Choosing a Caregiver – Part 1

by Brett Imura and Iona Macnab

The single most important decision a woman can make during pregnancy is where and with whom to give birth. It is indeed so important that I will devote two articles to this issue. Although birth is universal, the people you choose to accompany you along this journey can often make or break the experience for you.

It is of course important that you and your partner are ‘on the same page’ in terms of the style of birth you are looking for, but your relationship with your midwife or doctor is also paramount. The caregiver and setting a woman chooses determines the type of care she will receive; her relationship with that caregiver often determines how she will feel about it. If the woman feels as if she has had a high level of input in the decision making process along the way, then she is more likely to view the overall birth experience positively. Did she feel ‘done to’ or did she feel as if she did it? This also holds true for more complicated births which require even more of a feeling of partnership with her caregiver. If the couple has a high level of perceived control and participation, they will have a more positive experience overall.

Research has shown that women may not remember all the details about their births, but they will remember a positive comment, action or feeling imparted by their partner or caregiver. More importantly, they will also remember a negative comment or demeaning action by a staff member that ‘knocked the wind out of her’ and psychologically or emotionally changed the entire course of her labor. These memories are still vivid even decades after the birth and can impact the beginning of parenthood for better or worse. Building a trusting relationship with your chosen caregiver is vital in helping create an enjoyable birthing environment and getting mothering off to a good start.

The process of information gathering regarding birth choices starts with the couple, and ideally, before they are even pregnant. In order to start the search for your desired practitioner, you need to know what your desires are. Find a time to relax, put on some soothing music, infuse the room with a pleasing essential oil, close your eyes, relax through your breath, and imagine how you yourself might want to come into this world if you had the chance to do it all over again. Where would you be born? Who would be there to greet you? What kind of lighting, temperature, aromas, physical sensations would you like to encounter upon your entry into the world? Let your intuition speak to you. Then shift the scene to your present
pregnancy and upcoming birth. In what environment would you like your baby to be born? How would you like to be taken care of during the birthing process? As a couple, you can do this exercise separately and then talk about the images each of you envisioned.

How to integrate those images into your birthing experience then requires a bit of reading about the various ways birth is managed. Finding a good match with a facility and caregiver is easier if you have already pinpointed your personal desires for birth. Try a variety of sources, but keep away from negative birth stories. Books and websites by Sheila Kitzinger (, Gayle Peterson (, and Pam England ( offer clear and empowering information and exercises to help you envision a positive birth experience. Henci Goer’s materials ( make the ‘medicalese’ of obstetric research accessible to women and their partners, assisting in the process of making informed choices. Childbirth Connection ( can keep you up to date with ongoing issues in maternity care from an evidence-based point of view. Lamaze International (, a well-known name in the field of birth, offers many informative articles and online resources to help you get started.

Once you have a clearer image of the kind of birth experience you are looking for, you will have narrowed the field quite a bit. The circumstances of your pregnancy will also obviously play a role in choosing the facility and caregiver right for you. Although birthing in the ocean is not available (as it is in the Florida Keys or in the Black Sea), Japan offers everything from the most technically advanced prenatal and birth care for high risk cases to birthing with a midwife in your own home for women with no known risks.

Parenting Tip

To help imagine a positive birth experience check out visualization tapes from the following resources:

or create your own tape based on imagery in Carl Jones’ book, Mind
Over Labor, published by Viking Penguin and available from Amazon.

Brett Iimura ICCE, mother of two, is the director of the Childbirth Education Center (CEC), serving parents-to-be throughout Japan since 1997. Iona Macnab IBCLC is a lactation consultant in private practice in Tokyo and a mother of three. They have over thirty years of combined experience in Japan, and much experience raising bilingual, bicultural children!