The first step is to find out what's available locally. I would talk to your local doctor or a couple of local doctors. Another good resource can be the local public health nurse. Public health nurses are often pretty sensitive to people's needs, and they should know what the local resources are.

TF: So you could just call the county health department and ask for the public health nurse?

MW: Right. Free clinics or women's clinics are also good resources, if you're lucky enough to have one in your community. If you don't, you can get in touch with such clinics in the nearest big city. Two nationwide organizations can help refer you to a sympathetic doctor, too: the La Leche League and the International Childbirth Education Association You can write to both of these and they'll send you the address of their nearest local chapter.

TF: Could you suggest some good books to be reading around this time?

MW: Yes. Commonsense Childbirth, by Lester Hazell and Birth by Catherine Milinaire are both good. The birth chapter in Our Bodies, Ourselves, also has a lot of good practical information.

Once you've really gotten along into pregnancy, some good books are Spiritual Midwifery and Immaculate Deception. Then there's a super picture book, A Child Is Born, which has excellent color photographs of the fetus at the various stages of development. Pregnant women can spend hours with that one.

The midwives we work with have a library of books on these subjects which they loan out to prospective mothers. It's a really nice service to be able to provide.

TF: What are the most important things to focus on in the prenatal period?

MW: The single most important thing is that the mother respect herself and take care of herself. Prenatal care is not something the doctor does. You can only do it for yourself. What we're doing is monitoring the mother's and baby's well-being. It's the mother who's doing the real work.

TF: What can a couple do if they can't find a local doctor that does things the way they'd like?

MW: I would hope that they would tell their doctor what they'd like. Impress on her or him that these requests are very important to them. Hang in there, and be prepared to negotiate.

If you're assertive and persistent, you may find a great deal more flexibility than you expected. Ask the doctor what his reservations are about your requests. If the physician is worried about legal liability, you may be able to work out a legal waiver stating the things you want and the risks you're willing to accept. For instance, you may want to try to deliver vaginally in the case of a breech presentation, instead of automatically going to a cesarean. It's very important for you and your doctor to discuss these possibilities and choices in advance.

If you are negotiating with your doctor, it's vital to get good counseling regarding risks and procedures. A good deal of this can be done by phone if necessary.

TF: What are the possibilities as to where the birth will take place and who will attend it?

MW: Well, the alternatives range all the way from having the baby at home and delivering it yourself, to home birth with a lay midwife, to home birth with a nurse-midwife, to home birth with a physician.

In the hospital, the alternatives might be an alternative birth-canter-type room, where you can have your friends and family in to witness the birth but have a doctor or midwife in attendance. Or you might choose to have your baby in a regular delivery room, again with a midwife or a physician in attendance.