OB-GYN vs. midwife: how to choose your birthing provider

The person you choose to provide for your healthcare during your pregnancy, labor, and delivery can have a big impact on the kind of experience you have. And just as the type of experience you want to have is highly personal, so is choosing who you want to deliver your baby. In this piece, we’ll break down what an OB-GYN vs. midwife are and why OB-GYNs vs. midwife delivery rates are starting to shift and give you some resources for how to make the decision. The bottom line, though, is that you should consider what is important to you in pregnancy, labor, and birth—and who you would trust to guide you.

While OB-GYNs remain the most popular professionals delivering babies in the United States, midwives are growing in popularity. In 1989, certified nurse-midwives delivered just 3.2 percent of births in the United States. In 2013, the most recent year for which statistics are available, that number was close to 9 percent (and 12.1 percent of all vaginal births).

There are a few concrete differences between OB-GYN vs. midwife, namely, their education and training. But they’re commonly distinguished by their differing philosophies when it comes to birth.

What is an OB-GYN vs. midwife?

An OB-GYN is a doctor trained to provide medical and surgical care to women. They spend their residencies studying pregnancy, reproduction, and female medical and surgical problems. An OB-GYN will only deliver your baby in a hospital and is trained to manage and treat pregnancy complications.

There are different types of midwives, and licensing varies by state. Certified Nurse Midwives (CNMs) are registered nurses who have earned their master’s degrees in nursing, with a strong emphasis on maternity care. The different certifications makes a difference: Because CNMs are nurses, they can prescribe medication. Other midwives cannot.

Midwives work to provide individualized, family-centered obstetric care from the first prenatal visit until after the birth of your baby. They train in natural births, and they often work with a supervising OB-GYN who is available to assist should complications arise during labor or childbirth. Critically, midwives don’t handle serious complications—and their definitions of risk may differ. Some, for example, don’t handle multiple births, gestational diabetes, or attempted VBACs, while others do.

OB-GYN vs. midwives birth philosophy

OB-GYNs, as doctors, tend to approach birth as a medical process. Midwives, on the other hand, believe that birth is a natural physiological process.

There is little specific training for an OB-GYN in natural, uncomplicated birth.

Because OB-GYNs may have tight call schedules, midwives tend to be more present during labor and tend to allow more space for the labor to unfold naturally before moving to medical interventions.

Often midwives will deliver babies at hospitals, birthing centers, and family’s homes, but some midwives only deliver at hospitals, and sometimes those practices are affiliated with sister OB-GYN groups that help in the event of complications.

It’s important to note that midwives cannot perform emergency C-sections or operate if labor complications arise. They will help recommend pain medication if needed, but as is the case with OB-GYNs, pain management will be given by anesthesiologists or nurses on call.

Comparing reasons to use an OB-GYN vs. midwife

Reasons you might consider using an OB-GYN vs. midwife:

Strongly desire to have a licensed medical doctor present at your birth
Have a high-risk pregnancy or other health complications that you wish to be—or that have to be—closely monitored by a doctor

Reasons you might consider using a midwife vs. OB-GYN:

Desire to have few medical interventions if possible
Prefer a vaginal birth without the use of pain medication
Have anxiety about birth and wish to be coached more through pregnancy and labor
Have a low-risk pregnancy
Wish to give birth at home or somewhere other than a hospital

No matter which type of healthcare provider you choose, you should feel comfortable asking him or her questions and should feel confident and safe as labor approaches.

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Work-life balancing act

For 12 years, I was a fit aerialist, teaching 15 classes a week and performing in front of hundreds of people. I could easily climb a 20-foot silk fabric, barely breaking a sweat, wearing sparkly, sequined bras and gold metallic booty shorts, my toned belly proudly exposed to my adoring audience. I was fierce and fearless.

And then I had babies. When I got pregnant—twice, my children born 17.5 months apart—I was determined to maintain my life as a performer. I continued my aerial acrobatics throughout my pregnancies, even when things like urinary incontinence, diastasis recti, and weakened ankles wore me down.

I befriended new mothers who were struggling to find their identity without the structure and normalcy of their previous lives and jobs. Many of them confided that they longed to get back to work, the demands of motherhood way more than expected. Then there were those who dreaded working again, the crazy cycle of pumping and finding a decent daycare making their heads spin. And then there was me, with a failing body, not sure if I had a choice because my body was my work. As new mothers, we all longed to get our postpartum bodies back into shape, and to pursue the interests and passions that once fed our souls. However, the immediate demands of a newborn made any form of self-care seem almost frivolous and indulgent. There was simply no time or energy to do yoga and pilates. And without a strong core, how could I properly teach and perform again?

Like many women, I had developed diastasis recti, a separation in the abdominal wall caused by the muscles stretching and expanding during pregnancy. After my first pregnancy, I was diagnosed with a fairly mild, 1.5-finger separation, which healed after a couple months of dedicated core work. I was soon able to do inversions in the air, my abs springing back to life.

After my second, the center separation wasn’t bad—two fingers wide—but new separations appeared down the sides of my torso. At nine months postpartum, something popped out through the tears under my rib while I was holding a one-minute plank in yoga class. I sat there, breathing through the burning pain, perplexed and worried by this strange bulge. What would be classified as a hernia if it stayed out luckily slipped back into place with some deep breathing and applied pressure. My midwife said she could refer me to a physical therapist at the one-year-postpartum mark. In the meantime, she told me not to hold planks anymore. Like, forever?

