Last night at the Natural Birth Meetup in Fayetteville, we talked about different topics. The main topic of the night was Placenta Encapsulation, but it morphed into many other subtopics, as these meetings always do. I am always so refreshed to hear other women’s experiences, and to share some of my own. I felt compelled to share the experience I had with our OB when I was pregnant with Sydney, and during my birth. I stated that often, women do not ask the right questions, so this post is going to be a guide, of sorts, in dialogue form, to help you with the right questions to ask your provider.
The Wrong Questions:
Sally: I need to ask you some questions, do you have time?
Provider: Sure, (glances at watch).
Sally (feeling rushed and embarrassed for even asking): My partner/husband and I would like to do a natural birth, are you okay with this?
Provider: Of course.
Sally (feeling more confident, now): We would like to remain pregnant until 42 weeks, do you see any problems with this?
Provider: No, not really.
Sally: We would like to avoid induction, unless medically necessary, will you suggest medically unnecessary induction?
Provider: No, we do inductions that are necessary.
Sally: We would like to avoid c-section at all costs, do you have ways to help us do that?
Provider: Yes, we have many ways.
Sally: I would like to push in a different position than on my back, is this okay?
Provider: Sure, why not?
Sally: We request skin-to-skin bonding, where the baby is placed on my belly/chest immediately after birth, will you do this for us?
Sally: We would like for the cord to stop pulsating before clamped or cut, will you honor this request?
Provider: Um, sure.
Sally: (Feeling peppy and like she’s chosen the right provider) Thank you so much!!! We know we have chosen the right provider for us!
This line of questioning could go on forever, I could list so many more, but this line of questioning is all wrong. Notice how the provider does not say much, provides no detail, and really is not answering the questions. This is no indication of how the doctor might respond during birth. The questions Sally is asking are the right questions, but need much more detailed answers. She asks closed ended questions, or questions that do not require much more than a one or 2 word answer. So I will outline the correct line of questioning. This puts the ball in your court, and you can make a much more educated decision about your baby, your birth, and your provider or your place of birth.
The Right Questions
Sally: Dr. Moe, my pregnancy and birth experience are very important to me, so I would like to ask you some questions quickly (pulls out a sheet of paper and pen).
Provider: Um, Ok. (Sits)
Sally (feeling empowered and confident.): My husband/partner and I are preparing for a normal physiological birth (expound as much as needed: intervention free, few interventions, pain meds free, whatever you want to say), how many of the births that you’ve attended have been this way? And, how will you help me to achieve this?
Provider: (Slightly taken aback with this open ended question) Most of the births I attend at Candy Hill Hospital are medicated with epidural or some other form of pain management. I have only attended maybe 10 unmedicated births. I am willing to help you achieve this by allowing you to labor for as long as possible without intervention.
Sally: Okay… We would like to remain pregnant until 42 weeks, unless it is medically necessary to take action before hand. How many of your mothers have you allowed to continue being pregnant until 42 weeks? And what are your reasons as a provider for requesting birth sooner?
Provider: We generally don’t allow women to remain pregnant until 42 weeks, our cut off is 41 weeks. We don’t like women to continue pregnancy until 42 weeks because the risks of a larger baby/aging placenta/elevated blood pressure/etc go up.
Sally: (Red flags going up, immediately, she’s done her research): Okay, I understand your reasoning, and I’d love to see some written research to support this reasoning. But, in our case, we would like to request a non-stress test following 41 weeks to ensure everything is fine with baby and me, and to ensure that everything is going smoothly in my pregnancy so we can go until 42 weeks.
Provider: I guess we could do that, we will talk about it more as time gets nearer.
Sally: Sounds pretty good. Since we would like a normal physiological birth, we would like to avoid induction, unless medically necessary. What is your induction rate? And what are the reasons you induce?
Provider: Our induction rate is pretty high. We induce because the baby is too big, the baby is late, there are medical problems with the mom such as high blood pressure, diabetes, other issues, and to help the mother to be more comfortable.
Sally: Oh, ok. (Increasingly more uncomfortable with the answers her provider is giving) We would like to avoid c-section, unless medically necessary, first, what is your c-section rate? And, how would you help us to avoid c-section?
Provider: Our c-section rate is right along with the national average of 32-33%. We would monitor you and baby, to make sure that both are okay, and allow you your trial of labor, until it is deemed that c-section may be the best option.
Sally: (Thinks she may want to switch providers, at this point) All right… I would like to push in a position other than semi-sitting or flat on my back. How many births have you attended in which the mother was in an alternate position for pushing?
Provider: Since most of the patients I attend have had an epidural, we require the mother to lie flat during birth. I have not attended many births where the mother wanted to push in a different position, but I guess I’d be okay with it.
Sally: Okay. We would like our baby to come directly to my belly/chest following birth for immediate skin-to-skin bonding. Are there reasons you would not allow this? If so, what are they?
Provider: We generally take the baby directly to the warmer to do the assessments of the baby. While we understand skin-to-skin bonding is beneficial, we like to get the assessments done as quickly as possible so you can have your baby following. We could maybe do skin-to-skin bonding for a few minutes.
Sally: (Disheartened) Wow. Okay. We would like for the cord to stop pulsating before it is cut or clamped. Will you honor this for us? If so, why not?
Provider: We like to clamp the cord and cut it immediately, so the assessments can be done on the baby, and with the baby attached to the cord, we cannot do that. I guess we could do that so you could have a few minutes with your baby before we have to do the assessments.
Sally: (Feeling disheartened, discouraged, and frustrated, yet she knows she can switch providers) Thank you so much for answering these very important questions, we have some decisions to make.
Like I said, the questions are endless, and they all depend on what is important to you. In this line of questioning, Sally receives the complete picture of what her provider is like during labor and birth, and is able to make more educated decisions about whether she would like to switch providers.
Let me say something else, if you decide to switch providers, it is YOUR decision. You will not hurt feelings or step on toes, and if you do (Say this out loud to yourself), “IT IS MY BIRTH”. What happens at your birth should be the well thought out plans you’ve decided on, not that your provider has decided on.
My personal experience with this was much more like the first line of questioning. I can blame it on being a first time mom, being uninformed, or whatever I’d like it to be about, but what it came down to was I chose my provider for the wrong reasons. My neighbor at the time wanted a fully medicated birth, and said her provider was “really nice”. Well, most providers are really nice, they wouldn’t have much of a practice if they were ogres. So my decision was made because my neighbor, who wanted a totally different birthing experience than I did, suggested the doctor to me. If you want an intervention free birth, unmedicated birth, natural birth, normal physiological birth, however you want to describe it, DO NOT CHOOSE YOUR PROVIDER BASED ON THE CRITERIA OF “NICE”. Ask open ended, detailed questions that will require thought, words, and an indication of the actions your provider will take.
Also, remember that you may always decline any procedure. Simply say no, stand firm, and ask to sign a document saying you declined, if necessary. Again, I will say this, and again, I want you to say this out loud (let this be your mantra), “THIS IS MY BIRTH.”
Please share comments, experiences, input, whatever you want to say, myself and my readers would love to read it.
Thank you so much for reading. Have a beautiful day!