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HOW TO HAVE AN UN-MEDICATED CHILDBIRTH PART 2: CHOOSING A CARE PROVIDER

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I’m really biased when it comes to choosing a care provider.  I’m going to say right as we start that I like the midwifery model of care so.much.better than the obstetric one.  With that being said I have met plenty of horrible midwifes and many wonderful obstetricians.  The important thing is choosing who is right for you.  Midwifery is defined as the practice of assisting at childbirth.  Obstetrician is defined as the branch of medicine that concerns the management of pregnancy, childbirth and postpartum.  Those definitions speak very clearly to the attitudes different care providers have towards their profession.  The majority of Obstetricians I’ve observed are not there to support the woman in labor until she is 10+ centimeters and just about to deliver.  It seems odd to me to pay someone $2500 for 5 minutes of their time.  I love this article about one hospital that brought down their c-section rates-when OBs were finally asked to answer personally for the number of c-sections they were performing their numbers changed.

To really paint a picture of the difference, a personal story: With my first baby I interviewed and hired a great Obstetrician.  It wasn’t until numbers changed on my chart that he asked me how I was feeling if I’d been puking.  I’d lost 25 lbs in my first month of pregnancy and had been too ill to even bring it up with him because I just didn’t realize that what I had was far beyond normal morning sickness.  At no point in the previous 2 visits had he asked me how I was feeling-I had just had a pap done, and ultrasound done by a tech and been measured and sent on my way-too ill and despondent to know that pregnancy could be any different.  The first med he prescribed me to help with the nausea is actually considered a sedative-but he didn’t mention that at any point.  I worked and drove taking a tranquilizer (apparently my pharmacist sucked too!) and continued to puke, not caring as much because I was too high on this tranquilizer.  It wasn’t until I dragged myself back and explained that he prescribed me a proper med.  This was the doc that won in the interview process!  (Why did he win?  He’s anti-episiotomy, very patient, and had the lowest c-section rate of every doc I talked to.  The only thing I knew going into my first pregnancy was that I didn’t want anyone cutting any part of me).  This story is fairly indicative of prenatal care with an OB.  They’re usually very busy, short in their visits, and I often felt like I was on a conveyor belt when I visited.

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Midwives typically schedule longer appointments.  Mental health and nutrition are a higher priority.  Technological intervention is minimized. In many practices they don’t have a nursing staff and you meet directly with your midwife(s).  Ideally they are trained to refer you to an OB practice if needed.  Midwives stay with your while you’re in labor and are close by when you need them. Even delivering with a midwife that was part of an obstetric practice was completely different for me.  This article even claims better outcomes for women who deliver with midwifes and see them for their prenatal care (specifically licensed midwives delivering in the hospital environment).

Obviously all midwives are not going to be amazing and there are going to be some outstanding OB’s that take the extra time and care with their patients.  I’m speaking from personal experience, stories I’ve heard, articles I’ve read and years of working as a photog, doula and assistant to a midwife.

You can’t cover the topic of care providers without location coming up.  Obviously you can’t have an obstetrician at your homebirth and only specific midwives have hospital privileges.  Here in the state of Utah midwifery is poorly regulated (as with several other states) and so it’s extra important to ask lots of questions.  There are varying degrees of midwives and this is a great article about the differences.  Personally I prefer a CNM, mainly because I need the additional assistance that only a CNM can provide (zofran and lots of IV therapy).   The following list of questions offers some great insights into whether or not your interviewee is the right care provider for you. (the inspiration for this list can be found here)  I recommend answering the questions yourself first to see what’s most important to you and then interviewing care providers until you find the one that agrees most with you.  Some of these questions are definitely more specific to midwive or OB’s, but almost all should apply to both.

