The Missing Interview: Why You Must Screen Your Prenatal Provider Like a Doula—and How Their Model of Care Can Influence Your Outcome

As a doula, I have found an interesting problem in my field, and it needs to be addressed. As I meet with expecting mothers and their partners for the first time -  they ask me all sorts of questions to determine if we align and if I would be a good fit to their birth team. They ask me, “How long have you been doing this?”, “Where did you get your training?”, “How do you provide us with evidence-based information?”, “What does my labor & birth space look like with you in the room?”. I have to say, these are fantastic questions, and they should be asked of any doula. As a potential client, I understand that you need to see if we will be a good fit… I will help guide and be with you during an extremely vulnerable, personal, and once-in-a-lifetime moment! But my question is this… why are people not doing this with their Obstetrician (OB)? With their Midwife? I have client after client tell me they want a physiological birth, and yet have an OB as their doctor. Now, I want to tread very carefully here, because I don’t want to dog on Obstetricians. Not every OB is medically minded, but many are. There is a stark difference between the Midwifery Model of Care and the Medical Model of Care - even beginning with the type of training and education they receive. See below the differences, and you can understand how the model impacts the training/education moving through their career.

 Midwifery Model of Care

Focus on health, wellness and prevention.

View labor/birth as normal physiological processes.

Use interventions at lower rates, when needed.

Emphasize that “mother gives birth.”

Provide individualized care.

Medical (OB) Model of Care

Focus on managing problems and complications.

View labor/birth as dependent on technology.

Use interventions at higher rates, including routinely.

Emphasize that “doctor delivers baby.”

Provide similar care for everyone.

If you are looking to have a physiological birth, I would highly recommend seeing a CNM (Certified Nurse Midwife - who work in hospital settings) for your pregnancy and birth. What I am suggesting has been studied and shown true - that less cesarean sections and interventions happen under the care of a CNM, with similar apgar scores (a rapid, standardized test given to newborns at 1 and 5 minutes after birth) to that of an Obstetrician. Don’t just take my word for it - the data backs it up. 

(The studies are cited below if you would like to check them out in further detail).

A large medical review published in the Journal of Clinical Medicine analyzed data from over 1.4 million low-risk pregnancies (Sriram et al., 2024). When comparing midwife-led care to obstetrician-led care, they found that midwife-led care resulted in:

• Fewer major interventions: A significantly lower risk of unplanned C-sections, vacuum or forceps deliveries, episiotomies, and artificial labor acceleration.

• Less reliance on medical pain management: Lower overall rates of epidural or spinal anesthesia.

• Better postpartum recovery: Shorter hospital stays and drastically reduced risks of maternal infection, blood transfusions, or ICU admissions.

• Healthy babies: Favorable neonatal outcomes, including a lower risk of newborn breathing complications and fewer NICU admissions.

Another major study published in Obstetrics & Gynecology looked closely at 23,100 low-risk hospital births in the United States (Souter et al., 2019). Their findings specifically showed how much a provider's model of care impacts the outcome:

• 30% lower risk of a C-section for first-time mothers who chose midwifery care.

• 40% lower risk of a C-section for mothers who had given birth before.

• Significantly lower overall intervention rates across the board when compared directly to obstetricians.

The science is clear: greater integration of midwifery care into our hospital systems naturally reduces unnecessary medical interventions (Souter et al., 2019).

Most obstetricians from the start of their schooling are trained to simply manage and avert problems, except there isn’t always a problem with birth. There can be problems that arise, but there are not always problems to be fixed and we would be wise to not start from that mentality. Birth can take a while, or the mom needs to move into a different position for the baby to continue its descent, or a moms laboring body may need a boost in energy with a snack... And the list goes on. These situations don’t necessitate an intervention. Your provider's training can impact their values, and those values will impact the decisions and motivations of your OB/Midwife. This is why it is so crucial to know if the values of your provider match your values. 

So how do we know what our values are? Values are our guiding light into what is important to us in situations. They show us what we care about, how we want to be treated and what expectations we desire. It takes a couple minutes of silence to sit down and do some soul searching to think through what those values may be for you. But this seemingly small self dive will help guide you to ultimately have an empowering and positive birth experience. It’s important to first understand what your values are, and then move from there and find an OB/Midwife that matches those. This will mitigate problems that could arise during your prenatal care, labor & birth and postpartum care. 

