Carrying the complexity of human birth on Earth.

From the Archive…

Originally written for the Oakland Better Birth Foundation in March 2021; Reviewed and edited November 2025

When a doula is approached by a prospective client, more often than not that person is already part-way through their pregnancy, and looking for support that they’ve heard will help them have a more positive, dignified birth experience. They may also be looking to fill in the gaps where they have not felt supported thus far in their journey. 

The care that goes into a birthing person and family’s experience, physiological and otherwise, starts long before that moment, and ideally even before conception. But more often than not, by the time someone starts prenatal care, potential health determinants are already well-established in their body, lifestyles, and even their beliefs about pregnancy. Often seeing a new provider once conception is confirmed, a pregnant person may not have any type of continuous relationship with their health care team, or the accompanying guidance on long-term practices around stress reduction, nutrition, sexuality, etc. that comes with such relationships.

This is a primary impact of a for-profit American health system centered around crisis control, immediate symptom relief, and short-term solutions. Clients and their providers often find themselves addressing problems that might have been prevented with better, earlier care or a non-standardized approach – neither of which is typically made available before a problem occurs. This can show up in a family’s reproductive journey as preventable nutritional deficiencies, unmanageable stress loads, and unwanted dependence on medical interventions in what might have been an uncomplicated process with more appropriate, timely support.

Ironically, “family planning” often gets narrowly defined as decisions around contraception – important decisions surely, but very limited given the world of options and outcomes in actually conceiving, carrying, birthing and nurturing children. Family planning is a much broader process that can, if we let it, include not only freedoms to choose when to start or grow a family, but also how, in the most comprehensive sense. How do we want our bodies to feel while conceiving? What kind of baseline health do we want to achieve before embarking on the transformations of pregnancy? What is the status and feeling of our coparenting relationship? What model of care feels most aligned and appropriate for our family? These are questions that a thorough and healthy culture of sex education and reproductive care would make space for, and that clients are often forced to reflect on after the fact of a difficult experience.  

While we cannot control every aspect of our biology, with a little planning and support, preventable complications and discomforts can be minimized, and satisfaction, ease and dignity in parenting can be augmented. This is one of the reasons the Oakland Better Birth Foundation and our Community Doula programming through Shiphrah’s Circle aims to work  with pregnant people as early as possible, and celebrates opportunities to engage with reproducing people in between and preceding new pregnancies. We don’t often get to consult with someone before pregnancy, but we see time and again how early nutrition interventions, supporting clients who are still choosing or changing care providers, and early and repeated education make a difference in people’s physiology and psychology around pregnancy and parenting.

If you or someone you care for is early in their pregnancy or still considering their plans around reproduction, there are a few things you can offer them. One is early, engaging education, offered by community health offerings in pre-prenatal and whole-family education, or by an experienced doula who serves clients continuously from the moment they are hired.

Another gift is to illuminate the array of options that exist when it comes to prenatal health care provider choice. Very few people feel supported in looking outside of their insurance-based options, but for reproducing people with an overall low level of risk and typically healthy pregnancies (or preconception health), they are candidates for care from midwives, nurse-midwives, obstetricians, or a team of integrated practitioners – the international standard for birthing people. In countries where families have access to well-integrated systems of care from multiple provider types, outcomes for mothers and babies tend to be better than in the United States. Recent research shows that integrated systems that facilitate the collaboration of both midwifery and specialized care practitioners  is a greater determinant of success than any one particular credential or even birth location – although research is also showing how hospital design itself can impact care decisions even in the best of health circumstances.

Midwives are primary care providers who specialize in the wide range of processes that define normal physiology in pregnancy, birth and reproductive cycles. They work to establish continuous familiarity in the home or clinic, and offer guidance on lived realities such as nourishment, sexuality and shared decision-making. They may have special expertise in modalities like herbalism, and they are also trained to screen and assess clients for potential and existing complications. As needed, midwives share or transfer care with other experts as appropriate, and utilize all standard equipment for safe, hygienic processes, standard fetal and maternal monitoring and care, and interventions such as oxygen and antihemorrhagic drugs. They may also provide general “well woman care” for people assigned female at birth who want a more holistic approach to their life cycle health care.