I was longing to get back in the air. Defying gravity made me feel alive, pushed me past normalcy, gave me a special superpower. And yet every attempt to invert caused me to pee my pants. Not a lot, but enough of a dribble for me to notice. Enough that I started carrying spare undies in my backpack.

My ankles started giving me trouble after my first pregnancy and worsened after my second, due to the extra weight and weakened ligaments. I had to hold on to the wall when I hobbled down the hallway. I cried in pain after walking for a stretch of time, massaging my ankle with alternating ice and heat packs. I went through expensive high-support sneakers, specialty inserts, physical therapy, and boring exercises at night with stretchy colored bands. Nobody tells you about this before you have kids.

Still, I powered through all that and continued to teach and perform, until the last eight weeks of my second pregnancy when virtually all activity came to an abrupt halt. I had pubic symphysis separation, where the pubic bone comes apart just enough to grind together when you walk, causing unbearable discomfort. I had to wear a belly band and tie a scarf around my hips just to walk around the block. Needless to say, my aerial acrobatics had to finally be put on hold.

Overall, I knew I was lucky—I had two adorable babies. They were healthy. They were fun. They had these stunning red curls and gorgeous blue eyes. And despite my body falling apart, I was okay too. I reminded myself of this every day.

But I’m not going to lie. It was hard losing my strength, my agility, my bladder control, my ease of movement in the air, my ankle mobility. I didn’t like looking at my stretch-marked, jiggly, misshapen belly. Attempting to climb after childbirth was like swimming upstream with lead weights on my ankles. The lack of sleep, the chaos, the nursing-induced hunger, and the temptation of quick, salty carbs, along with enough postpartum lethargy to prevent me from hitting the gym, made it impossible to avoid metamorphosing into a new, heavier body. The curves, the squish, the weak muscles—this was what I had to work with. This is what I get to haul into the air. Soft, stretchy yoga pants became my go-to. Massive nursing bras to support my F-cup breasts, which bounced and jiggled like water balloons when I walked. I grieved the loss of my old self—the sparkle booty shorts getting shoved to the back of the closet. Would I ever fit in that B-cup sequined bra again?

“What’s your profession?” someone asked me recently.

“I’m an aerial dance teacher,” I replied. I left out the performer part since I’d only returned to teaching, terrified to squeeze my postpartum body into any form of sparkly spandex.

They eyed me up and down, taking stock of my soft, curvy, mom-bod. A far stretch from the stereotypical Cirque du Soleil aerialist, all carved muscles and ripped abs.

Now, 14 months after birthing my second child, I’m still nurturing my torn-apart body back into an activity that used to be second nature. Every climb brings me closer to my old self; that fierce someone who felt like she could fly. I do a Kegel whenever I invert, I stop if I feel my core twinging or popping, and I still don’t have enough time to train. But I continue to teach, watching as others discover their inner strength. I balance it all with the mother that I’ve become. I snuggle my babies close, I cherish being in the air, and I’m trying to love this new body.

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My personal trainer became my doula

I never considered having a doula at the birth of my daughter in 2011. I’m not even sure I knew what a doula was at the time. I did know, however, that I was going to need a little help. My midwife was brilliant and my husband supportive, but I wanted a third person on my team. Someone who would help me stay calm while encouraging me to channel the strength I didn’t always recognize within myself. Someone who could convince me to keep pushing when I felt like I wanted to give up. Someone who knew how to help me replace my fear and anxiety with confidence and peace. In other words, someone like Kili, my friend, personal trainer, and co-owner of the gym where I worked out. Kili had never helped deliver a baby before, but she did have three children of her own and — most importantly — she was one of the strongest and most empathetic women I knew. I had been working out with her for two years, and she had been extremely influential in helping me realize that the negative, preconceived notions I had about my physical capabilities were way off. She was the best fitness coach I had ever worked with, and she was in the process of becoming a certified life coach as well.

Woman Doing Yoga

So I asked her how she would feel about adding “labor coach” to that list. While it was obvious that the experience was going to be life-changing for me (I mean, I was about to become a mother for the first time), when she said yes, we never would have guessed how much the experience would impact her life. I asked her to be my labor coach because I thought she would be good at it and I felt comfortable with her. I didn’t know she was a doula in the making and that my daughter would be the first of many babies she’d help deliver.

Kili became a certified Pilates instructor shortly thereafter, and in 2017, Kili officially became a doula. I recently asked her to tell me a little more about her journey. This is what she had to say.

What was it like helping to deliver a baby for the first time? It was crazy exciting! Having three children of my own, I fully understood the significance and miracle of birth. But not until I supported someone else’s journey did I realize the strength and power of a woman’s vulnerability. I was nervous, due to the newness of the experience and wanting to truly help two people I cared about. But there was also a sense of ease because I was doing the work I was born to do.

Did you have any idea you would wind up doing this for so many others later on? I didn’t imagine this specifically. The community my husband and I created for physical movement (through the gym we owned) really facilitated the opportunity to witness and create physical, mental, and emotional growth This was just a natural progression of that growth. I think the idea of having a doula assist with childbirth was becoming more mainstream in our area, so the timing of this and the fact that more women in our community were starting to have babies really catapulted the work.

When you started the Pilates training, did you know the doula training would follow – or did that decision come later? I wanted to add Pilates to my repertoire of bodywork training and certifications long before I even knew what a doula was. The value of understanding movement, alignment, strength, and core was something I always sought out in my career, and Pilates was the obvious next step. When I realized how much this all intersected with childbirth, there was no question that I had to go through doula training.

