The Top Ten Questions to Ask When Choosing Your Birth Provider

May 24, 2012 Guest Blogger 0 comments

margaret
Making sure you and your birth provider are a good fit for one another is one of the best things you can do for your birth experience, and while this can be done at any time during your pregnancy, the earlier you find out whether you and your midwife or obstetrician are a good fit, the better. The following list is a good way to increase the likelihood you are birthing in a place where your individual needs will be met and your choices will be respected.

1. Where do you deliver and what do I need to know about the facilities?

Does the hospital or birth center offer tubs for labor and/or delivery? Can your partner and baby room in with you after delivery? Does the facility or practice prohibit eating or drinking during labor? The minutiae of the facility where you will give birth (such as pillowtop mattresses and downtown skyline views) are also nice to know, but keep in mind that many women feel the plushest of facilities cannot make up for a provider whose birth philosophy does not mesh will with their own.

2. What will I owe you?

Typically a question posed to your insurance company rather than your provider, this should enable you to have a fairly accurate estimate of what your out-of-pocket costs will be for a vaginal or caesarean birth.

3. Who will deliver my baby?

Midwives and obstetricians often work on teams and it may be important to you to know up front how many people are on that team and whether you will be able to meet all of them during your prenatal care.

4. What is the caesarean birth rate of your practice?

How does this differ from the hospital where your practice delivers, if at all? The current c-section rate is approximately 35% but a rate of around 10-15% or less is considered desirable by the World Health Organization as well as by other respected healthcare organizations and professionals; if you hope to avoid a surgical birth then finding a practice that has a lower rate of caesareans is in your best interest.

5. What is your philosophy of birth?

A provider’s philosophy of birth may be best understood by discussing a variety of topics. For example, does the provider actively manage labor or believe in letting it proceed on its own, generally with as few interventions as possible?  You may want to ask specifically about how they manage the third stage of labor (delivery of the placenta) and what their standard practices are immediately following birth, as well. This will help you understand whether they allow the placenta to deliver on its own or if they use any traction on the cord to do so. Do they allow skin to skin time between you and baby after birth and are they willing to delay routine exams and eye care, if you elect to have it? When does the cord need to be cut? These items may be important to you, especially if you want to delay cord clamping or immediately offer to nurse baby after birth. Consider whether the picture they paint of their birth philosophy blends well with your own.

6. What do you recommend for pain in labor?

What are your thoughts on epidurals? Whether you want an epidural or not, this question will help you understand whether your provider feels the same way. Some practices may be used to an epidural rate upwards of 90%, while others may be accustomed to much lower rates of 10% or less. Certain providers, for example, may not be used to seeing women labor without an epidural and may not know ways to offer comfort measures other than medication to a laboring woman; if avoiding medication is important to you, this provider may not be your best choice.

7. What positions can I labor in?

This will give you another idea as to whether this practice manages labor or allows it to progress naturally. If you desire an unmedicated birth, research has shown that women who are able to labor in different positions typically experience faster births and are able to use these positions to cope with pain, turn a posterior baby, and more.

8. Do you require continuous fetal monitoring?

In most cases, continuous fetal monitoring will require you to be tethered to a hospital bed, so knowing your practice’s policy on fetal monitoring (continuous or intermittent, and whether they have telemetry units available) will help you understand how mobile you are likely to be able to be if you deliver with them.

9. How do you help reduce the chance of tears or episiotomy?

ACOG guidelines now state that episiotomies should only be done if medically necessary, which is typically not often. Perineal massage, warm compresses, and gravity-friendly pushing positions are other ways to help reduce the chance of tearing.

10. How long past my due date will your practice permit me to go before induction?

A full term pregnancy typically lasts between 38 and 42 weeks. Many providers will not discuss induction until you near 42 weeks, but others are uncomfortable with letting a pregnancy progress beyond 41 weeks. Elective caesareans prior to 39 weeks are not recommended.

Also be sure to ask any other particular questions that may be of interest to you and your partner, such as whether your partner or you can help catch the baby or whether you can labor in your own gown, if you prefer. All of these questions should provide you a good understanding of whether you and your provider are a good fit for one another, or if you should keep shopping around. Consider the analogy of shopping for a car as similar to shopping for a birth provider; you would likely never pick up the first car you spot on the lot without doing your homework, right? Similarly, take your time when choosing your provider and do not be afraid to make a change if something does not feel right in your heart.

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Image provided by Que Brown

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