Picking out a doctor or midwife for your pregnancy can be tough! There are so many factors that we want to (and need to!) consider. Does this Nurse-Midwife take your insurance? Does this OB have privileges at the hospital you liked? A quick search will give you lists and interview forms – pages upon pages of questions such as
- “How many years have you practiced?”,
- “Are you board-certified?”, and,
- “What’s your rate of inductions and cesareans?”.
While those are some great questions to ask, you might not get a good feel for the provider out of yes-or-no questions. So I leave you with some questions that may not be on your typical checklist:
In what other ways should I get support for my pregnancy, labor, postpartum recovery and parenting, outside of your healthcare?
Your healthcare provider will have other patients to attend to. It is unlikely, even with the most hands-on providers, that your doctor or midwife will be able to personally provide all the prenatal education you may want. That they will be able to be by your side, uninterrupted from the moment you go into labor until baby has arrived is even more unlikely. But they know that these resources are available to parents in the community. They may have a list of doulas that they are familiar with. Your doctor or midwife may even have a preferred childbirth preparation style or offer classes in their office or know of a series of classes at their local hospital or birth center.
- Do you usually direct patients to take classes in childbirth, lactation, newborn care?
- Do you encourage patients to hire doulas? To whom would you refer?
In what instances might I see another doctor or midwife?
Many doctors and midwives work in larger practices where they share “call” and divide up who sees clients in labor on which days; patients may even see different providers at different prenatal and postpartum appointments. Providers who have a solo practice usually have specific colleagues who cover for them in instances where they are not available. It is important to understand how your provider makes sure you have support at all times.
For parents planning births outside of the hospital, it is also important to know your midwife’s usual plan for transfer of care (prenatally and in labor), whether or not surgical birth is part of your birth plan. Find out how they typically hand over your care to a doctor in a high-risk situation. Ask which hospital you would be transferred to if a complication arose in labor.
How do you feel about birth plans?
There is an ugly but popular aphorism that detailed birth plans lead to high-intervention births. (I tried rewording this for about 30 minutes, that’s the nicest way I can phrase that.) Luckily not every doctor or midwife feels this way. If you would like to use a birth plan to communicate your birth preferences with your provider and labor support team, start early and do not be afraid to revisit and revise.
- How do you involve parents in the decision-making process?
- How do I communicate preferences to you?
Can I try different positions in labor and birth?
Some of the best practices for vaginal birth encourage moving, changing positions, and using gravity and ergonomics to the advantage of both parent and passenger during labor and birth. In home birth situations, intermittent auscultation, getting into the shower, and frequent positional changes are common. In hospital environments, continuous fetal monitoring is common and mobile alternatives are not always available. Some hospital providers take a wait-and-see approach to positions and movement in labor, some know that they prefer to have a parent push in particular positions.
- Can I labor in water?
- What kind of fetal heart rate monitoring will you do?
- Can you describe a typical scenario when comes time to push?
What happens when baby is born?
How does the doctor or midwife (and the places where they practice) implement best practices for transitional newborn care? Do they participate and encourage “the golden hour” where baby stays with his parent skin-to-skin after birth ? Does the hospital do newborn procedures in their parent’s room? Or will the infant go to the nursery for routine procedures such as the newborn screening, bath or hearing tests? If parents are opting out of the typical routine, will their OB or midwife help communicate those preferences?
What will postpartum care look like?
Your body spent 40 weeks growing a baby and is suddenly faced with a new state of “postpartum”. After birth, your organs will slowly shift back to their former homes. Your uterus has to shrink back to its normal size. Your mammary glands are figuring out how much milk to make. All that relaxin that loosened up ligaments in your pelvis to facilitate birth has left its mark on a weaker muscular system. Your body is very different. Ask providers how long a parent can expect to stay in the hospital or birth center after they deliver, and how many visits their patients usually have as part of routine postpartum care (usually only one or two are part of routine care covered by insurance). Ask, also, if they routinely screen mothers for pelvic floor injuries during postpartum exams.
As much as your physical self may feel different, your mental state is also likely to be different. Baby blues are common for the first few weeks, but as many as one in seven women experience a perinatal mood or anxiety disorder, such as depression, anxiety, OCD, and even psychosis. Ask your provider how they screen for perinatal mood disorders and how often. Then ask them how they usually help parents with issues such as postpartum depression or anxiety.
- Do you offer lactation support in your practice?
- Will postpartum visits be in my home or in your office?
- Are infants allowed in your office?
What if a cesarean birth becomes part of my birth plan?
One in three births in the United States is by cesarean. While many argue about the “right” percentages as goals and how to reduce individual odds, it cannot be argued that there will be situations where the healthcare provider and parent decide that a surgical birth is going to be the best option for health of mother and baby. More and more OBs and operating room staff are making small changes for the involvement and comfort of the parents, like narrating the birth, clear drapes, and skin-to-skin in the OR and recovery room. These changes are part of “family-centered” or “natural” cesareans.
You will want to know if your provider and your hospital support trial of labor after cesarean (TOLAC). Evidence shows that many parents are able to have healthy vaginal births after cesareans (VBAC) if given the chance, but not all providers and hospitals allow for planning for such. If a cesarean birth becomes part of your medical history, you may want the option for a VBAC.
Reframing the questions you ask doctors and midwives will help you immensely during the process of selecting your provider. Take your time to find a provider you are comfortable with.