5 Questions to Consider When Choosing a Great OB or Midwife

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Choosing a great health care provider is one of the first steps to having an amazing birth!  Practicing medicine is an art and there are a world of ways to go about it.  What is most important is that your own philosophy and desires for birth are in line with your health care provider's.  Whatever type of birth you desire, having a skilled health care provider that you can trust is paramount.

I wish you could interview doctors like you can doulas or midwives.  But, unfortunately the hospital and insurance systems do not make this an easy thing for them to accomodate.  So, in order to meet an OB you'll most likely need to schedule a prenatal visit.  You can schedule as many prenatal visits as you want with as many providers as you want - except if they are in the same practice group or practice at the same hospital, then this causes both political disrupt amongst the group and scheduling difficulty within their appointment systems.  If you're choosing an OB, to help navigate this and save you some time you might like to ask doulas, labor and delivery nurses or women who have similar values in birth as you do who they recommend prior to scheduling an appointment.  Of course, you have the absolute right to fire and hire whatever doctor you like - but there could be some hoops to navigate. 

Read up on the difference between the midwifery model of care and the medical model of care.  This will likely help you identify what your own thoughts about birth are.  Then, understand that midwives and doctors practice on a continuum with some doctors practicing more 'midwife-like' and some midwives practicing more 'medical-like.'   It's not fair to assume that a doctor is your enemy or that a midwife is your friend.  When you have an understanding of your own ideas you will be able to better identify red flags and if someone is not a match for you.  Taking a non-hospital based childbirth class can also help with this.

Now, you've narrowed down things a bit, so here's some questions for you to ask your health care provider.

1. What is your primary cesarean birth rate?

 Not many women desire a cesarean birth.  Your provider's cesarean rate should not exceed 10-15% according to the WHO.   Ideally, a provider who supports physiologically normal birth will have a rate in or near the single digits.  Knowing this will help assure you that if your provider does determine that a cesarean birth is best for you, it probably is really, truly best and every opportunity for a vaginal birth has been given.  

2. What is your VBAC success rate?

Although you may not be planning a vbac (vaginal birth after cesarean), we live in the state (Louisiana) with the highest cesarean birth rates in the country and in a country with a 33% cesarean rate.  So, this is significant.  A health care provider with a high vbac success rate is one who is truly supporting women in physiologically normal birth.  It has become trend for some doctors to state that they support a woman's TOLAC (trial of labor after cesarean) or VBAC, but if they do not have a birth philosophy or skills to support this than it's just words with a planned repeat cesarean at the end of a hopeful pregnancy.  This doctor or midwife likely also has a higher cesarean birth rate than you migh be comfortable with.  You can read more about VBACs here. 

3.  Who will care for me during my labor?

Many of us have assumed that the health care provider we choose will be the one following us during labor and making decisions regarding our health care during this time.  Unfortuntely, this is not a safe assumption and how a labor is managed, or given space and time to progress normally, can greatly affect your birth outcomes.  Unless you are planning a homebirth, no hospital/birth center doctor or midwife will be able to guarantee you that they will be present for your birth.  So you might also like to familiarize yourself with their call group and who within that group you are comfortable with. If you are choosing to birth at a teaching hospital, your labor will likely be managed by residents and if you see your doctor it will only be toward the end of your pushing, just in time to catch your baby.  There is occasionally a rare resident who understands and is supportive of a physiologically normal birth, but they do not receive any training of this in medical school, they rarely if ever see an intervention-free labor/birth, and they do not know how to support a birth during the 2nd stage (pushing) without managing it (pulling on the baby to release shoulders rather than waiting for the mother to push it out).  They are also not skilled in difficult deliveries such as forceps or breech as these are not taught in medical school and they are less skilled in managing difficult presentations or shoulder distocias.

4.  Assuming a healthy mom and baby, how long are you comfortable with me carrying before discussing an induction?

Inductions before 39 weeks have decreased in occurance because now a baby born between 37 and 39 weeks is early-term, which could mean greater difficulties for the baby.  This means that inducing prior to 39 weeks needs medical reason.  However, a pregnancy is not actually post-term until after 42 weeks.  50% of mothers will delivery their babies by 40weeks and 5 days.  This means that the other 50% of babies are born after 40 weeks and 5 days!  If you are planning a birth with as few interventions as possible, you probably want to avoid induction talk until at least 41 weeks and a few days and possibly 42 weeks, depending on you and your baby.  No doctor or midwife can make you any promises here as inductions should be very case specific.  But if you're interviewing a doctor who always induces at 40 weeks and 3 days, you have to know that it is statistically likely that you will be induced and this may or may not actually be medically necessary, but rather habit.  Choosing a health care provider who does not regularly schedule inductions and prefers that labor begin on it's own may be a better match for you and your birth, even if an induction becomes necessary.

5.  Can we forget the bed?

I hate to villify the hospital bed, because it can be a useful tool, but it can also be a place where things quickly go awry for an otherwise beautiful labor and birth.  A quick google of birth plans will result in numerous links with lines like "move in labor as I wish."  I suggest that you take this up a notch and plan to labor, push and birth how and where you wish!  Forget the bed.  Listen to your body and trust it to lead you to the perfect pushing position(s) for you and your baby just as you trusted it to lead you the best positions for labor.  Maybe you end up on the bed in some fashion (they really can be pretty go-go-gadget-ish), which is fine - if it is where you end up on your own accord, not because someone said "just hop on the bed for a moment, let's try pushing this way." - which will ultimately lead to you being in a semi-reclined position, curling over your baby, your legs in stirrups or someone's hands (this is sometimes called a 'lying squat' or 'modified squat'), your perineum at greater risk, and your birth at an increased risk of being managed.  A health care provider comfortable with you pushing and birthing however you do will be on board with you laboring however you do. Want to know more about how forgetting the bed might impact your birth?  You can read about that here. 

Of course you can also familiarize yourself with hospital policies and procedures concerning monitoring, vaginal exams, water birth, showers and more.  But, if you have these five questions in place the others will likely all come together for you!

Want to know how not to choose a health care provider?  You can read about that here. Interested in hiring a New Orleans doula or taking a childbirth course?  Have questions about choosing a doctor or midwife?  Contact us!

 

Amanda Devereux is founder of Nola Nesting, a Doula, Birth Boot Camp Instructor, program developor and trainer of Birth Boot Camp DOULA and mom of three breastfed babes.