5 Questions To Ask BEFORE Your Birth

As recently seen on Mindful Mama

As a doula, I’ve heard this lament time and time again: “I received the name of my doctor from a friend, and if I had known what to ask, I probably would have switched doctors a long time ago. Now I feel it is too late to change!”

Ideally, it’s best to have a very important conversation with your doctor at the beginning of your pregnancy — to make sure that the way he or she practices medicine matches up with the way you want to birth. If you’re already into your pregnancy and a relationship with your doctor, be sure to ask these key questions at your next appointment! When you’re in labor, it isn’t a good time to start negotiating your labor and delivery wishes. It’s essential that you feel heard, supported and respected — long before the big day!

What is your birth philosophy?

There are two basic philosophies to approaching birth. The first is the medical model, which emphasizes the pathologic potential of pregnancy and birth. As the art and science of managing pregnancy, labor, delivery and postpartum, this approach tends to lead to more managed care.

The second approach is the midwifery model, which subscribes to the idea that pregnancy and birth is a natural, physiological process that should be inherently trusted. This approach tends to have fewer routine interventions.

Neither of these schools of thought are wrong. It’s just important to find out ahead of time which direction the care provider tends to lean. If you’re approaching birth wanting to avoid most routine interventions, you should make sure that your care provider and the entire practice approaches birth that way. You can’t change the way your provider practices medicine, but you can change your provider.

How aggressively do you manage patient care?

In terms of a low-risk, healthy woman, how open is the practice to various birth options? For example: Is the practice going to let the laboring woman have intermittent monitoring, or are they insistent upon full-time EFM (external fetal monitoring)? When do they advise the mother to come to the hospital? Is she allowed to eat or drink freely throughout labor? Is the care provider open to non-traditional ways of pushing (i.e. side-lining, squatting, the all fours position), or do they prefer her on her back? Will the mother require mandatory IV fluids? Is the practice open to natural ways to augment labor — like castor oil, nipple stimulation, acupuncture or evening primrose oil?

Many of the routine managed interventions have been studied and determined not beneficial for the mother and baby. In fact, ACOG (American College of Obstetricians and Gynecologists) recently changed their guidelines in regards to only offering ice chips to laboring women. They are now supporting clear liquids, such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, sports drinks and clear broth. However, many care providers still have not changed their practice to adjust to this new information.

Restricted food and beverage intake is just one of the many routine interventions still enforced without strong evidence of the benefit. Have a clear understanding what you — as a laboring mother — would like or not like, and go over it point by point with your care provider.

What kind of schedule will you be on?

Some of these decisions may be hospital protocol; others may be up to the care provider. Discuss the following areas of schedule ahead of time:

* How long can I labor before artificially augmenting labor (using pitocin), assuming the amniotic sac has not broken?
* How long can I labor if my water has broken?
* How long can I labor with labor augmentation?
* How far past my estimated due date can I go without being induced, assuming my baby and I are fine?
* How long am I allowed to be in the second stage of labor — the pushing stage?
* How long can I labor at home?

If you’re feeling resistance, ask a few questions that might help clarify the reason for the resistance, and possibly give you more time. (”What would happen if we wait? Am I OK? Is baby OK? Can we have more time?”)

What are the statistics or rates of the practice?

Taking a closer look at the rates and statistics of the practice will help answer a lot of questions regarding the care provider’s approach to birth. Inquire about the following:

* What is your c-section rate?
* What is your induction rate?
* What is your episiotomy rate?
* What is your instrumental delivery (forceps and vacuum extraction) rate?
* Does your practice work with more high-risk women than low-risk women?

These answers will color the statistics of the practice. If the practice primarily works with high-risk women, they may be more inclined to suggest an induction or cesarean birth, because they may be used to approaching birth in that manner.

When does your care provider arrive at the hospital or birth center? How involved is he or she in the labor process?

On several occasions, I have seen women ready to push, but were told not to since their care provider was not at the hospital yet. These births were not particularly speedy, and should have given the care provider enough time to arrive and be prepared. A mother should never have to fight her natural impulse to push her baby out, simply because her care provider is not present.

Some care providers are very involved with the labor process and check in often, or even stay in the room for a bit. Usually midwives are most involved in the labor process — but some doctors are wonderfully supportive, as well. A doctor once told me, “My teacher in medical school told me, ‘The most important thing an OB needs is a comfortable chair. Sit back and let nature unfold.’” This is the kind of support laboring mothers need — and deserve!

