While I didn’t know the exact definition of family-centered maternity care (FCMC) when I was pregnant and planning my birth, the birth I envisioned and hoped for fit that model without my knowing it.
I came to be more interested in the concept when I joined a patient and family advisory council for maternal services for our local health region. I joined not because I want all moms to have my exact experience, but so they may each have the experience they desire and their choices respected.
There are various definitions of FCMC but the main gist is that it respects and takes into consideration the patients’ preferences and empowers patients to be responsible for their self-care. It also reduces the use of interventions that are unwanted, inappropriate, or not needed (more on this definition can be found here, though there are many others as well). Reducing the use of unnecessary interventions matters because interventions can directly affect breastfeeding.
It was fitting then when last fall I was contacted by a postpartum nurse/instructor who is also a PhD student focusing on obstetrical research. She wanted to speak to a woman about her birth experience to see how it fit into the FCMC model. I’m always happy to share my birth story, and I was even more excited because she wanted to make a video project. My only regret, if you can call it that, from our birth is I forgot to call our birth photographer we’d booked – baby just came too fast and it slipped our minds! My doula took some pictures, which were amazing, but of course not quite the same.
This nurse and I discussed how my birth fit into the principles of FCMC. Here they are in more detail:
- Childbirth is seen as a wellness, not illness, and a normal life event.
- Care is personalized to the individual needs of the family.
- The hospital team assists the family in making informed choices for their care during pregnancy, labour, birth, postpartum, and newborn care, and strives to provide them with the experience they desire.
- The father and/or other supportive persons of the mother’s choice are actively involved in the care.
- Whenever the mother wishes, family and friends are encouraged to be present during the entire hospital stay including labour and birth.
- A woman’s labour and birth care are provided in the same location unless a cesarean birth is necessary. Whenever possible, postpartum and newborn care are also given in the same location and by the same caregivers.
- Mothers are encouraged to keep their babies in their rooms at all times, and nursing care focuses on teaching and role modelling while providing safe, quality care for the mom and baby together.
- Parents have access to their high-risk newborns at all times and are included in the care of their infants to the extent possible given the newborn’s condition.
These don’t sound like outrageous expectations, but they are not the norm for every family when they go to give birth in a hospital, and that’s a shame.
Why does this matter? Because a mother’s birth experience has a direct effect on her postpartum experience. We already know we need to do more to improve postpartum care for moms. A good first step would be improving her birth experience as much as possible so she gets off to a good start and doesn’t have to add dealing with a traumatic birth on top of healing her body and taking care of a newborn.
Watch the video below to see the beautiful representation Darcie did of our birth and how it fits into family-centered maternity care. I’d love to hear how your experience fits into this model of care or how it could have been improved to better reflect it.
I knew before I became pregnant that I wanted a doula. I knew the stats on how much a doula could help me achieve the birth I wanted (and conversely, navigate my birth if it didn’t go the way I wanted). With the help of a good friend, I selected four and met them for interviews.
I met two of them outside of my home: one in a coffee shop, one where she worked. The other two came to my home. All lovely women, they were a good mix: one taught yoga and was a registered massage therapist. Another also taught yoga and did placenta encapsulation. Two sort of fit the stereotype many think of with doulas: a bit on the hippie-ish side. The other two didn’t fit that stereotype at all. One taught pilates and was also an esthetician. The other has four of her own children, including a VBAC birth, so vast personal experience.
I was drawn to two of them: the pilates instructor who had years and years of experience and had attended nearly 100 births (she doesn’t have any of her own children, which didn’t cross my mind at the time, so I guess it didn’t matter to me, or I might have asked). The doula who had four children was my last interview and our chat lasted two hours. I felt like I was talking to a friend. I wanted to hire her immediately.
Related: Why silence is golden: the importance of choosing the right caregiver, part 1
When I talked it over with my husband, he wondered if it was because she was the last one, and said people are often drawn to the last choice, in part because we remember it best. In the end, I hired the pilates instructor who had two doulas apprenticing under her. Our rationale was I liked her, we were getting 3 doulas for the price of 1 (one of whom was also a massage therapist, which seemed like a good idea when labour would become painful), and she had a ton of experience.
I continued my relationship with the other doula. She lent me two of her books and ended up being the teacher at the prenatal classes we decided to take. When I spoke up about the importance of hiring a doula at this class, I felt a twinge of guilt that I hadn’t chosen her, even though she didn’t seem bothered at all by it. We kept in touch, and I eventually asked the doula I hired if she could be the backup. All of this signalled to me I should have trusted my heart and my gut.
My son and I were always drawn to her warm heart. Here she had just snuggled him to sleep.
As I grew closer to this fourth doula, I had this nagging feeling in the back of my mind that she was the one I should have hired. When the doula we hired forgot our first meeting, that nagging grew stronger. I tried to ignore it, but eventually I said it out loud to my friend who had helped me choose the four to interview. I needed to say it to someone in a safe space and just get it off my chest. Admitting it was another sign I should have followed my heart.
It’s as if the universe was listening. My water broke and contractions began nearly four weeks before my estimated due date. The doula I’d hired was on vacation, so it was my backup I texted, called, and who attended my birth. And when she texted my friend to say I’d had a beautiful birth and delivered my baby boy, our friend replied, “It was you she wanted there all along.”
I know I still would have had a beautiful birth if the doula I’d hired had been there. She is a lovely person, I loved my prenatal pilates class, and it was through that class I met one of my best mommy friends, so I can’t say I regret that decision. It worked out in the end anyway – funny how that happens.
Choose a caregiver with your heart, not with your head. After all, matters of childbirth and parenting are mostly matters of the heart. It didn’t matter who had more or what experience or how many doulas for whatever price; what mattered most was the connection I felt, and it was undeniable. Who has a two-hour visit with someone they just met? People who will become close friends who text each other regularly, try to have coffee together regularly, and tell the other they love them regularly.
Listen to your heart. The heart doesn’t lie. It will guide you to the right decision when choosing a caregiver who will be sharing in some of the most beautiful and intimate moments of your life.