Choosing a great health care provider is an important step towards having a satisfying birth. To aid in this process I have come up with a list of questions I like to ask maternity health care providers. Remember that you are an individual and the answers to these questions only have to satisfy you and your birthing goals.
1. What is your philosophy about birth.
This is an important question and the one that will really help you to determine who this care provider is and what they are or are not comfortable with. A care provider who answers this question from the point of view that birth is inherently dangerous or birth is a problem waiting to happen is going to provide a different type of care to a provider who believes that birth is a normal and natural (physiological) process. This is also a good time to discuss the expectant versus managed approach to birth.
2. How much of your care is based on current evidence and how much is based on experience?
Ideally, a health care provider will base their care on a mixture of those things. Too far either way and they risk not being able to adapt to the particular circumstances of the woman in their care. A really good health care provider will be up to date with current evidence-based practices and have the experience to know when a woman's individual circumstances would dictate that they should or shouldn't be followed. Remember that it is ALWAYS your choice as to weather you take the advice of your health care provider or not.
3. What are your cesarian rates, induction rates, unmedicated vaginal birth rates and VBAC rates? What are the main reasons for these rates?
This question requires some discussion with the provider. Different providers will have different reasons for their rates depending on the demographic of women they care for. If a provider is not willing to be open and honest in their answers here, it is probably a good indication that they are not going to be open and honest about other aspects of their service.
4. Do you place restrictions on labouring women?
Does this health care provider like to place a cannula "just in case"? Does this provider like to have an epidural inserted or wear a hospital gown "just in case"? What are their thoughts on monitoring? Do they prefer to use continuous or intermittent monitoring and are they open to no monitoring? At what point to they like to intervene in labour? Are there time restrictions? What positions do they prefer women to labour in (Tip: if they say "on your back in lithotomy", run a mile).
5. What happens if I go over 42 weeks of pregnancy?
Some health care providers restrict their service for various reasons after 42 weeks gestation. This can leave pregnant women in the stressful position of having to choose between induction, caesarian, changing providers at the last minute or birthing unassisted. If allowing your pregnancy to continue past 42 weeks to its natural term is important to you, this is something you should definitely consider when choosing a provider.
6. Have you heard of maternal assisted or natural cesarians? Do you perform them?
At the alarming rate of 32%, Australia has one of the highest caesarian section rates in the world. There are many ways that you can reduce your risk of having a caesarian however it is still important to consider what might happen if you do in fact end up birthing your baby this way. Your health care provider should be able to provide you with your options should a caesarian birth be necessary (or you want one).
7. What is your ideal scenario for the birth of the placenta?
The third stage of labour is the birth of the placenta. Many women aren't aware that they even have options when it comes to this part of birth however there are many! You may choose to have an injection of artificial oxytocin to speed up the process, or you can choose to delay cord clamping, birth the placenta naturally or even lotus birth. I highly recommend reading Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices by Dr Sarah Buckley for more information on this very important part of birth.
8. What is your philosophy about the first hour post birth?
As undisturbed first hour post birth has many huge benefits for mothers and babies. This Midwifery Today article by Michael Odent describes this critical stage. https://www.midwiferytoday.com/articles/firsthour.asp
9. How do you feel about breastfeeding? Are you able to refer me to an IBCLC (Internationally Board Certified Lactation Consultant)?
Breastfeeding has many amazing benefits for mothers and babies however adequate support can sometimes be hard to find. A good maternity health care provider will be able to assist you in the initial stages of learning to breastfeed and at the very least provide a list of resources to support you beyond the immediate postpartum period.
10. How do you feel about the use of complementary therapists/medicine in maternity care?
There are many benefits to utilising the services of complementary therapists during pregnancy, birth and postpartum. A good heath care provider will recognise that complementary therapies and medicines can be useful for many aspects of maternity care and may be able to refer you to some of these services.
11. Have you worked with a doula before?
The role of a doula is to provide physical, emotional and educational support to women throughout pregnancy, birth and the postpartum period. Doulas do not provide medical advice or perform clinical tasks. Doulas, midwives and obstetricians each have different jobs and skills and usually work harmoniously together to support each woman throughout her pregnancy, birth and postpartum period.
Remember that your doula is employed by you and is there to support you and your choices. If your health care provider is skeptical about you hiring a doula ask them for reasons why. Generally, it is because they don't have a clear understanding about what a doula does and how doulas and health care professionals can work together to support their client. Each person in your birth support team (including health care providers, doulas, partners, family or friends) need to understand their role is solely to support you. Placing restrictions on who you can or can not have around you to support you in your birth is not conducive to a supportive birthing environment.
12. How do you feel about VBAC (vaginal birth after caesarian section), VBAMC (vaginal birth after multiple caesarian sections), VBB (vaginal breech birth), natural birth of multiples (twins, triplets etc)? Are you trained in these areas? If not, who would you refer me to if you needed extra support in this area?
This is a good way to assess the skill and experience of the health care provider as well as their attitude towards natural birth and variations of normal birth. Ideally, a maternity health care provider should be trained in all these areas. If a health care provider is uncomfortable with any of these areas, it would be worth asking what would happen in the case of something unexpected happening (like an undiagnosed breech baby).
13. Who is your back up should you be unavailable when I go into labour? When can I meet them?
Health care providers need time off just as much as any person. It is important to know who would be looking after you should your own provider be unavailable to attend your birth and how their birth philosophies align with your own.
14. Are you planning holidays in the next 9 months?
There are few things more annoying that forking out thousands of dollars to find out that your health care provider never intended being available for your birth. It is not unreasonable to ask whether they plan holidays or to advise you with as much notice as possible if that plan changes so that you can make alternative care arrangements.
15. What are your fees? Are their any extra costs that I need to be aware of?
In Australia, fees for private obstetricians and midwives can vary from "no gap" fees to up to $10,000 or more. You may also find yourself out of pocket for all scans and tests, paediatricians fees, anaesthetist fees, hospital fees and health insurance hospital excess fees. Make sure you get a clear list of all fees and charges that may apply to your situation.
At the end of the day, remember that you are employing this person to care for you. Finding the right maternity care provider can go a long way to helping you achieve your birthing goals, whatever they may be, and feeling comfortable with the care you are receiving is crucially important to feeling safe and happy during your birth. Xx