How has your approach to delivering a baby evolved over the years? I think the biggest evolution in my approach has been my commitment to the mother. While I love babies, I realize now that it is really all about the mom — her safety, her health, her experience, her choices, her pain, her comfort and coping. Her goal is to deliver a healthy baby. My goal is to protect her choices and needs and to connect her to the people who love her most in a very uncontrollable (and sometimes scary) environment. I want to be the support she and her partner need to get the job done. So, while a lot of the techniques have stayed the same (e.g., massage, breath, and focus work), the intent has shifted.

How do you incorporate your Pilates/pelvic floor expertise into being a doula? The Pilates and pelvic floor work I do with women prior to birth prepares them for the endurance, strength, and release their bodies will need for labor and pushing. I also help them prepare their minds through focus, breath, and awareness, which are all very important in the practice of Pilates. After birth, my role is to help women rebuild core strength. I also help them reincorporate self-care and movement into their routines.

What do you like best about the path you are now on, helping women with childbirth and pelvic floor health? I love how this work helps women connect with their bodies, and I love when women realize how amazing and powerful their bodies are. The process of birth and pregnancy is unfortunately the very first time many women even become aware of the pelvic floor region. My hope is that the value of pelvic floor health becomes something we start to teach to our daughters at a much earlier age.

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The invaluable support of a postpartum doula

Women are notorious for believing we can do it all on our own. Whatever the “it” may be, we are strong. While that is definitely the truth, childbirth and the early months of motherhood are one of the greatest challenges we face. My postpartum doula was integral to my early days of motherhood. From teaching basic childcare, through the scary weeks of postpartum depression, and in dealing with tragedy, my doula was not a luxury but a necessity.

Within days of having my first child—via emergency C-section—I was plunged into a nightmare of postpartum depression.

Noah had turned breech in the last week of my pregnancy, and my doctor scheduled a C-section for the following day. It was my first major surgery. It was the first time I’d ever stayed in a hospital. Physically, it was harder than I thought it would be, and I was terrified from the start. But Noah was born and I took him home, and as the hormones raged and rearranged themselves, the sleepless days and nights began to pile up. My thoughts turned dark. I wanted to die. I wanted Noah to disappear. It’s still so hard, 11 years later, to write those words. I wanted my old life back. Everyone around me was terrified and confused.

There were whispers from well-meaning friends and relatives: “We thought she‘d be such a good mother. We don’t understand.” “She was so good with her nieces when they were little. This doesn’t make sense.”

My husband didn’t know where to get help for me. He spent hours on the phone trying.

I was supposed to simply dance into motherhood with all the accoutrements that came with it. There didn’t seem to be as much brutally honest information out there about motherhood in 2008. Or more likely, I didn’t think I’d need any. It all just comes so naturally, right? I was not the type to ask for help. I really was convinced I could do this on my own.

With time and a hefty dose of an antidepressant medication, I started to come out of my darkness. It took a few weeks. But I will never forget its intensity. The extreme thoughts of wanting to disappear subsided. But the day-to-day was still so hard. I really wished someone had told me about this part.

On the suggestion of my OB-GYN, we were referred to a postpartum doula through the hospital where I gave birth, and soon a tall, gentle woman named Arlene came to our garden apartment door. Almost as if Mary Poppins had gently glided down from the sky with her umbrella and carpetbag of tricks, Arlene had me crying on her shoulder within the first few minutes of meeting. That was what I needed. To get the words and tears out. To say just how hard this all was.

She taught me that cottage cheese mixed with yogurt was delicious and an excellent source of protein when my appetite was nonexistent.

She talked to me about her thirty-plus years of marriage and four children.

She talked to me about sunlight. The very first thing I needed to do every morning was open the drapes. Not only to begin teaching Noah the difference between day and night, but for me too.

I started to feel much more joy than sadness in my everyday. I began to enjoy opening the curtains as I brewed coffee in those early mornings. I never would’ve guessed what was coming less than two years later. I thought the worst was behind me.

I was in love with motherhood. I was obsessed with the brilliance of my baby boy. I was good at it all. In my way, I was the best mother I could be. Even when my own mother died when Noah was one and a half, I had a sense of peace about it all. Like she had given me all the tools I needed to go on without her.

In July of 2010, my husband, Noah, and I were moving into my father’s house. He was widowed, had plenty of space, and a swimming pool. But in the proverbial blink of an eye, our lives changed. Noah silently opened a door I never thought he would or even could. I was maybe 25 feet away. Silent. My husband found him within minutes. I heard a scream and a splash. My father dialed 911 and I stood in the kitchen in shock. It was too late. Noah had drowned.

Arlene was among the hundreds of people that attended Noah’s funeral. She waited for me as I came out of the ladies room right before the graveside service was about to begin. I just remember her smile. It was as if her care for me had come full circle. In life and death.

Arlene continued to send cards on Noah’s birthday. Knowing that she remembered him…that he existed…was a gift that meant so much.

We knew we could never ever replace him, but we soon began fertility treatments and continued them for two years to create our daughter. But we would never ever live life with the innocent joy we once did. It was all measured in extremes now. My extreme grief was reminiscent of the darkest days of my postpartum depression but even more brutal.

When Miriam Phoenix was born two and half years after Noah died, I was prepared for the PPD monsters. This time I knew what they would look like. Even with all the delirium of finally having a child again, I was not immune to the hormones and exhaustion. Exactly ten days after my daughter was born, as I was washing my face at my bathroom sink, those postpartum monsters swooped in again. I opened the door of the bathroom, face still wet, and simply said to my husband, “It’s starting again.”

