BIRTH PLANNING QUESTIONS TO ASK YOUR OBSTETRICIAN

When choosing a doctor, it’s important to find one who is in sync with your values and needs.  Be sure you clarify your values before you choose your doctor. Take our survey Clarifying Your Values for Birth Then you can find one who has similar philosophy about  childbirth as you do. You can also check out The Birth Survey and find out what other women have said about your doctor and hospital. See link at bottom of this page. We also recommend you find out if your hospital is a Mother-Friendly and/or Baby-Friendly Hospital. The following questions are based on 10-evidence based steps called The Mother-Friendly Childbirth Initiative (MFCI), a concensus document authored by The Coalition for Improving Maternity Services, a coaltion of over 45 leading organizations with concern for maternal and infant health and were published in the peer-reviewed Journal of Perinatal Education. Download a copy of the journal: Evidence Basis

A brief summary of the 10 steps of the MFCI is below:

1. SUPPORT. Unrestricted access to continuous  emotional and physical support from a  family member or a labor-support professional; including access to professional midwifery care.
2. INFORMATION. Provides accurate descriptive and statistical  information to the public about its  practices and  procedures.
3. CULTURAL  COMPETENCY. Provides culturally competent care.
4. FREEDOM OF MOVEMENT. Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth
5. COLLABORATION. Has clearly defined policies and procedures for collaborating and consulting throughout the perinatal period with other maternity services;  linking the mother and baby to  appropriate community resources.
6. EVIDENCE-BASED. Does not routinely employ practices and procedures that are unsupported by scientific evidence, and limits others.
7. PROMOTES  NON-DRUG  METHODS OF  PAIN RELIEF. Educates staff  in  non-drug  methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
8. TOUCH.HOLD.BREASTFEED. Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
9. DISCOURAGES  CIRCUMCISION. Discourages non-religious circumcision of the newborn infant.
10. PROMOTES  BREASTFEEDING. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” promoting successful breastfeeding.

 THE QUESTIONS AND RECOMMENDATIONS                               

1. What is the length of your appointments? How long must I wait to see you?
2. How many patients do you deliver per month? (over 30 this may mean 5 or 6 per day; long office waits/short dr. visits at prenatals).
3. If you’re not on call, or busy with another birth, then who will deliver my baby? Do you have partners?
4. What happens if I go past my due date? Evidence-based recommendation: labors should not be induced before 39 weeks unless there is a serious medical condition where the risk of medical induction outweighs the risk to mother and fetus of induction.
5. For what situations do you induce labor? Evidence-based recommendation: as induction may increase risk of cesearean section, therefore, it should only be done for a medical reason, and not before 39 weeks gestation, and  only after an Estimated Fetal Weight determination is done  and a Bishop Score is done to determine favorability of the cervix for induction.
6. Do you do a Bishop Score before deciding to induce labor?
7. What percentage of your patients have  a Professional Labor Companion/Doula? What do you think of them? Who have you worked with? What do you like/dislike about doulas, and why? What doula would you recommend (if any)? Evidence based recommendation: Doulas decrease length of labor, decrease need for pain medication, decrease rates of cesarean section, and reduce medical interventions, increase breastfeeding success and decrease maternal depression after delivery.
8. How do you feel about my hiring a Monitrice? Have you worked with any? How do you feel about them?
9. Do you work now or have you worked with midwives? How do you feel about them? See step 1 of the MFCI
10. Do you do Vaginal Birth After Previous Cesarean? (VBAC)  What is your VBAC rate?   For more information go to  vbac.com
11. Do you deliver twins  or breech vaginally?
12. What is your Cesearean rate? Evidence-based recommendation: should not be higher than 15%. See Step 2 of the MFCI
13. Do you allow your low -risk patients to:

• eat or drink in labor? See Step 6 of the MFCI
•  have intermittent monitoring or telemtry instead of continious electronic fetal monitoring? See Step 6 of the MFCI
• decline to have an IV? See Step 6 of the MFCI
• have a heparin lock instead of an IV? See Step 6 of the MFCI
• decline not to be shaved or given an enema? See Step 6 of the MFCI
• walk, assume any position they like in labor? See Step 4 of the MFCI
• use the shower or bath in labor for pain management instead of pain medication? See Step 7 of the MFCI
• use non-pharmacological methods for strengthening weak contractions instead of Pitocin augmentation? see Step 6 of the MFCI
• have a doula for labor support? See step 1 of the MFCI
• have friends, family members, siblings present at birth? See Step 1 of the MFCI
• push in any position they like, including out of bed, on floor or toilet? See Step 4 of the MFCI
• use a squatting bar for pushing? See Step 4 of the MFCI

14. What is your time limit for latent phase of labor? active phase?  pushing? see Step 6 of the MFCI

15. What percent of your patients need a vacuum extraction or forceps? See step 6 of the MFCI

16. What percentage of your births do you  cut episiotomies?  See Step 6 of the MFCI

17. Do you do perineal massage with mineral oil?

18. Would you  be willing to use warm compresses on my perineum?

19. Do you place the baby on the mom’s belly once delivered?

20. Will you wait til the cord has stopped pulsing before cutting  the cord?

21. Will you let  the baby’s  father catch the baby?

22. Will you let me breastfeed  the baby to help my placenta deliver instead of giving me pitocin after the birth?

23. How long can I keep the baby with me after birth? Evidence-based recommendation: 1 hour or more.

24. Have labor and delivery nurses been trained in breastfeeding at the hospital? See the Baby Friendly Hospital Initative

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, please contact us at 626-388-2191 or email:support@socalbirth.com