5 Questions to Ask Your Doctor BEFORE Your Birth

May 20th, 2007

Here are 5 questions to ask your doctor BEFORE your birth…

1. What is your c-section and episiotomy rate? How far past my “due date” can I go?

Of course the well being of mom and baby come first, but some doctors have a low threshold for allowing the expectant mother to go past her due date. Postdates pregnancy is defined as a pregnancy which exceeds the 42nd week. Check to make sure that your doctor will allow you time to birth on your body and baby’s schedule.

Today, most doctors do not perform episiotomies unless it is extremely necessary; most like to allow for a natural tear. Check to see if your care giver will try other methods to allow the perineum to soften and stretch. For example, some doctors will apply warm compresses and massage the perineum before reaching for the scissors to cut.

As I said before, the mom and baby’s health is top priority, but some doctors tend to react quicker to c-sections than others. The USA is an extreme example where the c-section rate climbed from 4.5% in 1965 to 22.7% in 1985 without a decrease in mortality rate. (Information from World Health Organization) In NYC in 2004 the c-section rate rose to 28.6 %. Check out your doctor’s c-section rate. (Information from Medical News Today)

2. If all is well with mom and baby, do you allow intermittent monitoring?

Intermittent monitoring will allow you time off the monitors to move around as you please. You have the freedom to walk the halls, take a bath or shower and assume any position that feels comfortable to you without the discomfort of the monitors. “Only in women with increased risk, such as labours which are induced or augmented, complicated by meconium-stained amniotic fluid or by any other risk factor, does electronic monitoring seem to be advantageous. In the majority of labours without increased risk, electronic monitoring increases the number of interventions with no clear benefit for the fetus and with a degree of additional discomfort for the women.” (Information from World Health Organization)

3. May I labor in any position I find comfortable and effective?

Until the time comes, you will not know what positions feel beneficial and comfortable to you, so it is helpful to know that you will have freedom to choose how you want to labor.

4. May I push my baby out in any position I find comfortable and effective?

Some doctors are very strict about this and want you in a reclined position with your feet in stirrups or semi-seated drawing your knees to your shoulders. This is a very traditional position, which gives the care giver the best “view.” But it is probably the least helpful for the laboring mother since she is working against gravity and closing off all the elastic space of the rectum. This decreases the mobility of the tail bone and the space of the pelvic outlet.

Other options are side lying, squatting, on all fours, and a supported squat using a birthing stool. Even if you don’t end up using any of these positions, it is nice to have the option.

5. What is your philosophy on birth? If I choose not to take pain medication, are you fully supportive of natural birth? Or do you prefer your patients to have a medicated birth? If I have had a previous cesarean, do you support VBACs?

It is so important that you and your doctor are on the same page about how you want to birth. I had a client that was really working hard to have a natural birth. During her labor when she was in a lot of discomfort the doctor made the comment, “I want an epidural during my annual check ups, I would never have a baby with out one!” To the woman in labor, this was not displaying a lot of support for her choices. The doctor that made this comment was a very capable doctor, but probably not the right fit for my client.

I have had many conversations with students that lament, “I got the name of my doctor from a friend and, if I had known what to ask, I probably would have switched doctors. Now I feel it is too late to change!” (I actually had a doula client last summer that switched to a new OB 10 days prior to her due date. And she was glad she did! She ended up with a beautiful natural birth in the St. Luke’s Roosevelt Birth Center. Some doctors are willing to take on new patients even at the end of the pregnancy if their schedules allow it.)

Ideally it would be best to have this 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. But if that is not a possibility, at your next appointment, go ahead and ask these important questions! During your labor is not a good time to start negotiating your labor wishes. It is essential that you feel heard, supported and respected.

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