I called my doctor immediately and got back on the meds. I called Arlene and asked if she could come give me a “refresher course” with a good cleansing cry included. She did.

Miriam is now six years old. She is pure joy with quite a backstory.

I still have my dark days. But just like Arlene taught me, I will always start my days by opening the curtains. A cup of coffee, yogurt with cottage cheese, and some sunlight.

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When PPD doesn’t feel like PPD

Sitting in a dark room, clinging to my newborn son, rocking him for more than an hour as he struggled to fall asleep, I whisper-sang the words to every single Taylor Swift song I could think of. My breath was heavy and my chest was tight. I wanted to scream and cry, but I just kept rocking and whisper-singing late into the night like some country music–obsessed zombie. On nights like this, my mind became a tangled mess of thoughts: I wondered if I was a good enough mom. I obsessively questioned how I was supposed to keep not one, but now two, of my own children alive and well-cared for. I felt like a failure. But I never thought that I might be experiencing postpartum depression (PPD) for a second time.

The pressure on a second-time mom to handle the ups and downs of adjusting to caring for both a newborn and another child (in my case, a toddler) was something that I was completely unprepared for. During my first pregnancy and immediately after giving birth, people around me were quick to give advice or be forgiving if I didn’t know quite what I was doing.

When I became pregnant with my second son, I noticed that the words of encouragement I received changed from instructive in nature to comments that were borderline dismissive. “At least you know what you’re doing now because you’ve done it before,” and “Oh, come on! You’re a pro now!” were statements I heard frequently from friends and loved ones during my second pregnancy when I expressed trepidation about adjusting to life with a newborn and a toddler. In reality, I did not feel like a ”pro” or like I knew what I was doing at all, but those comments flipped a switch in me that made me vow to be the perfect mom of two that people imagined me to be.

Despite being treated by a psychiatrist for PPD after my first son was born and knowing that I could develop PPD again, no one explained to me that the experience could feel completely different. I thought that experiencing PPD before at least gave me a leg up in recognizing it: I knew the sadness, exhaustion, and fog that came with PPD after my first pregnancy. But I didn’t know that emotions like anger and rage, while less stereotypical signs, can also be elements of postpartum depression. Had I known that my PPD could look totally different after each pregnancy, I would like to think that I would have noticed the warning signs the second time around and sought treatment sooner. I also knew that every birth experience could be different, so I’m still not sure why I didn’t connect the dots sooner that PPD symptoms could also differ. But then again, I was being constantly reassured that I knew what I was doing the second time around, making it hard to question much of anything.

With my first, PPD might have been expected: I was a newlywed in an unhappy marriage that ended in divorce just a few months after I gave birth. My second son was born nearly two years later into a much happier, albeit slightly more complicated, situation with my now-husband, who has two children of his own from a previous marriage.

After giving birth the first time, I truly felt that “dark fog” of depression that people talk about. I vacillated between utter despair and outrage. While I had suffered from anxiety before, this was completely different. I felt like my thoughts were swirling in an endless sea and I couldn’t grasp any one of them long enough to hold a decent conversation.

I felt numb and isolated—and angry once I realized these feelings were happening during a time I was supposed to be happy.

After baby number two, people would ask me how I was feeling, and I’d deny that anything was wrong. After all, I had already had one baby and had been through PPD, and how I was feeling after baby number two didn’t feel like that. At my six-week postpartum check-up, my doctor asked how I was adjusting and whether I needed additional anxiety medication. I denied any need for additional meds and reassured my doctor and my husband that I was doing just fine. I was communicating, but I wasn’t revealing the important feelings buried beneath the surface. Deep down, I wondered if I really was doing anything right, and it was overwhelming, but I was afraid to admit it. I was afraid that everyone who had told me that I had it under control would look at me struggling and see me as a failure.

Because I was an “experienced” mom, I thought I knew what I was doing. I thought that getting out of the house was the right thing to do, because I didn’t want our other kids to be bored or for people to think that I couldn’t handle having a new baby. So I took my two-week-old son to my stepdaughters’ softball tournament because as a “good” mom, I thought I should be able to support all my kids at once. I took him at four weeks old to walk around the entire Houston zoo in the blazing hot, dead of summer heat for the sake of entertaining my older kids. I’m sure that poor baby was overheated, but I was on a mission to prove myself. But I know now that this was unhealthy and borderline dangerous. What I didn’t understand until much later was that this compulsive need to prove myself (and the accompanying feeling of utter disappointment when I felt like I was failing) was PPD rearing its ugly head.

I didn’t sleep. Even when the baby slept, I would just sit in his room holding him and crying over not living up to the standards of being the perfect mom I thought I should be. My anger got the best of me more days than not as I began to look at my life begrudgingly. As my second baby grew, my husband and I both noticed that I was becoming more and more stressed and frustrated despite coming out of the newborn phase and the haziness that it brings for everyone involved. I was trying hard to be a perfect mom and felt like I was failing, which fed feelings of resentment toward my family and my life in general. Things that I had really enjoyed doing for my first son, like making homemade baby food, were suddenly unimportant and even nonexistent for my second. I sought professional help for coping with these feelings out of sheer necessity. I could not function in the mind-set that I was in. It took me months to come to terms with the fact that I was dealing with PPD again and that this was keeping me from accepting my new reality with the grace that I wanted to.

