Interviewing Doctors and Midwives: What should you ask? | Ruth Castillo Salty Mama Doula

Interviewing Doctors & Midwives: What should you ask?

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: Continue reading

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What Defines a birth? Cesarean birth and language choice | Ruth Castillo, Salty Mama Doula & Family Services

What defines a “birth”?

A closeup photograph of a dictionary entry for the word, "birth". | Ruth Castillo, Salty Mama Doula & Family Services

Birth: a : the emergence of a new individual from the body of its parent
b : the act or process of bringing forth young from the womb. 
Birth.” Merriam-Webster.com. Merriam-Webster, n.d. Web. 5 Apr. 2017.

Who decides what counts as a birth or not?

“Vaginal” and “natural” are often used synonymously to describe birth; instead of considering that “cesarean” would be the antonym, some people would rather use language that detaches “cesarean” completely from “birth”.  There are those who reject phrasing such as “cesarean birth” because it would normalize cesareans as a part of the birth landscape – as if 1 in 3 American births was not by cesarean.  Some people feel that since a surgeon intervened in delivering baby, that it was not “giving birth”.  Toxic thinking like this leaves some parents feeling detached from the experience of their child’s birth.

But cesareans are births.  The body still must open, and baby must come out.

So who decides what counts as a birth?

You do.

Ultimately, you define birth when you do it.  For you birth, may be a very active, all-hands-on-deck birth at home with two doulas, a photographer, a midwife and her assistants, and your family.  Birth might be a quiet affair with just you and your partner in a hospital.  Birth might even be a cesarean.

I most often use “cesarean birth” when I work with clients or speak of my own experience, but I also say cesarean, cesarean section, section, C-section, and surgical birth. Why? When I work with clients as their doula or childbirth educator, I use reflective language. Mirroring the phrasing and language my clients use gives them the power to define their experience. I want to validate that some of my clients give birth via cesarean, and that their journey and decisions are just as valid and valued.

Birth workers like myself, will always work towards encouraging healthy pregnancy and birth practices — practices that increase the overall health of all parents and infants.  When we work on a one-on-one level, we step back from philosophy and support each individual where they are.

I help people as they navigate pregnancy and birth, however that happens. I will always help them find the best practices to use for their health – physical and mental.  If my use of the phrase “cesarean birth” helps them to frame their experience of their child’s birth, then that is precisely what I plan to do.  Because language matters.

Best Laid (birth) Plans…

Or, “Rethinking the ‘BIRTH PLAN.'”

As more gestating parents become more aware that they have options in birth, more parents rely on “birth plans” to communicate how they want their birth to go.  But there’s a few problems with this.

The phrase “birth plan” is a misnomer.

Whether it’s a five-page form, a one-page list, or a fun minimalist poster, calling it a birth “plan” just isn’t quite right.  I like to call them “birth intentions” or “preferences”.  I’ve seen them called maps, visions and wish lists.  And that’s what they are.  It’s a collection of preferences, not an itinerary.  When we say “plan” over “preferences, we set ourselves up to be upset.

Birth plans are not a substitute for childbirth education and preparation.

Nowadays, we can go to just about any pregnancy-focused website and find a blank birth plan form.  These six-page monstrosities list options that sometimes are out of date or maybe not available in your city, state or even country.  (Sad but true: Nitrous Oxide as a pain management option is not currently available in South Texas.)  There is an attitude that by having decided which boxes to check, one knows their options.

It isn’t so!  Many childbirth preparation courses will help you understand different birth-related medical procedures and options available to you ahead of labor.  And a good class will give you and your birth partners the tools to make decisions when the work of labor and birth are taking their toll on you.  A well-prepared laboring pair is able to be flexible about the “plan” because they are ready to ask questions of their health care provider when changes in the plan come up and give their informed consent.  Modern childbirth preparation classes are as much about the mental and emotional preparation as they are about the physical and factual.

Birth plans are not a substitute for communication.

Some people never talk about their birth plans with their health care provider.  And maybe it’s because their doctor or midwife never asked if they had a birth plan… but do not assume that means your healthcare provider is on board with your plan.  Doctors, midwives and maternity care facilities draw upon their experience and philosophies towards birth and already have a baseline plan of action for patients giving birth.  Discussing your birth plan during prenatal care appointments gives both parents and their providers the chance to understand each other’s philosophies better.  And maybe if the parent’s attitudes and desires toward birth don’t mesh with their provider’s, there’s still time to seek out a provider who will.

So promise me parents, use your birth “plans” as a starting point to facilitate communication between you, the laboring parents, and your health care providers.  A doula or childbirth educator can help get you started.