Questions for Your Care Provider
The relationship between you and your care provider can be one of the most satisfying partnerships during your pregnancy. Communication, key in any good relationship, is especially vital as you near the end of your pregnancy.
Unfortunately,
most care providers don’t spend a lot of time explaining their labor & birth management
philosophy. However, most care
providers will be delighted to discuss their preferences, standards and
protocols when asked. Starting these conversations as early as possible during your
prenatal care will
strengthen your relationship with your care provider:
they’ll have a greater understanding of your wishes and you’ll feel
confident in their judgement. While
no one can predict the course of your pregnancy, or labor and birth,
understanding your care provider’s management style may give you a glimpse of
what’s in store for you.
What
are your “hot issues”? Since most OB visits are less than 15 minutes, make sure to
ask the questions that are most important to you first. You may want to spend each appointment on only one or two
topics. You may want to email your
questions ahead of time. Also, ask
your questions in order of occurrence: ask
questions regarding management of late pregnancy issues before asking labor
questions.
INDUCING MY LABOR:
1. When is it medically necessary? Most care providers will suggest artificial induction for the following:
ROM (rupture of membranes) either preterm or at term if mother is GBS positive
PIH
(pregnancy induced hypertension)
GD
or MD (gestational or pregestational diabetes)
Post
dates.
Rupture of Membranes At Term (See examples of care provider answers.)
1.
If
my membranes rupture before I start labor, what is your policy?
2.
How long will I be allowed to wait for labor to start?
3.
Will you limit vaginal exams?
4.
How often does this occur in your practice?
5.
Are you seeing any trends?
6.
Are you practicing differently now than you did 5 years ago?
7.
How do your partners practice differently?
What are “ends of the spectrum” within your practice regarding management of ROM?
1.
How do you define post dates?
2.
How long do you typically allow pregnancies to progress past 40 weeks?
3.
How do you manage post dates pregnancies?
4.
How often does this occur in your practice?
5.
Are you seeing any trends?
6.
Are you practicing differently now than you did 5 years ago?
7. How do your partners practice differently? What are “ends of the spectrum” within your practice regarding management of post dates pregnancies.
1.
Towards late pregnancy (38 – 42 weeks), will you palpate to find baby’s
position in relation to my pelvis?
2.
If my baby is occiput posterior (OP, back-to-back), after the 38th
week, what are your recommendations?
3.
What can I do at home to encourage my baby to rotate to the occiput anterior
(OA, back to tummy) position before labor begins?
4.
In your practice, are you seeing more OP positions now than 10 years ago?
Eating and Drinking during Labor (See examples of care provider answers.)
1.
How do you feel about eating and drinking to hunger and thirst during active
labor?
2.
What
are the risks and benefits of IV hydration over oral hydration in active labor?
1.
How do you define FTP (Failure to Progress)?
2.
How
do you manage slowly progressing labors?
3.
What
are your goals for dilation/hour?
4.
When
are you likely to suggest augmentation with Pitocin?
5.
At what point would you suggest a c-section delivery?
1.
How
do you define FTP?
2.
How
long will I be allowed to push?
3.
Can
I use gravity positions (squatting, kneeling, hand and knees) with an epidural?
4.
If
I have an epidural, may I “labor down” (wait for the urge to push or wait
for the baby’s head to be nearly visible before actively pushing) before
pushing?
5.
At
what point would you consider vaccum extraction, forceps or a c-section
delivery?
1.
When
do you consider an episiotomy necessary?
2.
What
is your “perineum management” philosophy?
Letter of Agreement: Describes the nuts and bolts of my practice, including my fee.
Dads and Doulas: How fathers and doulas work together.
Articles: Clinical studies on the benefits of doula-attended births.
Continuum of Care Provider Philosophy: Examples of both conservative and liberal care provider management styles.
Email me with comments and questions: pjames@oz.net