BIRTH PLANNING: QUESTIONS TO ASK WHEN CHOOSING HOSPITAL, BIRTH CENTER OR HOMEBIRTH MIDWIFE

©Shawna Wentz Photography Sacred Womb Artistry

Hospital | Birth Center | Homebirth | Hospital Midwife | Homebirth Midwife

Doulas and Monitrices

What is Transparency In Maternity Care?

Transparency in maternity care means providing health care consumers with the information they need – and the means to interpret it – in order to evaluate the quality of care provided by individual providers and institutions. Transparency is the missing ingredient to truly informed choice.

You may also want to check out The Birth Survey. A consumer reports for birth, patients will rate their doctor,  hospital, birth center or homebirth practice. If you’ve given birth in the past three years, please take the time to rate your doctor, midwife, birth center or hospital. The ratings are based on The Mother Friendly Childbirth Initiative and The Baby Friendly Hospital Initiative, which are evidence based recommendations to support early breastfeeding initiation and mother-infant attachment and evidence-based maternity care practices.

Parents-to-be have many choices to make. These include Choosing the Place of Birth (hospital, Birth Center or Home), Choosing the Birth Provider: Hospital Midwife, Homebirth Midwife or Doctor?  The following are some suggested questions to ask.

CHOOSING THE PLACE OF BIRTH

Questions to Ask the Hospital

•  Has this hospital implemented the Baby Friendly Breastfeeding initiative? (see http://babyfriendly.orgwww.babyfriendly.org)
•  Has this hospital implemented the Mother Friendly Childbirth Initiative? (see
• Does hospital have one room available for labor delivery and recovery? How many? What happens if someone is occupying it?
• Is it always staffed?
• What’s the nurse/patient ratio? (ACOG guidelines are 1 to 2 in labor and 1 to 1 in pushing).
• What’s the hospital’s c-section rate? (should be no higher than 15%).
• How comfortable are you with patients bringing their own Labor Support Professional/Doula?
• If I have a cesarean how many people can be present?
• Can I keep the baby with me after surgery?
• Do you do Vaginal Birth After Cesarean? What is the rate of mothers who deliver vaginally after a previous cesarean?
• What is your epidural rate? How many women have drug free birth and can squat, walk, kneel? sit on toilet? In bathtub? In shower? When is this not allowed? Why not?
• Do you have lactation consultants? Breastfeeding classes/instructors in maternity ward?
• Do you have rooming in with infant?
• What percentage of mothers who are breastfeeding upon dismissal?
• Can baby stay with me at all times? Is it okay to sleep with the baby in same bed? Can my partner spend the night too?
• Can my older children be present at the birth? When can they visit me?
• The Electronic Fetal Monitor policy: what is minimum amount I must be monitored? In what circumstances is constant monitoring required? Is remote monitoring required or is intermittent acceptable? Do you have telemetry in this facility? If MD or CNM approves, can doppler be used instead of EFM?
• How often do you use internal monitor? What circumstances require it?
• Does this hospital do fetal scalp ph sampling to confirm fetal distress before doing a c-section?
• What is your policy on the IV? Can a Heparin Lock be substituted for the IV? What about if I am a VBAC? Can ice chips and/or water or juice be taken? Can I eat in early labor?
• Can we take our placenta home? (To bury in our yard and plant a tree for the baby or encapsulate).

Questions to Ask The Birth Center

• Do you work with CNMs or MDs?  Will I actually meet the OB or CNM? Will s/he be present at the birth or prenatal visits?
• What’s your hospital transfer rate?
• In what situations will you transport mom or baby to hospital?
• What’s your Cesarean rate?
• What hospital and doctor do you use?
• Who is your pediatrican back up?
• What are the most common reasons for transport to hospital?
• When  in labor will I come to the birth center? When after the birth will I leave?
• Are drugs available here? What type? In what circumstances do you use them?
• Are childbirth classes, prenatal visits, postpartum visit included in price? What method of childbirth preparation are taught? Who teaches the classes?
• How long are your prenatal visits?
• Who will be with me during labor and delivery?
• Do you have assistants and or students/apprentices? When will I meet them?
• What prenatal tests do you offer? Do you do them here or send client to lab?
• Do you use, Electronic Fetal Monitor, ultrasound doppler or fetoscope? Why?
• What emergency equipment do you have on hand? ( should have anti-hemorrhaging medicine, oxygen and infant resuscitation equipment, IV, sutures).
• What situations that develop in pregnancy or birth will I be too high risk for the birth center? When will you consult with the back up doctor? In what situations do you transfer care to physician?
• What hospitals do you use for transports?
• If I am transported, will it be by ambulance or car?
• Who is your back up physician? Will I meet him/her before the birth?
• Do my fees cover the hospital and MD services in a transport?
• Do you have birthing tubs? Do you do waterbirth?
• What is your philosophy about childbirth? Why did you become a midwife? Why did you open the birth center?
• At what point in labor will come to the birth center?
• How do you accommodate more than one woman in labor at a time?
• May my family and children be at te birth? How many people can be present?
• At what point after the birth will I go home? Will you come to me for postpartum visits or must I return to birth center?
• Do you have breastfeeding support services?
•   Which insurance plans do you take?
• Do you take Medi-Cal? AIM?

Questions to Consider When Considering Homebirth

Homebirth is not for everyone. It is for healthy mothers having normal pregnancies. Some psychosocial issues also make homebirth inappropriate.  If you answer YES to any of these questions, homebirth MAY  not be the right place for you to give birth. However, discuss your specific situation with the midwife.

