Let’s set the stage. You want a natural child birth with minimal interventions and you want to do it in a hospital. You would REALLY like it if you didn’t have to change doctors or drive to another county or State to do it. So what’s important to know about your doctor or midwife’s birth philosophy?
I’m here to break down the 5 most critical questions you can ask your birth provider, why they are important and how to ask them.
The Big Five
The following are the five most important questions you can ask your provider about your labor and birth. Why these five? Because each of these questions can open up the conversation to ask more detailed, thorough follow-up questions. Obviously, the list could be much longer, but these five all center around the management of labor and delivery and will give you a good overall perspective on what you can expect from this particular provider. Before we get to the questions, take a second to think about the approach you will use to talk to him or her. I’ve written a detailed post with tips on talking to your provider with confidence here.
Ready? Let’s dive in!
1. I am planning on having a natural birth with as few interventions as possible. What are your thoughts and personal experiences with natural birth?
Great Response: “That’s a great goal! I’ve worked with many moms in the past who have had natural childbirths. This is your birth, I’ll do whatever I can to facilitate that goal.”
This provider gets it. She’s not there to manage your healthy, normal pregnancy and labor for you. It’s your birth and your baby and she’s just there as back-up in case of a true emergency.
Bad Response: “Really? You know that epidurals are completely safe, right? If you try to have a natural childbirth and then need a c-section, you’ll end up under general anesthesia and miss the birth completely.”
This provider has no respect for your wishes. She makes you feel small and stupid and uses scare tactics to guilt you. Don’t walk, run!
2. If the baby and I are healthy, I would like to wait until 42 weeks to discuss an induction. When and under what circumstances do you typically schedule an induction?
Great Response: “As long as you and the baby are healthy, there is no reason to induce before 42 weeks.”
Nothing more you can ask for here. I don’t know of a OB or midwife that practices in a hospital who would endorse a woman carrying a pregnancy past 42 weeks. I know many women who have chosen to decline an induction at 42 weeks, but if they are delivering in a hospital, it’s almost always against their doctor’s advice.
Bad Response: “As soon as you reach your due date, you will be induced. There is no benefit in staying pregnant past that point and we see a lot of problems with babies born post term.”
This response has it all: bullying, scare tactics, generalizations and a healthy dose of a superiority complex. Bye, Felecia!
3. It’s very important to me to have full freedom of movement during labor. How often do you monitor the baby during labor?
Great Response: “We will need to monitor the baby periodically during your labor, but we will keep you off the monitors as much we can.”
Hospitals generally have a protocol about how many “strips” they need to collect every hour. You are generally in bed while two straps with monitors are placed around your belly. One monitors the frequency and length of your contractions and the other monitors the baby’s heartbeat. The monitors are attached to a machine beside the bed to prints out a strip of paper with the real time results. The hospital staff wants to see how the baby’s heartbeat reacts during contractions and that it “recovers” quickly when the contraction is over. A common practice is to do 20 minutes of monitoring with 40 minutes off.
How often you are monitored is going to depend largely on how your unique labor unfolds, so don’t be discouraged if your provider won’t agree to no monitoring. It’s not a deal breaker. This is one of those items that may be mandated by hospital protocol. A related follow-up question to this would be the policy on IV fluids. Many hospitals will compromise and allow a woman to have the IV port (called a hep-lock) administered in case of an emergency, which still allows for full freedom of movement.
Bad Response: “You will need to be on the monitors continuously. You can stand by the bed if the cords are long enough.”
That’s a big fat nope. If the baby looks fine and you have no risk factors, there is no reason to be monitored continuously. In fact, it’s not an evidence based practice and the American College of Obstetricians and Gynecologists (ACOG) even acknowledge that here.
4. I understand that labor can sometimes take days and I’m prepared for a long labor. How do you manage a labor when water breaks and/or labor has a slow start?
Great Response: “As long as the baby looks good, there is no reason to rush things. We will keep a close eye on you and give you 24 hours before we talk about augmenting your labor.”
Again, this is probably as good as it gets in a hospital setting. Hospital protocol is going to push back HARD against moms with ruptured water who want to labor past the 24 hour mark without intervention. This is one of those times where you need to be informed about your options and prepared to either accept or refuse intervention.
Bad Response: “If your water is broken, the risk of infection goes up and so we would need to start pitocin immediately to get labor going.”
This is not acceptable. The biggest risk of infection is when they check your cervix in the hospital, which they will do fairly often. Some women are very comfortable staying at home after their water has broken and waiting for labor to start naturally before they go to the hospital. Have a game plan and know what your plan is if your water breaks and labor does not immediately follow.
5. Under what circumstances would you recommend a c-section?
Good Response: “A c-section is always a last resort. They are for true emergencies and I will not be quick to recommend one even in a slow progressing labor.”
The #1 cause of c-sections in the United States is failure to progress (FTP). There is a problem with the way that our culture views labor and delivery in a normal, healthy pregnancy. Hospitals and traditionally trained Obstetricians are taught how to manage labor, and labor does not need to be managed. If a labor stalls or doesn’t follow the “normal” timeline, women end up with a c-section for “failure to progress”. What that often means is failure to wait. You want a provider who understands that as long as you and the baby are fine, you want labor to take it’s natural course, even if that means a longer labor than the hospital generally “allows”.
Bad Response: “There are many reasons you could need a c-section. If your labor isn’t progressing or the baby is in distress, you will need a c-section. Sometimes the baby just won’t fit through your pelvis.”
Watch out for providers who bristle when asked questions like this. They want you to blindly trust their judgment and that’s not reasonable or acceptable.
Other Ways to Gather Information
I’m going to guess that in many cases, the answers women receive from their providers when asked these questions are somewhere in the middle, just hanging out in the lukewarm zone. It can sometimes be very difficult to gauge how a doctor will manage your labor based on their answers. They may be super cryptic or extremely laid back. Another common issue is a group practice, where the providers rotate and you have no idea which provider will be in the delivery room for your birth.
Don’t despair. The internet is an incredible thing with the ability to connect you with people who have the information you need to make an informed decision about your provider. If you have a doula, she will be an invaluable resource to you – if she doesn’t have personal experience with your doctor, you can bet she has connections to get the information you need. Reach out to other moms who share your birth philosophy and ask them to share their experiences with you.
The goal here is not just to find a provider who fully supports you, but to piece together a picture of what a labor looks like at your hospital under varying circumstances. A hospital tour is another great way to ask questions and prepare for any potential obstacles.
Preparation is Key and Knowledge is Power
When my family takes a vacation, I plan our trip meticulously. I take planning trips to the organized notebook with colored tabs level. I research local restaurants, read reviews on different excursions, print maps and gather as much information about our destination as possible. Standing on a street corner under the boiling sun is not a good time to be searching your phone looking into transportation options. I’m not afraid of my vacation. I’m not worried or anxious. It’s just important to me that we have the best time possible and I’ve found that planning and taking care of all the details ahead of time can deliver that. I’m trying to minimize unpleasant surprises and stress for my family.
Birth is the same way. Information is power. The more you know, the better choices you can make and that can only increase your odds of having the natural birth you desire.