletic feat! And an epidural was like driving a car up the mountain. The last thing I wanted to do was follow the easy path. I have always been aware that what is ease right now is not always what is best for you in the long run. Childbirth is an excellent example where that is definitely the case.

    There are many, many more reasons why a woman might choose a natural birth, these are just the top motivators for my decision. My advice always is: do your research, know your options, know the risks, and do what is best for you and your situation. Please feel free to contact me with any questions, feedback, or topics you’d like to see me talk about in future posts.

Hope to see you back next week!

Have a blessed day,

Jaime Mackey

Preparing your body, mind, and soul for a natural childbirth.