While I won’t be having any more children of my own, I want to help other moms be aware of how PPD can manifest in multiple ways and be different from one pregnancy to the next. If just one mom can read my story and recognize in herself what it took me too long to see in myself, that is progress. Awareness, education, and candid discussion are the first steps to challenging the stigma surrounding PPD and helping rewrite the narrative for all families after childbirth.

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Three different births

During my first pregnancy, I took two birthing classes: Bradley Method and hypnobirthing. I meditated and practiced my Kegels, repeating chants with the totally calm doula on our class recording. All my husband had to do was whisper, “And now it’s time to relax…” and I immediately lowered myself into my preferred birthing position, synchronizing my breathing to match my visualizations of a smiling baby gracefully and rapidly entering the world.

I had a full birth plan in place. I knew every stage of labor by heart. I packed my hospital bag two months before my due date, hooked up the co-sleeper to my side of the bed, and met with a lactation consultant and baby-wearing expert. My nurse-midwife high-fived me for my focus and dedication, using me as a teaching model for the new nurses on staff. I prepared in every way for my perfect birth and the trophy I would receive for birthing my son naturally, even as I faced a challenge in terms of baby size (everyone thought I was having twins).

I was ready.

It wasn’t until much later—32 hours deep in my labor when the midwife announced, “We’re sunny side up” and “Wow that’s a huge head”—that I realized my birth plan had begun to unravel.

I had dilated quickly but took forever to efface, and the baby just refused to drop. By that point, after not sleeping for two days, I found it impossible to do my hypnobirthing visualizations; in fact, I couldn’t visualize anything other than killing my husband for his role in this nightmare. I didn’t want a massage or encouragement. I refused to squat anywhere near the man who’d done this to me.

Eventually it became clear to both the midwife and me that I needed some rest if I was going to be able to get this baby out. She suggested an epidural, which went against my vision of a natural birth, but she thought there was a chance it would give me back my focus and hope. But once the pain was dialed down, I was devastated. I had failed. I wouldn’t get that trophy after all.

Over the next few hours, the baby finally dropped and I began to push. Then, after all that struggle, his shoulders got stuck. He was jammed in place, unable to budge, his heart rate fluctuating dramatically. I was transferred to the OR and my baby was born via C-section less than 30 minutes later.

I watched my husband holding our son. He cried in relief and joy, kissing our baby’s purple, cone-shaped forehead and told me what a great job I’d done. But I knew better.

The fallout from that birth was intense. I responded poorly to both the epidural and the morphine, which delayed my milk production. It took two weeks to get the hang of nursing, and supplementing with formula was another guilt rollercoaster I rode as a mother. I had very little perspective, and the birth itself was a traumatic experience that I had to revisit and work through as I approached my next pregnancy two years later.

With baby number two, I saw an obstetrician who specialized in VBACs, vaginal births after cesareans. I didn’t take any classes and spent the entire pregnancy chasing after my toddler. I agreed to the doctor’s demand for an epidural “just in case.” When it came time to deliver, I faced the same difficulty with my baby refusing to drop. When the doctor loudly questioned the potential VBAC, I got mad and really started to push.

I got my VBAC that day, though a cord emergency at the end required an intervention that resulted in 18 stitches. No natural birth trophy for me again, but I had my healthy baby girl and the vaginal birth I’d long hoped for—and I also found forgiveness easier this time around.

I also didn’t have the lingering depression that I’d had after my first baby was born. My milk came in quickly, and my daughter took to nursing like a champ. The stitches were pretty awful, but perspective tempers everything.

“Hey, you wanted that VBAC!” the doctor reminded me, and it struck me that a good chunk of the struggle we have with expectations around birth is rooted in patronizing, brisk caregiving. All too often, we’re treated like children ourselves. I nodded and thanked him, then found a different practice to go to.

Three years later, with baby number three, I talked freely with the midwives at my new practice about my complicated history. I asked questions without apology, offered opinions based on my experience, and expected those opinions to be respected. It was an entirely new patient-caregiver relationship.

This time around, I had patience with my body and could remind the medical staff: My babies always wait to drop until the very end. I always dilate fast but take forever to efface.

I recognized my own body and its patterns, and my husband did, too. I also had two older, amazing children at home waiting for me. Their very different births, neither perfect or natural, had in no way impacted their health or abilities. I finally realized how much my own mental state impacted my birth experiences and recovery, and how birth itself was simply its own transition from inside to outside: from pregnancy to motherhood.

So when I got to the hospital at 2 a.m. with baby number three rumbling in my giant belly, the nurse asked, “Do you have a birth plan?”

“Just to have a healthy baby,” I said.

My midwife let me dance until it was time to push. When I yelled, “I’M NOT DOING THIS!” at the very end, my husband laughed and knew enough this time to just whisper, “You’re doing great!” and then back out of the strike zone. Three hours in, I pushed my daughter out like I always dreamed. I held her on my tummy and let her worm her gooey self up to nurse—just like in the birth movies I’d watched five years earlier.

It was lovely, truly. But it also didn’t make me think about trophies. I was so happy she was healthy and strong, like her siblings. But I immediately remembered those earlier births, and wished I could go back and hug myself, tell myself, “Listen to your husband. You did great, mama. You did just right.”

Because every birth is sacred and hard. However our babies arrive, we did it just right.

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The struggle of ambivalence

“Excited?” the nurse asked as she passed me in the hallway of my doctor’s office. I was sitting with my husband and clutching our first-ever sonogram. I was dizzy and six weeks pregnant, although I’d known for two weeks already.

