Who’s who in pregnancy and birth: lead your own care
"Pregnancy care works best when you understand that you are the person the care is for — not the system, not the appointment, not the outcome." - Jilly Clarke, First Trimester Antenatal Specialist, Antenatal Educator and Doula
For many people, pregnancy introduces an entire cast of professionals and supporters they’ve never had to navigate before.
Midwives. Obstetricians. Sonographers. GPs. Physiotherapists. Doulas. Birth partners. Sometimes independent specialists, sometimes hospital-based teams. Each with their own role, remit, and way of working.
What rarely gets explained is how all of these roles fit together — or where you sit within that structure.
Without that clarity, care can begin to feel directional rather than collaborative. Appointments can feel like instructions rather than conversations. Decisions can appear to arrive fully formed, rather than as options you are actively shaping.
This blog exists to make the structure visible — because once you can see how pregnancy care is organised, it becomes much easier to take your place within it.
How the maternity care system can shift control away from you
Pregnancy care operates inside systems designed to manage risk, time, and resources.
Appointments are short. Information is often shared in response to guidelines, screening results, or timelines. Professionals rotate. Continuity varies. Much of the structure prioritises efficiency and safety — which makes sense — but it also shapes how conversations happen.
Over time, this structure can subtly reposition you — from the person decisions are centred around, to the person responding to decisions as they’re presented. Information begins to flow in one direction. Appointments follow set agendas. Decisions are framed as outcomes rather than discussions. It can feel like getting onto the birth conveyor belt. And once you're on, it can be difficult to get off.
Recognising this dynamic matters. When you can see the system clearly, you’re able to engage with it deliberately rather than being carried along by it.
Your role in pregnancy and birth: the person at the centre
You are the central decision-maker in your pregnancy and birth.
Not symbolically. Practically.
Every appointment, test, recommendation, and plan exists because it relates to your body and your baby. Everyone else enters the picture to provide expertise or support for part of that journey — not to take ownership of it.
Leading your own maternity care doesn’t mean rejecting medical advice or professional knowledge. It means understanding that recommendations are offered to you, not made for you. Consent is active, ongoing, and contextual.
When pregnant people step into this role fully, conversations change. Questions come more easily. Decisions feel steadier. Care becomes collaborative — even when circumstances are complex or emotionally charged.
What midwives do — and where their role begins and ends
Midwives are usually the main point of contact throughout pregnancy and labour.
Their role includes:
• monitoring physical wellbeing
• recognising patterns that sit outside expected physiology
• providing information and guidance
• supporting physiological labour and birth
• escalating care when medical input is needed
What midwives don’t control are wider system pressures — appointment length, staffing levels, local trust policies, or hospital-wide protocols.
Understanding this distinction helps conversations land more clearly. A midwife may be the right person to discuss labour physiology or coping strategies, while decisions about induction thresholds or surgical birth sit elsewhere.
What obstetricians and consultants do in pregnancy care
Obstetricians are specialists in complications of pregnancy and birth.
Their expertise becomes particularly relevant when:
• medical conditions are present
• pregnancy deviates from expected patterns
• interventions are being considered or recommended
Their role is to assess risk, explain medical options, and outline recommended pathways based on evidence and clinical guidance.
UK maternity guidance explains that shared decision-making should be part of everyday care in all healthcare settings, including maternity, and describes how clinicians and people accessing services should work together to make choices. It emphasises collaborative conversation and joint decisions based on evidence and personal preferences.
Recommendations inform decisions. They do not replace them.
Why medical professionals can feel like the default authority in the room
Authority in clinical spaces is often communicated before anyone speaks.
You arrive into someone else’s environment. They are seated. They control the computer, the notes, the agenda, the clock. The setting mirrors familiar hierarchies — classrooms, offices, institutions — where one person leads and others respond.
This doesn’t mean professionals hold authority over your decisions. It explains why it can feel that way.
Recognising this dynamic allows you to consciously rebalance it — by asking questions, setting the pace of conversations where possible, and remembering that expertise and authority are not the same thing.
Expertise informs decisions. Authority over your body remains yours.
Birth partners: active support, not passive presence
Birth partners are often told they are “there to support”, without much explanation of what that actually involves.
Their role includes:
• helping hold information when decision-making becomes frequent
• supporting communication with professionals
• protecting rest, focus, and emotional bandwidth
• helping you stay oriented when things move quickly
When birth partners understand both labour physiology and how the maternity system works, they become anchors rather than bystanders.
What doulas and independent support roles actually do
Doulas and independent practitioners offer continuity and relational support alongside medical care.
They don’t diagnose, prescribe, or make decisions. They support you — by helping you process information, reflect on options, prepare questions, and stay connected to your priorities under pressure.
Their role strengthens your ability to engage with maternity care, rather than replacing it.
Explore what a Doula does, in this blog.
How understanding roles changes how decisions feel
When roles aren’t clear in pregnancy care, decisions often feel sudden.
A recommendation is made, but it isn’t obvious whether it’s coming from clinical evidence, local policy, system pressure, or genuine urgency. You’re left trying to work that out in the moment, usually with very little time or space to think.
When you understand who is responsible for what, those same conversations feel different. You can tell when guidance is being offered, when medical risk is being discussed, and when the system itself is shaping the options on the table.
Instead of reacting to decisions as they appear, you’re able to engage with them.
Instead of guessing what’s flexible, you know where questions belong.
And instead of feeling carried along by the process, you remain the person present in every decision.
Leading your care means using support without giving up ownership
Leading your care doesn’t mean doing everything yourself or rejecting the expertise of the people around you.
It means understanding that support works best when it is in service of you, rather than in place of you.
Midwives, doctors, doulas, birth partners — each brings something valuable. Their role is to contribute expertise, care, perspective, or presence. Your role is to hold the thread that connects those contributions together.
When that balance is clear, advice becomes information rather than instruction, and decisions feel anchored rather than urgent.
Pregnancy care that places you at the centre
This perspective underpins all of my antenatal education — helping you understand the system so you can engage with it clearly, confidently, and without losing yourself in the process.
If you want to approach pregnancy and birth feeling informed, supported, and firmly rooted in your role, that learning lives there.
Explore the Refresher Antenatal Course
