A lot of moms choose their care providers from friend recommendations, PCP recommendation or just randomly picking one out of the insurance choices. This is dangerous. Take time to really research this choice, because it can have a HUGE impact on your birth.
Their impact on your birth often starts before your birth even begins! Starting with if they routinely do late term ultrasounds. This is often just a way to say, “Your baby looks BIG!” Which leads to, “You need an induction/cesarean.” If your care provider likes to induce most of his patients and you don’t know this, then you will likely believe their “scare tactics” when they give them. It is better off to find a care provider that doesn’t usually do this.
How can you know… ASK! Ask your care provider questions (list below) and also ask local doulas and Childbirth Educators for recommendations/opinions. They are a great resource, please use it!
The earlier you ask your care provider these questions, the sooner you will know if they are a good fit. If you don’t like the answers then SWITCH! Or if you don’t like the way they answer the questions, then SWITCH! But remember, it is never to late to switch. I have had doula clients switch at 37 weeks, but I know moms who have switched later. Don’t think, I will just wait until my “next birth.”
BASIC QUESTIONS
- Do they require an IV or is a heplock ok? (IV restricts your movement because you are connected to a bag and pole and may overload your body with fluids. A heplock means they put the part in your arm, but it isn’t connected to a bag. This allows them to feel better, because a vein is open in case of an emergency.)
- What kind of monitoring do they require? (Continuous Fetal Monitoring has greatly contributed to our rising c-section rate while not improving infant outcomes or reducing rates of cerebral palsy. Intermittent Fetal Monitoring when they monitor 15-20 minutes out of the hours, is a much better choice. This is also what ACOG recommends)
- Does your hospital have telemetric monitoring? This allows moms to be monitored while walking the halls and in the tub.
EPISIOTOMY QUESTIONS
- What is your episiotomy rate for first time moms?
- What do you do during birth to help prevent tearing?
INDUCTION QUESTIONS
- What is your induction rate?
- What is your philosophy on going past 40 weeks? (If they typically schedule inductions at 40 weeks (or before) that is a red flag. They should be fine going to 42 weeks as long as you and baby are fine. Let them know you are willing to do NST to reassure them of this.)
- What medications do you use to induce? (If Cytotec, Misoprostrol or Miso) Do you have other cervical ripening agents available, if I refuse Cytotec? What about using a foley bulb if another cervical agent isn’t available.
- Do you routinely do late term ultrasounds? Why? (These late term ultrasounds typically lead to the whole Big Baby Scare)
- What is their philosophy on “big babies?” (ACOG Practice Bulletin No. 22 which appeared in the November 2000 issue of Obstetrics and Gynecology found no value in inducing for “big baby” since it simply doubles the CS rate and does not prevent shoulder dystocia or reduce newborn morbidity. Nor do they support cesarean section for “big babies.
CESAREAN QUESTIONS
- What is their CS rate? (If it’s greater than the World Health Organization’s recommendation of 10-15%, this is a huge red flag. This is often connected to their induction rates, OBs who induce most of their moms are going to typically have more cesareans, maybe because of “pit to distress” syndrome.)
- Do they perform an automatic CS if waters have been broken for more than 24 hours, even if there is no evidence of infection and mom and baby are fine? (If they say yes, huge red flag. Find another provider.)
- Do they have a time-limit on how long your labor can be before they c-section you? (There should be no limit as long as baby and you are fine.)
- If I do need a cesarean –
- do you do double suturing?
- Is the baby with me in the recovery area or does he/she have to go to the NICU…if so for how long?
