OK, I am home today with a not-so-sick five year old and my new 12 cup French Press coffee maker. So, sorry about the overabundance of posts today. I have super caffeinated typey fingeritis.
I wrote some more advice to my mom-to-be cousin Susan:
There are a few questions you can ask practitioners when you interview them. I would pick a few things you are particularly concerned about and use them to judge your practitioner choice (along with your gut feeling about your rapport with them, of course). It’s really up to you what these things are but here are a few examples:
1. Episiotomy: Do you employ them? Routinely? Under what circumstances?
It is up to you, but this would be my main litmus test. Episiotomy is not evidence based, at all, and there is a HUGE effort to restrict and/or end their use. It causes lasting harm to the mother, and the practitioner should at least show some hesitation, and boast about a low to non existent rate. In my opinion, the only time an episiotomy should be used would be if forceps had to be applied, and it facilitated that. And, forceps are rarely applied.
2. Cesarean section: What is your cesarean section rate? Under what circumstances do you do them? (Specifics, like…how long would someone have to be stalled in labor? 4 hours? 12? 24? What if my water breaks? How would you define a non reassuring fetus during labor?)
3. Induction: Do you do elective inductions on your first time moms? What percentage of your first time moms do you induce? Is it at their request, or is it the routine practice to do them at a certain gestational age? What are your guidelines for doing them? What are your guidelines of letting a pregnancy run past its estimated due date?
Again, your priorities in this situation are up to you, but I wouldn’t recommend an elective induction unless your Bishop score was 10 or more, which is a score of how ready your cervix and the fetus are for delivery. Inducing someone who is post dates is more understandable, but most guidelines say not to do so until at least a week post dates, even two if the fetus has reassuring status. Many practices starting pushing inductions at 39 weeks with an unfavorable Bishop’s score.
Those are the big three. Now, there are other points you may want to discuss, based on your own priorities.
During labor, can I eat and/or drink? Can I have access to a tub for labor, or a shower, or walking, or a birth ball, or my own clothing, or (fill in the blank)? Can I bring a doula to my labor? How many support people can I have, and what are the visitation rules in general? Can my support person spend the night with me in labor and after the baby is born? Do you require an I.V.? Do you require continuous external monitoring? Can I get intermittent monitoring if I am low risk and in early labor? Do you routinely do an artificial rupture of membranes in early active labor? What are your guidelines for ruptured membranes, do you have a time limit for how long they can be ruptured before you move to cesareans section, if everything else seems low risk? Do you routinely administer pitocin to strengthen contractions, or do you have a guideline for stalled labor before you use it? Can I have (whatever accommodation you may need, such as a vegetarian meal, or a kosher meal, or a disability accommodation, or religious accommodation)? Can I have access to an epidural at any time, or only during certain hours? What other pain relief options do you offer, and how are they offered? Are you supportive of patients not wanting to use epidural pain relief or IV pain medication? When do you show up to a labor? Who will show up to my labor? (It may depend, if it’s a large practice). What sorts of situations would you show up to the hospital for, and what ones do you expect the nurses to handle? For example, if I thought I was in labor, do you want me to come by the office? If I was admitted to the labor floor, do you do show up in early labor? (Most docs in this area don’t, but some do in other areas. As for the other complications and issues, you’d be surprised. I would love to hear this question asked. I wouldn’t dare when I was pregnant, but hey, why not throw it out there? I would hope that I’d be happy to ask that when I am an ob/gyn).
I could go on and on. Pretty much, ask them the questionnaire I am doing for my research project.
I would also see how they respond to being asked these questions. Hopefully, they will support your right to want to know the answers, and take the time to answer them. And, I think it needs to be done before a traditional birth plan is written, generally in the third trimester. That will be as important as what the answers are.