“Working on it,” I said to her. She stared for a second, as though I’d just told her that my favorite hobby was tossing puppies off bridges, and then walked away.

I wasn’t surprised by her reaction, but I was disappointed by it. For all of my adult life, the idea of becoming a mother and having children had left me in a state of ambivalence. I could just as easily picture life without kids as with them. But in the age of public bump watches and gender reveal parties on social media, confessing that to others felt too vulnerable.

That day at the doctor’s office, it wasn’t that I was unhappy we were having a baby. Mostly, I was scared, which I quickly learned is not something others like hearing from expectant mothers. It seemed the world wanted me to say I’d always known I wanted kids, or I was over the moon about being pregnant, or I was sure every moment of those nine months would overflow with joy.

But none of that was accurate. My ambivalence did not magically transform into confidence at that doctor’s appointment. Instead, it morphed into something more akin to anxiety. What would I do about work? Would I be a good parent? Would my kid like me? Would I ever write again? Would I even recognize my life in a year? I was relaxed and going with the flow on the outside—but panicked on the inside.

When people asked how I was doing, I based the truthfulness of my response on how much I trusted them and how much I thought they would balk at any answer if it didn’t burst with maternal bliss. For reasons I didn’t fully understand, I resisted some of the common trappings of modern pregnancy, like having a gender reveal party or baby shower (I compromised on a small family “get-together” when I saw how much it meant to my mother). I didn’t want to post bump updates online to share that my baby was the size of a coconut that week. Some people understood how I felt, while others couldn’t wrap their minds around why I didn’t want these things.

It was the still-persistent ambivalence but also a lack of interest in being a part of modern pregnancy culture. I worried I’d be a terrible mother because I didn’t want the things so many other women seemed to want while pregnant.

But on a cold February morning just after midnight, our son was born. In an instant, my feelings morphed again, this time into something I was better able to understand.

Once I had that squishy, tiny boy in my arms, wrapped in a hospital blanket like a breakfast burrito, I felt an internal Oh. Now I see.

I now understood my ambivalence for what it was—simply a part of me that had to see the outcome to feel sure about it.

There have been things in my life I’ve been able to visualize and times when I knew for certain that I’d be happy with a choice, like buying a house or going to grad school or marrying my husband. I didn’t have the same certainty about becoming a parent, not because I was bound to be a horrible mom but because between the choice of having kids or not having them, neither felt more or less right.

It became clear to me that I also had been pushing back against the way pregnancy and motherhood are commonly viewed today. There seems to be a performative expectation to all of it, as if women can only be totally good with these two tremendously life-altering, sometimes difficult transitions. There’s room for us only to say we’re excited, we’re feeling great, we love motherhood, we’re exhausted but happier than ever. Often, we can say the rest of the truth only when we’re with someone we trust.

I wonder what might’ve happened if that nurse at our first appointment had smiled at me and said, “Hey, that’s OK. However you’re feeling right now is fine!” The emptiness of her response, however, has stayed with me. Motherhood is hard enough without being expected to act overjoyed at every moment, too.

Now that my son is here, I wouldn’t change a thing, of course. He was the right choice and I’m sure about him in the deepest part of my human makeup. But it was only after I made the transition to motherhood that I knew feeling ambivalent before feeling sure is absolutely OK.

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Dealing with my postpartum anxiety

Just before our son was born, my husband and I moved to a new town over an hour from the one we’d called home for four years. I was isolated and alone in a new place with no friends, no close family, and no support. My husband drove my car to work, so my only transportation was a beat-up old pick-up truck with no air conditioning and no safe place to latch a carseat. I was alone with my son from the time we woke up until 7 every night, when my husband got home. Still recovering from an emergency C-section, I had no one to help me with housework or cooking, no one to hold the baby so I could shower, no Meal Train or frozen casseroles from friends.

I was alone with my baby and my thoughts and it was terrifying.

I’d lie awake in the middle of the night, afraid to go to sleep, convinced that my son would stop breathing, that the few weeks I’d had with him would be the only time I got. I hovered and fretted, checking his breathing constantly. I stayed awake until I was physically unable to keep my eyes open, only to wake with a start a few hours later, panicking that I’d drifted off and left him alone.

I had postpartum anxiety, although at the time I didn’t even know that postpartum anxiety existed. Postpartum depression, sure—all new mothers read about the horrors of PPD, the baby blues x 1,000. It was on my radar and contributed to my worries: What if I developed PPD and was unable to care for him? What if my depression got so bad that I had to be hospitalized? Who would feed him and change him and love him while I was away? Postpartum anxiety is characterized by irrational worry and fear, intrusive thoughts, insomnia, racing thoughts, and an overabundance of caution about everything.

There was nothing wrong with my son. No medical problems, no delays, nothing at all that would indicate he might not be well. He was a robust, healthy five-week-old baby who was developmentally on track. Still, I obsessed over his health. I pored over baby books and articles. I lurked in new mom groups where desperate mothers told stories of their own babies’ illnesses and failures to thrive. I scoured the internet for every bit of information I could find on caring for a newborn.

I was consumed with his well-being and I was tormented by worry and guilt and shame because I was struggling. I was convinced that I was failing and that something awful was destined to happen to him because of my failures. I waited every day for social services to knock at my door and tell me I was unfit because he wasn’t napping well or because he cried and was fussy. I cried constantly and was overwhelmed with worry.