Here are some examples of questions you can ask yourself to figure out what your values in birth are:

“When I picture the ideal atmosphere in the delivery room, what does it feel like?” - This question uncovers your personal guidelines for comfort and safety, showing what you need in your space to feel secure during labor. 

“Whose voices and opinions matter most to me during labor?” - This question uncovers your source of truth during a high-stakes moment, revealing where you place your trust.

“If my birth plan has to change completely due to medical necessity, what will help me feel like I still had a "good" birth?” - Birth is notoriously unpredictable. This question is the ultimate test because it separates your methods (the plan) from your values (the core needs). It reveals what you require to avoid birth trauma if things go sideways. 

[You can sit with a notebook and answer these… bonus points if you add these values to your birth plan for your entire care team to read and know!]

When we find ourselves conflicting with the medical staff, it’s not (always) about right and wrong.. But misaligned values. The medical team is not the enemy, rather, we more strongly value different things. Here are some examples of questions you can ask your OB or Midwife to figure out what their values in birth are:

"If my labor is progressing normally but slowly, and baby and I are both totally fine, what is your typical timeline or approach before recommending we speed things up?" - This question reveals whether they view birth as a natural process that takes time, or a medical event that needs to be actively managed for safety. 

“When we are in the delivery room and a decision needs to be made, how do you see the dynamic between your medical expertise and my personal preferences playing out?” - This question gets to the heart of the power dynamic in the room. It reveals whether they value Collaborative Care (Informed Consent) or Medical Authority (Compliance). 

"If my birth plan has to change unexpectedly—say, we need an unplanned C-section or a medical intervention—what do you do as a doctor to help me feel supported and part of the process during that transition?" - This question reveals how they handle patient trauma and emotional well-being. It tells you whether they value treating the whole person or only treating the physical body. 

I’ve had clients ask me some of these exact questions → it’s time to start asking our OB’s and Midwives these same questions, early in your pregnancy care. You don’t want to be 36 weeks pregnant and realize that you and your doctor are misaligned. 

Now, what if you are 36 weeks pregnant and are now realizing that you are in fact misaligned with your current provider… Don’t lose hope! And please know that as your doula, I am on your team and will advocate for you fiercely no matter who your provider is. But there are things we can do to bridge the gap and ensure you still walk away from your birth feeling safe, respected, and heard. The things in your control are…

1. Hire a doula! They can stand in the crossfire and advocate for your values and protect your birthing space.

2. Master the “B.R.A.I.N” acronym. Use this tool for every intervention proposed. Ask your provider: What are the Benefits? What are the Risks? What are the Alternatives? What does my Intuition say? What happens if we do Nothing for an hour? 

3. Focus on informed consent and clearly communicating with your doctor.

Birth is about you (& your partner), your values and your experience. You are the consumer and the primary decision-maker here; you are in the driver’s seat of where you take your insurance or hard-earned money during your pregnancy, labor & birth. It’s okay that our values don’t always align with everyone around us. 

Choosing the right provider is all about finding someone whose values align with yours. If you feel most secure with a highly structured medical approach and prefer to rely on your doctor’s specialized expertise to guide the process, then an OB is likely a good fit for you. On the other hand, if your goal is a physiological/low-intervention birth where you lead the decision-making, I highly suggest exploring a homebirth midwife or a Certified Nurse-Midwife (CNM) who practices in a hospital setting. 

Keep asking us doulas these great questions! But I would encourage you to explore these same topics with your OB or midwife first. Our ultimate goal is to help you build a cohesive birth team where everyone is aligned, supportive, and seeking the same outcomes. Your prenatal provider matters.

Resources

National Partnership for Women & Families. (n.d.). Maternity care provider basics. Childbirth Connection. https://nationalpartnership.org/childbirthconnection/healthy-pregnancy/choosing-a-care-provider/care-provider-basics/ 

Souter, Vivienne & Nethery, Elizabeth & Kopas, Mary & Wurz, Hannah & Sitcov, Kristin & Caughey, Aaron. (2019). Comparison of Midwifery and Obstetric Care in Low-Risk Hospital Births. Obstetrics and Gynecology. 134. 10.1097/AOG.0000000000003521. 

Sriram, S., Almutairi, F. M., & Albadrani, M. (2024). Midwife-Led Versus Obstetrician-Led Perinatal Care for Low-Risk Pregnancy: A Systematic Review and Meta-Analysis of 1.4 Million Pregnancies. Journal of Clinical Medicine, 13(22), 6629. https://doi.org/10.3390/jcm13226629