The problem with alternate birthing positions is that she has probably only ever seen birth with women on their backs, so it can be disorienting to her to attend a woman in any other birth position. She may object that she has never received a baby with the mom on hands-and-knees (or in some other alternate position), and you can laugh and say that you’ve never given birth on your back either, so it will be a first for both of you! You can catch more flies with honey than with vinegar. Alternatively, you can say that you are the one paying her, so you expect your wishes to be accommodated within reason, and it is certainly reasonable for you to give birth in some other position than lying on your back in bed, since that is so much harder for you and the baby. If you can find some information to present to her (unfortunately, you probably can’t get her to watch a video during your appointment — although perhaps downloading some YouTube videos and burning them to a DVD for her to watch at home might help [you can download them using <a href="http://www.keepvid.com"KeepVid]) that discuss the benefits to mom and baby from physiologic birth positions, that may be helpful. But, I wouldn’t hold my breath — and even if she acquiesces during your prenatal appointment, that won’t mean that she’ll remember during your birth, nor that she’ll be the birth attendant. Remain optimistic, but also realistic.

Other things you can do include having your husband well-versed in natural-birth philosophy, as well as hire a doula to help safe-guard your space and your plans. You will need to avoid drugs, so that you can use the birth labor tub, and also so that you can remain in control of your body during pushing so that you can avoid being on your back. Realistically, if you have an epidural and can’t feel your legs, you’re going to find it very hard if not impossible to be in any sort of position other than what others can put you in — probably on your back with your legs in stirrups.

Despite the fact that the hospital offers rooms with large water tubs, we are not actually permitted to give birth in the tub, we have to lay down on the bed during the pushing phase. This seems rediculous to me, so I asked the doctor, and she says it is for the doctor’s convenience. Now… I’m wondering the policy on disobeying doctor’s orders, because even though this is my first, I think I will be reluctant to get out for coached pushing.

I strongly recommend a doula in just about every circumstance. Choosing a doula who will advocate for you in this situation would be a definite plus! Talk to doulas in your area (you can do internet searches; DONA.org and CAPPA.net ought to have listings that you can use as a starting point) to see if they know of some OBs who are “natural” minded, and will support you in your desires. Also, try to get in touch with women in your area to see who they recommend and *why*. (The “why” is very important, because you will find some women who chose a particular doctor for exactly the opposite reasons that you might choose. You probably wouldn’t marry your friend’s husband just because she liked him; in just the same way, you shouldn’t pick a doctor just because a friend likes him.) You can call OBs (but you’ll probably have to set up a consultation), and ask them if they’re comfortable with catching the baby with you in a vertical position. Most of them will have never caught a baby like that, so expect some hesitation. I’ve heard that some doctors will not have a problem with women laboring in any position they choose, but will want the woman to lie down on the table/bed to give birth. From now until you give birth, you can try to sound out your doctor(s) to make sure that they will be a good match for you. Listen carefully to how they say what they say, because some people can be very good at making it sound like they agree with you, when in reality they’re just saying what they know you want to hear. You may also be able to have a midwife as an option (although you’ll want to interview them just like you would doctors, because some midwives are as stuck in the medical mindset as any doctor).

I’m not sure if military insurance is different “regular” insurance, as to who and what they cover, but in most states, if midwives are legal, insurance would have to cover them — although there may be some more hoops to jump through or paperwork to fill out if the midwife is not a “preferred provider.” You may even be able to have a home birth (with CPMs or CNMs) covered by insurance in this way, but you’ll want to do your research to make sure. If you have a CNM in a hospital, you’ll likely be able to have insurance pay for it, although it will depend on your particular policy and preferred providers.

In my opinion, it’s worth the extra cost to get a provider you’re comfortable with, who will work with you to do what you want and respect your wishes, and not try to coerce or threaten you into doing something you don’t want to do and is unnecessary anyway. This goes for doctors and midwives. And, depending on your insurance (if you have to pay a percentage of the final bill, as an example), you may end up paying less if you pay for a home birth out-of-pocket than a hospital birth that ends in a C-section; also, since different care providers have different rates for C-sections and other interventions, you may end up paying less for a hospital birth if you choose an out-of-network doctor/midwife who helps you avoid costly and unnecessary interventions, instead of going with a “preferred provider” who coerces or causes you to need a C-section. If you have a single charge (or no charge at all) for the birth, regardless of cost to the insurance company, then this becomes less important. But if the intervention is unnecessary, then it is worth avoiding even if it doesn’t make any difference in your pocket.