Obstetrician-Gynecologists are medical doctors and surgeons specializing in higher-risk care, with training specific to treating complications of pregnancy and birth, and reproductive processes. Obstetricians may see their client during pregnancy regularly or alternate visits with other care team members, including ultrasound technicians, pediatric specialists, or pathologists, especially if someone has specific health challenges that require additional care. They often work in larger practices or within a hospital model that cannot guarantee their presence at birth, simply due to business model and facility design. While obstetricians treat the majority of women and birthing people in the United States, their surgical skill and expertise around complicated pregnancies may not be needed or appropriate for every person.  

A Nurse-Midwife is a primary care provider with an advanced nursing degree, comparable to a nurse practitioner in their scope of care for maternal patients. Depending on their background, interests and practice, a nurse midwife may combine elements of traditional midwifery skills with their obstetric (non-surgical) training. They often work at hospitals with physicians, and may also be providers at birth centers or home birth settings. Since the context, partnerships, and training background for a nurse-midwife can vary so widely, so does the style, approach and specialties involved in their care.

Each type of provider faces prohibitive malpractice insurance costs and different pressures based on their geographic location, state funding for clients without private insurance, available facilities, interprofessional collaboration resources, and economic disparities inherent to profit-based medicine. However, most care from OB-GYNs, which tends to be high in cost, is accessible through various forms of insurance, while access to diverse midwifery care – which tends to cost less –  is incredibly limited, and the profession itself faces legal obstacles in many states. This is an equity issue, as well as a cultural one – the history of obstetrics and midwifery illuminates how predatory regulatory practices, racist fear tactics, economic disenfranchisement and misinformation created a near-monopoly of male-dominated obstetrics over midwifery in the United States over the last century. 

For anyone considering combined or midwifery-led care, we want to highlight that such services do exist in California, through a combination of partial insurance coverage, community-funded scholarships, sliding scale fees, and crowd-funding. Such options only become more available if health care “consumers” demand it, so whether or not your final decision is to work with a midwife, OBBF invites you to do your research, ask your insurance provider about more choices, and help fellow community members to know they have options. Working with a doula early on in your process can be one way to support such choices, and no matter who provides your medical care, a doula can contribute to the holistic and educational pieces of your longer journey.

We sometimes encounter pregnant women and people who question if a different model of care is “worth it”, and so we invite them to to start asking their own questions, using the following for inspiration, and we affirm that every single human being is deserving of respectful, appropriate, informed, quality care.

Health & Risk Considerations in Choosing Care

• Do I have any high-risk health status requiring surgery or substantial use of medication?
• Does my identity or perceptions about my identity put me at risk within a historically racist and sexist for-profit medical culture?
• Would I benefit from counseling and guidance around issues like nutrition, mental wellness or movement for pregnancy?
• Am I dealing with personal challenges around self-care, sexuality or emotional health that would benefit from trauma-informed care?
• What are the rates of induction, epidural use and Cesarean section at the hospital facilities in my area?
• For out-of-hospital providers in my area, what are the rates of induction, Cesarean section, and hospital transfer, both emergency and non-emergency?

Logistics Considerations  in Choosing Care

• Ideally, where would I like to birth, and who would I like to have with me?
• How highly do I value continuity of care, or receiving care from the same person(s) between my prenatal care visits and my labor and delivery experience?
• What are the closest medical facilities to me? Does my insurance cover care, spontaneous or planned, at these facilities?
• If I do have insurance, what does it cover beyond minimal prenatal care? Are additional visits for nutrition, acupuncture, physical therapy, etc. available to me?
• Who are the independent birth center or home birth practitioners in my area? 
• Do I desire or want to accommodate longer prenatal care visits?

Cultural & Personal Considerations in Choosing Care

• What kind of relationship and communication style would I like to have with the person who helps me to birth my baby? How would I like to access them? 
• How would I like my wider support team to work together?
• What has my care experience been like so far?
• What have I learned about birth, and from whom? What kind of birth attitudes and beliefs have I inherited from peers, family, etc?
• What value do I place on fully informed choice, consent, feedback, and the option to change my mind?
• How important is culturally responsive care and sensitivity to me? 
• What helps me to feel respected and heard in my identity, needs and desires?