• Are you afraid of the hospital?
• Are you opposed to using any kind of medicine during pregnancy or birth?
• Are you a smoker, or did you quit recently?
• Do you take psychotropic medications for mental conditions?
• Do you  or your partner currently take or have a history of taking  recreational drugs or alcohol?
• Do you have a history of hypertension, diabetes or other chronic illness?
• Do you have a history of herpes?
• Are you HIV positive or have AIDS?
• Have you had uterine surgery?
• Have you had a previous cesarean section?
• Is your baby breech?
• Are you having twins or triplets?
• Have you delievered a premature or low birth weight baby in the past?
• Have you delivered a macro-somatic (very large) baby in the past?
• Are you over 42 years of age?
• Are you under 18 years of age?
• Are you a single mother?
• Do you have Medi-Cal, AIM, HMO Insurance  or are  you uninsured?
• Does  your family have a problem with you having a homebirth?
• Is your partner unsupportive of your having a homebirth?
• Are you homeless?

CHOOSING THE BIRTH PROVIDER

Questions to Ask the Doctor or Hospital Midwife

• What is the length of your appointments? How long must I wait to see you?
• How many patients do you deliver per month? (fewer than 10–will give you time & attention; over 30 this may mean 5 or 6 per day; long office waits/short dr. visits at prenatals).
• If you’re not on call, or busy with another birth, then who will deliver my baby? What percentage of your patients do you actually deliver?
• How much time do you spend with me in labor and delivery? During Pushing?
• What percentage of your patients have hired a Professional Labor Companion/Doula? What do you think of them? Who have you worked with? What do you like/dislik about doulas, and why? What doula would you recommend?
• How do you feel about having my labor assistant, if qualified to do so, conduct vaginal exams, vital signs and ausciliate fetal hearttones?
• How do you feel about my coming into hospital only when I’m in active labor (5-8 cms.)? What about if I am a VBAC?
• What is your Cesearean rate? (should not be higher than 15%).
• What is your induction and augmentation rate? For what reasons do you induce labor?
• What is your protocol if pregnancy goes past the due date? At what point do you insist upon induction? Why?
• What percentage of your patients have:
• epidurals?
• pitocin?
• I.V.’s?
• Confinement to bed?
• Internal monitors?
• Continuous fetal monitoring?
• Intermittent monitoring?
• Remote monitoring (telemetry)?
• Episiotomies?
• Do you have time restriction for labor? Pushing?
• How often do you use a vacuum extractor? Forceps?
• What is your protocol for ruptured membranes in early labor?
• Do you use fetal scalp PH sampling to confirm fetal distress? Why? Why not?
• Do you do a Bishop Score before inducing labor?

Questions to Ask A Homebirth Midwife

• How long have you been practicing midwifery?
•  How many births have you been the primary midwife?
• How many births did you manage while a student?
• What is your philosophy about childbirth?
• Why did you become a midwife?
• How did you receive your training?
• Are you certified or licensed? By what organization? Why or why not?
• Do you practice with a partner or assistants/apprentices? When will I meet them? What happens if I don’t want one of them, or prefer one of them at my birth?
• What happens if two people are in labor at once?
• Who is your Obstetrician back up doctor?
• Who is your pediatrician back up?
• What back up hospital will we use?
• Will I see the back up doctor in pregnancy? Labor?
• What situations do you consult the doctor for?
• What situations do you transport to hospital for? What is your transport rate?
• What complications have you handled? How did you handle them?
• What emergency equipment and medicinals do you bring? (Midwives should bring pitocin and methergine, newborn resuscitation equipment, oxygen, suturing materials, IV, fetal heart rate monitor).
• When will you come during labor? What happens if my labor goes on for days? What happens if it’s so fast you miss the birth? Have you ever missed a birth? Why? What happened?
• What are your fees? What do they include? When is payment expected? Does insurance or Medi-Cal  cover your services? What insurance do you accept?
• How do I get my lab work done? What routine prenatal tests do you do? What happens if I don’t want to have a test?
• What situations should they occur, would I be too high risk for homebirth?
• Where do you conduct prenatal examinations?
• How many women do you see at prenatals daily?
• How long do you give each woman? What is discussed? What is done?
• Do you do a postpartum home visits? When? How many? When?
• How do I contact you ?
• What pharmaceutical drugs, homeopathics and/or herbs do you use prenatally and at births?
• How do you monitor the baby in labor?
• How many babies do you deliver per month?
• Do you hwork with a specific clientele (i.e.,  from a religious group)?
• What is your Cesearean rate? What are the most common reasons?
• How many women in your practice need medical inductions?
• Do you offer family planning and well woman gynecology services?
• Do you have breastfeeding support services?
• Can I have a referenece from parents you’ve worked with?

Questions to Ask Doulas and Monitrices

• What is your philosophy about birth?
• Why did you become a doula?
• When did you become a doula?
• Where did you get your training?
• Are you certified? By whom?
• How many births have you attended?
• What midwives, doctors and hospitals have you worked with?
• What ways do you help during the labor and birth?
• Do you provide prenatal visits or prenatal education?
• Do you come to the hospital or home after the birth?
• Do you have any training in lactation support?
• What other services do you provide (ie, massage, hypnobirthing, etc.)
• Can I have a reference from parents and doctors you’ve worked with?

Links of Interest:

New Mothers Speak Out – Women’s Experiences of Postpartum – by Childbirth Connection

“Why Have Natural Childbirth?” by Shelly Girard, CPM, LM, MPH

Join our newsgroup Pregnant with Questions!

Listening to Mother’s Survey I and II -U.S. Women’s Experiences of Childbirth

Check out The Birth Survey! Share your birth story. Rate your hospital, doctor or midwife. Find out what women are saying about your doctor and hospital. Go to The Birth Survey by clicking below:

For answers to your childbirth related questions, email us at: support@socalbirth.com