Some New “Questions For Your Care Provider”

As you go through your prenatals, you might want to ask providers a little bit about what they do during the birth itself.  The questions below are useful whether you are meeting a new potential provider or your current one.  
You don’t always need to know what someone’s rates of “this or that” are (and you can look up NY rates on Choices In Childbirth’s site)- it may be more important to ask a few litmus test questions.  Many times this conversation is saved for closer to your estimated due date, but to make sure you’re in the right practice, you might want to learn some things sooner.  

Then your questions may want to address the basics for receiving respectful care and whether your care provider is likely to be the one attending your birth. Some questions are “how many other doctors are in your practice?” or “what days/how many days of the week are you on call?” or “when I am active enough in labor to come in to the hospital, will you be meeting me there, or will I be attended by a resident until I’m pushing?” If you’re considering a hospital-based midwife but feel like you might get locked into a natural birth, some questions are, “how do you support clients with epidurals?” “What are the epidural rates in your practice?” They can be fairly high. You might also want to ask any provider, “how do you help ensure privacy at my birth if I don’t want cleaning staff or students observing/entering my room, or if I don’t want many residents asking me distracting questions only for the sake of practice (as opposed to one person doing a valid initial intake)? If I have a cesarean, will it be you or a resident doing the actual suturing? In case nursing at the breast will be delayed, can you help facilitate a breast pump waiting for me in postpartum to stimulate milk supply?” In two systematic reviews, researchers identified the following factors associated with women’s satisfaction with their childbirth experience: personal expectations, sense of control, caregiver support, the quality of the caregiver–patient relationship, and maternal involvement in decision making (Hodnett, 2002; Hodnett, Gates, Hofmeyr, Sakala, & Weston, 2011). So notice your care provider’s vibe during these questions – is she engaging you in dialogue or does she seem uncomfortable including you in the behind the scenes?

When asked, “do you support natural birth?,” I have never heard of a care provider saying “no!”  But if you want more clarity on their level of experience supporting natural birth, some litmus-test type questions are “how do you support women who want a natural birth?” and “what are some of the positions you have delivered (caught) babies in?” If you hear things like, “Oh, you’ll want to labor at home as long as possible, try staying active and mobile throughout, bring a friend familiar with natural birth or hire a doula, oh, there’s a book Natural Hospital Birth you may want to read! And also I’m really mindful of how I touch my clients without epidurals, because some doctors may not be as gentle helping baby come out when they’re used to women all having epidurals!”– well, you have an idea that they have done this before. If the first response is, “well, birth isn’t really conducive to being planned…” you might be working with someone who thinks the luck of the draw is all that determines if you can see it through.  If you hear “we do whatever you want…” or “we can deliver your baby in any position you want,” it sounds good but is somewhat simplistic – you might ask the follow-up question, “how often do you find yourself helping women who planned a natural birth?” (as opposed to those who labor so fast that you just have to catch the baby).  “Can you tell me about a time you delivered a baby in a position other than back-lying or side-lying?”
You probably already know to ask about policies regarding food and drink in labor (“how often do your patients end up completely free of intravenous fluids?”) or episiotomies (you might hope to hear “oh we rarely to never do it” as opposed to “only when it’s necessary,” which is vague).
Basically, someone who is open with you and has thoughts and suggestions can be a better sign than either yessing or doubting.

Beyond questions about insurance, transfer plan, and where prenatal meetings take place, you may want to find out, “What types of medical procedures do you do routinely? And what types of medical skills do you have in case of an emergency?”  These questions get at two different things – the first gets at routine interventions, and the second gets at skill in case of an emergency.  In my opinion you want the answers to the first question to sound modest and the second question to sound robust.  For example, some homebirth midwives will more likely automatically give the baby a shot of vitamin K after birth – others will talk to you about ordering oral Vitamin K drops for the baby.  Some will automatically hang an IV at some point during labor, others would never unless something was wrong.  Some midwives and doctors say they trust a woman’s body to labor and birth spontaneously but routinely reach inside while the baby is emerging to “help” you stretch, and others truly have a hands-off approach that focuses on following your lead or at most assisting with positioning techniques without being prescriptive about them.

You can also google for a comprehensive “list of questions for your care provider” to jog your thoughts about what’s most important to you, but of course you don’t need to hit every question on a list, and some you will know instinctively based on answers to other things. 

In short, no matter who you choose, a satisfying birth is often the result of you feeling like you’ve been treated with respect and involved in decision-making.  I’ve seen women give over their voice and power as soon as they are in the hands of a midwife, as if they don’t need to participate anymore!  Absolutely give up second-guessing when you find a care provider who jives with your birth philosophies. And still remember that if you made the decision to hire someone offering personalized care as opposed to treatment by the numbers, your voice is essential in the dialogue.  

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