  1. How long have you been practicing?
  2. Why did you become a midwife/ob/doctor?
  3. What is your training/education/certification? this question is especially important interviewing midwives
  4. Will you deliver the baby, or will you assist me in birthing him/her/them?
  5. Are you familiar with non-traditional delivery positions? (ie squatting, hands & knees, etc) most midwives will be very familiar-OBs not so much.  If delivering in a non-traditional position is important to you, I would drill them on this particular question.
  6. What are your feelings about un-medicated childbirth? this quickly tells you if you’ll be supported.
  7. How do you feel about birth plans? this also says a lot about the practitioner. It’s not that they should promise to keep every bit of your plan, it’s that they support you putting one together and thinking things through.
  8. How often during labor do you perform vaginal examinations?  How necessary do you consider them?
  9. Are you familiar with other ways of assessing dilation? (i.e. vocalization)
  10. Do you deliver breech? Do you deliver all kinds of breech? Do you have training and experience in this kind of delivery?  If not, do you have a care provider you would refer me to if the baby had not turned?  Some OBs still do breech deliveries, particularly in the instance of a breech twin. I would hesitate to do a breech baby out of the hospital, but it’s a challenge to find an OB that will.
  11. Do you have experience with turning babies that are breech?  some OBs do and some will need to refer you to another one.
  12. At what point would I get ‘risked out’ of your practice? this is particularly important to ask midwives, but it applies to OB’s as well.
  13. Will you allow me to delay cord clamping? get details about this and specifically how they follow through with it.
  14. How often do you perform episiotomies?  Do you consider them routine? sometimes just wasn’t an acceptable answer to me.  I wanted details about “sometimes” and what that meant.
  15. What will you do to prevent tearing/episiotomy?  How will you repair if I do tear? you want to know that you’ll be supported and helped not to tear (lubricant, hot compress) and that if you do, they know what they’re doing when they stitch you up!
  16. Can I be monitored with a doppler instead of continual monitoring? get details about this if you’re planning a hospital birth.  This alone can be the difference between getting an epidural and delivering without.
  17. Do you have experience and recommendations for prenatal nutrition?
  18. Do you deliver twins? How do you handle twins and how possible is it for me to have a vaginal birth? this is another thing I wouldn’t attempt at home, but it would be a huge priority for me to find an OB that supports vaginal birth of twins.
  19. Are you connected to a birth/parenting community I could get to know?
  20. What kind of breastfeeding support will be available to me?
  21. Do you do the Gestational Diabetes screening?
  22. Do you continue to see clients with Gestational Diabetes, or do you refer them to an obstetrics practice?  How will being diagnosed with Gestational Diabetes affect my care and delivery?
  23. How much do you charge, and by what date would the full amount be due?
  24. Do you accept payment plans? What is your refund policy if we decide to switch care providers?
  25. How often do your clients succeed in having their health insurance provider reimburse them?
  26. Do you work with doulas?
  27. Do you work with birth photographers?
  28. Who is your back-up pair of hands/midwifery assistant? When can I meet him/her?  If you won’t be attending my birth,who will?
  29. What is your hospital transfer rate?
  30. What is your c-section rate?  Midwives/OB’s should know their stats on this one and this number matters if you don’t want a c-section.
  31. How do you feel about VBACs? (vaginal birth after cesarean)  What has been your success rate with them?
  32. In what situations do you feel that an induction is necessary?  What is your induction rate? this is also a very important number to ask about, along with how they induce-do they go straight to pitocin or are other induction methods available?
  33. How far past due will you “allow me” to go before transfer/induction/c-section?
  34. What equipment do you bring with you to a birth? Are you legally allowed to carry medications (for complications)? Do you?
  35. Are you trained in neonatal resuscitation?  Walk me through a situation where my baby needed to be resuscitated-what should I expect? this seems like a “the hospital will just take care of it” sort of a thing.  It’s good to ask. Our hospital resuscitates in-room unless you happen to be in the small room at the end of the hall.  Then everyone just leaves you and takes off with your baby. Prepare yourself for these possible scenarios.  At home they had better be certified and they had better have an assistant that is to.  This alone is a deciding factor as to whether or not you should hire your midwife.  If they use the phrase “it’s not necessary” run.
  36. How many births do  you take on per month/year? this indicates the likelihood of your person being there for you.
  37. Are you planning any vacations, trips, major surgeries, or other events that would interfere with your attendance at the birth?
  38. What kind of postpartum care do you offer?
  39. Do you facilitate water birth?  Laboring in the water?
  40. What methods of pain management do you recommend?
  41. My partner has x, y, z fears about  birth. How have you dealt with this in the past?
  42. What is your preferred method of communication, prenatally (phone, email, text)?  Will I have a direct phone number to reach you for labor?
  43. Have you had any loss (baby or mother)? Why and what happened?

Also, here are some questions to ask yourself after the visit:

  1. Would you be friends with these people? Why/Why not? friendship absolutely should not make this choice for you BUT it is a plus
  2. Were you able to ask all the questions you wanted to? Why/Why not?
  3. How did you feel about the birth when talking with them, compared to how you feel about it normally? More or less excited, more or less anxious?
  4. Was the visit enjoyable?
  5. If there were other family members present, what was their experience of the interaction?
  6. Did you sense that either was intimidated by your birth nerdiness and stance as an educated consumer?

The important thing when asking these questions is to prioritize.  By answering these questions yourself you should be able to assess what is most important to you.  Then, ideally, you go find a care provider that aligns with your same beliefs.  Interview people.  I often tell women that they wouldn’t allow a waitress to treat them the way their midwife/doctor is treating them, and you pay your waitress A LOT less money.  If we commit to asking questions and finding the best care providers, we end up with a much better line up of doctors and midwives, simply because the demand was for better.  If we continue to allow ourselves to be treated badly, we perpetuate those problems.  I want the next generation of women to be treated better than we currently are, just like we’re being treated so much better than the generation before us.  Considering what our grandmothers went through to get us here, we are very, very blessed.  But there’s still so much room for improvement-we’re now ranking the worst of all the developed countries and I feel like we could be doing better.  We just have to ask for it.

Make sure your partner is on board with your choice as well.  Partners are a big part of the labor and delivery process and I think it is so important that they know who will be helping you deliver.  I once went to a birth and the woman had hired a female OB.  Her OB didn’t want to come in until the very end and so a partner in her practice was covering in the meantime.  Her husband was furious a male doctor was examining his wife’s lady-parts and very uncomfortable with the whole thing.  Had they asked her who would be covering her in the event of her absence they could have discussed the possibility of a male OB before they were actually in the situation.  Ideally if that doctor had known how uncomfortable the husband was she could have been a little more sensitive to the fact and been there-or referred them to a practice with more than one female OB.  It’s no fun dealing with an upset spouse when you’re in the middle of delivering a child.

Have anything to add?  What questions were of most value to you in determining your care provider?  Comment below!

MORE FROM BIRTH WEEK:

A BEAUTIFUL MATERNITY SESSION & THE BEGINNING OF BIRTH WEEK

HOW TO HAVE AN UN-MEDICATED CHILDBIRTH PART 1: EDUCATION

HOW TO HAVE AN UNMEDICATED CHILDBIRTH PART 3: HIRING A DOULA

WHY DO I WANT AN UNMEDICATED CHILDBIRTH?

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