My mind was constantly swirling with intrusive thoughts, thoughts that, even now, I don’t like to admit I had during that first year. I waited for him to get sick, to die, to be taken away. I waited for the doctors to tell me he had a horrible disease. I waited for my husband to take him and leave. I was convinced that some unimaginable thing was just around the corner.

A year after he was born, we moved again, this time to a larger town with more options for mothers with young children. Where we’d been before, a tiny town with a population of less than 5,000 mostly working-class people, didn’t have much in the way of mom groups or library programs. The majority of families had two working parents and kids in daycare. Our new home was different, and I was able to find and join mom’s group where I met a few mothers with kids the same age as my son. They don’t know it, but they saved my life. After a year of constant anxiety and fear, I finally had a support network. I finally had experienced mothers who could answer my questions and help calm my fears. I had friends. I had relief.

A few months later, when my son was around 18 months old, I finally recognized that my experiences weren’t the norm. None of the mothers I’d befriended worried like I did or had anxiety attacks over everyday things like rashes or teething or milestones. So I saw a doctor about my symptoms. I was diagnosed with PPD and PPA and referred to a therapist. The fog finally lifted. I could see my son for the amazing little boy he was and not as a source of fear or anxiety. My worries calmed to normal, typical mom levels and, thankfully, after my second child was born, I was aware enough of the symptoms of PPA and PPD to overcome them.

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Birth stories: the myth of “one size fits all” birth plan

When my mother recounts my birth story, she says she remembers very little about the experience. She entered the hospital with labor pains, received a medication whose name she can no longer recall, and woke up having birthed a baby. She remembers nothing of the long hours in between or the push and pull of her womb contracting. She remembers holding me, her firstborn, hours later, but even this memory lies shrouded in fog—a result of the lingering effects of the medicine.

My own three birth experiences varied—and though I had a plan each time, I quickly came to realize that there isn’t necessarily a “right way” to give birth. Each birth is its own experience, and adjustments made along the way are normal—and the options we have to choose from are even liberating.

When I became pregnant with my first child, I remembered the mystery of my own birth story and I knew I wanted to choose a different path. Doctors no longer medicate laboring women to the point of unconsciousness, but I wanted more control over the story the little girl growing in my belly would hear about her own beginning. As a nurse, I had experienced my share of medicalized births on the maternity ward, and while I fully supported and appreciated this choice, I felt it wasn’t the best option for me.

I found a wonderful, holistic midwife to deliver my first baby, but she only delivered in hospitals, so I went to the hospital too. My labor was surprisingly slow and arduous, and I grew exhausted after many hours of contractions with no sign of an actual baby. I had planned for the least invasive, most natural birth possible, but my first birth became a hybrid of medical care and alternative medicine, eventually ending in an induction with a complete epidural. My midwife supported every decision this inexperienced mother made out of fear, pain, and an extended labor. Although it was necessary at the time, in retrospect I felt disappointed that my attempt at natural birth had become a medical procedure.

My second child, born three years later, drew his first breath from my bedroom floor. A breeze blew back the curtain from the open window, filling the bedroom with light as my son entered the world. We lived in England at the time, and home births via midwife were considered normal and a very popular birthing option. When I first told family and friends in the United States that we were planning a home birth, I could feel their collective anxiety radiate across the phone lines. This was risky in their eyes: Why wasn’t I giving birth in the hospital where all laboring mothers belonged?

But I wanted a more natural experience than my first. I remembered the strange and sterile environment of my first birth, the shaking and vomiting after the epidural, the elusive nature of sleep in the hospital. With no complications and a low-risk pregnancy, I felt grateful for a home birth option. Not every mother has the opportunity to choose how she wants to birth their child. I ended my son’s birthday in the bathtub sipping a cup of strong, milky tea while the midwife weighed and measured him beside me.

My youngest daughter, our third child, laughs about her older brother’s birth on the bedroom floor, although it remains my favorite birth story. Like her older sister, she slipped into the hands of a midwife in an American hospital. Our family had returned Stateside the year before, and I wanted another home birth but was unable to find a midwife who would do so. Instead, I decided on a midwife-led hospital birth without medication, just like the first time, but this time everything progressed just as I planned it—which is rarely the case when it comes to having a baby.

After my girl’s birth, the attending nurse sat with me and chatted as I breastfed my newborn daughter. She told me of the day she brought home her adopted daughter and the unbelievable connection she made when she realized she’d been the nurse attending her daughter’s birth in the same hospital months earlier. I shook my head, incredulous at such serendipity.

My nurse’s story, as well as the experiences of the many women I’ve seen give birth in my own days as a nurse, reminded me of the many ways there are to birth and bring home a baby. While I had a particular vision for my own experiences, it didn’t always connect with the vision my family and friends had for me. However, I trusted my instincts regarding the welfare of my body and my children’s birthdays. There is no one-size-fits-all birth option. I find this incredibly liberating. There is no shame in choosing pain medication or natural birth, choosing a midwife or a doctor, choosing one birth option and then an entirely different one years later. There is no shame in changing one’s mind at the last minute, or scheduling a cesarean section, or bringing home a baby through adoption rather than through one’s belly. We are women living in an age where we are spoiled for choice and options. It’s a gift to choose, and it’s a gift to receive medical intervention if the need arises.

