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 (at least by 32 weeks) 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 will help you understand how your late pregnancy, labor, and birth will be managed.
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 questions.
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)
GDM or DM (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 of when to induce
labor?
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