1 comment May 28th, 2010

Fear Not!

My latest published article as it appears on Mindful-Mama.com (Check out the website- it is really great!!)

Birth intrinsically brings some level of fear and anxiety, since it can never fully be planned. I have met very few women during my career as a labor support doula that have not expressed some sort of fear or anxiety about their upcoming labor. In fact, I remember a midwife once telling me that it’s those who don’t have any nervousness around labor and delivery that worry her most.

To begin to understand, address, and hopefully put fears to rest, a birth plan is essential. Creating a birth plan involves discussing how the parents foresee their upcoming birth, determining whether they have birth preferences, and generating open dialogue that identifies any fears and anxieties about the labor and delivery process. Commonly, fathers are concerned about the well-being of mother and baby. The mother is often concerned about how she will tolerate labor, how long it will be, or if the labor she envisions will be the labor that occurs.

Fear’s Role in Labor

Beyond the emotional drain of fear during labor, there is a biological response to fear. Labor progresses, in part, because the body produces oxytocin, stimulating uterine contractions. When all is going well, the oxytocin flows and labor runs smoothly. However, when the body is stimulated into the “fight or flight response” because the mother is afraid or feeling unsafe, the body overrides the production of oxytocin and produces adrenalin, which slows labor down.

While walking out of the front door on her way to give birth, one mother I worked with said, “Next time I pass through this threshold, I will be a mother.” For some women, that is extremely exciting. For others, extremely frightening.

It’s not uncommon for a mother who is in a nice, steady labor pattern at home to enter the hospital or birth center — with its unfamiliar smells, bright lights, noise, new people — and see her labor pattern space out or stop completely. This is due to the increase of adrenalin or, as some doctors call it, the “white coat syndrome of labor.” Going back to our roots in nature, most animals birth privately or in hiding. They don’t give birth in the middle of a room with bright lights shining on them. We, as animals, also need to find that comfortable, non-intimidating space so we feel safe to open up and birth.

Appreciating the Mother

The best support comes when those attending the labor and birth understand the woman. If a mother has expressed she is afraid of the pain, talking about different pain management techniques that can be employed often eases fear. If a mother feels shy about having a lot of people present during labor and delivery, finding ways to limit unnecessary traffic and create a quiet, intimate atmosphere where she feels less exposed is important.

Some mothers come into labor with the memory and experience of previous births. These births may have either heightened their confidence or diminished it, depending on how the first birth evolved. If it was a traumatic experience, listening carefully to the birth story, and pinpointing the fear that’s associated can help relax her for the next birth. By identifying these concerns ahead of time, a mother’s confidence can be built up, and she can understand that her fears and concerns are being heard — and met with a supportive response.

Of course, there are times when, regardless of preparation, subconscious fears are revealed during labor. One mother I worked with, who had a particularly rough labor, called me and requested a meeting a year after her baby was born. She told me that after spending a long time reflecting on her labor, she realized it was so difficult and long because she was subconsciously holding her baby in. She was deathly afraid of letting the baby be birthed, and having to take the responsibility of becoming a mother. This was the first time I had ever heard a woman say that. It took a lot of bravery and insight, and she isn’t the only woman who has had those feelings.

Building Confidence

One of the most successful ways of handling the natural fear surrounding labor and delivery is to make sure the expectant mother is aligned with a supportive birth team. The environment as a whole (a woman’s partner, doula, care provider and place of birth) should be considered carefully.

It’s also important for mothers to read and listen to positive birth stories. If a woman is continuously bombarded with negative, traumatic, fear-provoking birth stories, it will impact her ability to be confident that her body can successfully birth her baby. Stay away from the birth drama in TV shows, and choose Ina May Gaskin’s “Guide to Childbirth” instead for amazing, encouraging stories from other women.

Doulas Get Nervous, Too!

After 7 years, more than 80 births, and 5,000 prenatal students, I feel confident that I understand the mechanics of labor, common inventions and problems that may arise. However, I still get a touch of nervousness when I head into a birth — I want everything to go well for the parents. I don’t want to let them down. In response to my doula anxiety, I’ve created a personal ritual: Before I knock on an expectant mom’s door or make an appearance, I take a deep breath, close my eyes and ground myself. The best I can do is be fully present and open, and offer my knowledge and experience mindfully.

2 comments May 7th, 2010