I’m grateful for my complication-free birthing experiences, for the midwives, and for the freedom to decide how I would like to give birth to my children. Looking back, I believe I would have been happy no matter how my children arrived here, regardless of how contrary the experience may have been to my own vision. And after seeing many women successfully navigate unexpected birth stories, I recognize that while planning is healthy and wise, it’s how we nurture our children inside and outside the womb that matters.

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Just doula it

“Matrescence” describes a person’s transition into parenthood. It’s a time of growth, learning, and celebrating the birth of your healthy baby. But what happens when the matrescence you dreamed of isn’t your reality? What happens when your newborn isn’t healthy? The postpartum months are already challenging, and when you add the stress of caring for a newborn with special needs, the weight can be crushing. I know because I’ve lived it. I’ve learned that parenting a child with special medical needs requires support, and that’s why I’ve chosen to take my experiences and use them to help serve other parents through my work as a doula. Over the last two years, I’ve experienced deep pain intermingled with incredible joy and a newfound ability to give back to those who walk the path after me. My matrescence has been a gift that I didn’t know I needed, and I love sharing that gift with others.

In 2016, I became pregnant with twins after about a year of IVF treatments. I remember breathing a sigh of relief. Getting and staying pregnant is the “finish line” of fertility treatment, and my twins and I had made it. In my mind, we were safe. I rode this high through the first 19 weeks of pregnancy, and then came the 20-week anatomy scan. Carrying twins meant that I had more ultrasounds than during a typical pregnancy, but I had been really looking forward to this one. With my first daughter, this scan had been a traumatic appointment that came at the end of a month-long bedrest. This time around, I was ready for a happy visit where I’d get confirmation that the babies were healthy, find out their sexes, and give them names. But that’s not what happened.

The ultrasound tech spent much more time focusing on “twin A” and her heart. I could tell that something was wrong, because she breezed right through the scan of “twin B” and went back to spend some more time on “twin A.” When the high-risk OBGYN came into the room, my heart sank. My daughter was given the complex diagnosis of hypoplastic right heart syndrome— essentially half of her heart was missing. This meant that without open-heart surgery she would die within weeks of birth. Immediately, appointments were made with a pediatric cardiologist, and then my husband I were whisked through the back office door in tears. Our focus changed in the blink of an eye, and we entered survival mode. We learned about mortality rates and surgeries (she’d need three before age five) and met other families in similar situations. We gained strength from these families’ success stories and mourned with those who had suffered devastating losses. At 37 weeks’ gestation, my twins were born via planned cesarean section. In the operating room, each baby had her own NICU team waiting for her arrival. I was strapped onto the operating table, having a total out-of-body experience and absolutely terrified. Would my brain let me love someone who was so fragile, a baby who may never come home? June, “twin A,” was born at five pounds, four ounces.

June had her first open-heart surgery at just two weeks old and was on life support for days afterward. She came home 41 days after birth. She had her second open-heart surgery at five months old and sailed through her recovery in just a week. The months between the two surgeries were full of weight checks, feeding tubes, oxygen monitors, and wondering if life could ever feel good again. Not only was I taking care of two newborns and a toddler, but everyone else seemed to have moved on with their lives. Didn’t they see that I was drowning? I wish I’d known about postpartum doulas when the twins were young—I thought doulas were only for birthing babies. What I needed was someone to come in and care for me, to nurture me and meet me exactly where I was in my matrescence. I needed someone who wasn’t going through the same traumas and transitional growing pains as me, and now I know that a postpartum doula would have filled that role beautifully.

Eventually life began to settle into a new normal. June’s personality started to shine through, and we’ve been given the incredible honor of seeing her grow up and thrive. She’s two years old now and the date of her third heart surgery is quickly approaching. Along the way, our family has gotten to know many other children with heart conditions who haven’t made it. I have a list in my phone of 14 children who have lost their lives to heart defects. I stop and remember how lucky we are to still have her with us every single day, and I know that one day it could be her loss that we’re mourning.

Settling into my role as a mother of a child with special needs has been a slow process. There’s a lot to work through, and I don’t think that my matrescence will ever really be over. Over the last two years I searched for ways to find purpose in this pain, finally finding it by becoming a birth and postpartum doula and helping other parents become empowered advocates for their families. I provide care for all birthing parents but place special focus on families who’ve received a life-limiting prenatal diagnosis for their child. I make postpartum visits in the hospital if that’s where a child is living for the first few weeks or months of their life. I help parents make the hospital feel like their child’s special place and supporting them as they learn how to help care for their child while they’re still in the hospital.

I remember being so afraid to touch my daughter while she was hooked up to her various wires and IV lines. Nurses don’t usually have time to nurture and educate the parents, or ask them how they’re bonding with their newborn, because they’re so busy just keeping their patient alive. I’m here to help bridge that gap and make sure that parents are being supported in their new role, no matter where they spend their first few months after birth or adoption.

I also offer “first day home” services, where I help families make the transition from hospital to home after being discharged. I wish I’d had this kind of support when we brought our daughter home! I didn’t know the simple skills I’d need to succeed in my new role as a “medical mama” and love being able to help bring the knowledge I’ve gained and the resources I have to these families. I’m also planning to enroll in bereavement doula classes, because loss is an unfortunate outcome for some families who give birth to these special babies, and they need support through their grief journey too.

It takes a strong support system to help a new parent thrive, and it’s an honor to be a part of a family’s care team. Before I had my twins, I thought that the only truly successful birth experience was one where all of the outcomes were positive. Now I know that beauty also exists in the struggles and the triumphs, in finding strength in the darkness, and using that strength to help support and make space for other families who need it.

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