With many years of experience as birth professionals, we have come to understand how critical the choice of care provider is to the family’s birth experience. Often, parents spend a lot of time preparing and educating themselves for birth and may even hire a doula to help them through the process; however, these steps may not be enough for them to achieve their birth goals if their doctor or midwife is not also on the same page. Whether you are thinking of becoming pregnant or nearing the end of your pregnancy, it is never too early or too late to ask questions, consider your options or find someone (new) who will support your desires for birth. Follow these steps to evaluate your current care provider or when choosing a new care provider for your pregnancy.
Step 1: Understand Your Provider’s Philosophy (and Make Sure it Matches Yours)
There is a wide spectrum of attitudes and beliefs about birth. Your care provider's perspective of the birth process can have a HUGE impact on your birth. Is your care provider supportive and encouraging of the natural process or does he/she prefer the medical approach of a "managed" birth? (For more about these differing approaches see Childbirth Connection.) How can you determine your care provider’s philosophy and be confident in your choice?
Some examples are listed below with an explanation of what your care provider’s answers may mean. Please note, that the medical degree your care provider holds and their specialty (i.e. Obstetrician, Family Practice, or Midwife) should not be used to assume their perspective on birth. Some midwives practice "managed" care, while some physicians practice "midwifery-like" care and are very trusting of the natural process. It is up to you to find out what your care provider believes and how he or she typically practices. You don't want to be in a position to have to fight for your preferences, be surprised by your provider’s actions or try to change his or her mind during your labor or birth. You want someone you trust, who is on the same page and will openly support your choices during your birth. (Please note that these questions are best used to have an open and mutually respectful dialogue, not to grill your care provider. You may wish to choose one or two that are the most meaningful to you to start, and ask for a longer appointment time to discuss your goals and desires for birth.
Tell me about a “typical” birth that you attend. (This open-ended question will shed a lot of light on the provider’s perspectives, philosophies and standards of practice.)
What is your standard practice for women who go “past due?” (A provider who routinely induces labor at 40 or 41 weeks in the absence of medical indications may not be a good fit for a mother who wishes to avoid induction.)
What is your rate of induction? What is the most common reason for induction? (Induction introduces risks and can increase your chance of a cesarean due to fetal distress or failure to progress. Care providers can differ in the frequency of and reasons for an induction.)
What percentage of your patients have natural, spontaneous childbirth (labor that starts and continues without interventions)? (A provider with a high percentage most likely has a philosophy of trusting birth, knows how to support natural birth and will be more comfortable doing so.)
What is your after-hours procedure? (Will you be able to talk to your personal doctor/midwife or just the person on call?)
What percentage of your patients’ births do you attend? (How individual is the care they offer? Do they make an attempt to attend most of their patients’ births themselves, or do you end up with whomever happens to be on call?)
How many partners are in your practice? (If there are 10 doctors who rotate call then you’re not likely to know the person attending your birth. This also means that you are more likely to encounter someone who does not have the same philosophy about birth.)
What percentage of patients have a cesarean section in your practice? (This doesn't tell you the whole story, but it can help you better understand your risk of having a cesarean. Read more about C-section rates on childbirthconnection.org)
What percentage of patients have episiotomies? What is your suture rate? How do you help women avoid tearing? (Again, this can help you better understand your risks. You can learn how likely they are to provide perineal support, to assist you in finding the best position to avoid an episiotomy and to avoid interventions that increase the chance of having an episiotomy [such as epidurals, forceps or vacuum extraction]).
What is the most common choice for pain relief among your patients? (If you desire a natural birth, be concerned if your care provider encourages pain medication or even chastises you for not planning on having pain medication. Though the choice for pain relief is always yours, your care provider’s attitude can influence you during labor. If desired, there are many alternatives to anesthesia or narcotics to help a woman cope with labor and your care provider should discuss these with you.)
How quickly do you clamp and cut the umbilical cord? How do you feel about delayed clamping? How much time is allowed for the spontaneous delivery of the placenta? What do you do if this limit has expired? (What approach is used during 3rd stage for a natural birth or for a medically managed birth? Is the natural process respected or is there a standard protocol? Does your care provider encourage you to nurse and release you own naturally occurring hormones to help expel the placenta?)
Will I be given immediate and uninterrupted skin-to-skin contact with my new baby after birth?(This is quickly becoming recognized as critically beneficial to both mother and baby and should be standard practice. Be concerned if the provider insists on immediate separation of baby and mother.)
There are many other questions you may wish to ask your care provider or anyone you are interviewing for your birth. Take notes to better remember the information discussed and ask follow-up questions at a future appointment. When you have gathered enough information, read Steps for Choosing the Right Care Provider Part 2 for information on how to evaluate your options (step 2) and if necessary, how to find a new care provider (step 3).
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