| 1. What is your philosophy of birth? (They may have it in written form-even better.) 2. What are your practice protocols? (What do they do routinely for every patient?) 3. How many births do you do a month? (Will they be available for you?) 4. Do you attend your own patients or do I get whoever is on call for your practice group? (This is more the rule now than the exception.) 5. Will I have an opportunity to meet all the physicians and or midwives in your practice? 6. Will they abide by any agreements made by you and I? 7. Which settings do you practice in? (Hospitals, home, birthcenters, etc) 8. How do you feel about ____________________ (epidurals, episiotomies, routine IVs,or conversely birth balls, squatting, or loud verbalizations – you’d be amazed by how many providers think the birthing woman should be quiet) 9. What are your parameters for inductions? (What medical or non-medical criteria do they use to decide?) 10. How available are you (or your staff) for questions between and during appointments? |
| Questions To Ask Your Potential Care Provider |
Consumer First, Patient Second
Finding the right care provider for your pregnancy and birth
I had a long conversation with my friend, Pam, the other night. She is in her final month of pregnancy, with her first baby,
who is in breech position. Her physician is suggesting a cesarean. If attempts to turn the baby are unsuccessful, she will
consider a homebirth in order to avoid the surgery. I urged her to let her doctor know her thinking. Woman are often
unwilling to have a frank discussion with their caregivers about their wants and desires. I reminded my friend that she
selected this provider (or group of providers) and that she is paying them to be competent partners in this process. During a
crisis is not the time to start doing things behind their backs but tell them exactly what you plan to do and why and listen to
their feedback (but take it with a grain of salt- they don't have the final say- you do). I think this approach is important
because it preserves the integrity of the relationship. Physicians and midwives are not mind readers. They need to know and
understand what type of care clients desire, or what they don't want and why. Otherwise they'll just continue to think women
are happy with the care they are getting.
Think about this question: What is the role of your pregnancy and birth care provider? Is it to manage your pregnancy, labor
and birth for you? Is it to take care of you during pregnancy and birth? Is it to deliver your baby for you? Is it to ensure that
you have a healthy baby? May I make the audacious statement that all these things are in your own power to do. When I hear
statements like, “my doctor won’t LET me do that” or “my doctor says I can TRY that and see how it goes” it tells me how
out of balance the care provider is with the care receiver. It is not the proper role of any physician or midwife to tell you how
to have your baby (or where, or when). Receivers of health care must adopt a more pro-active consumer role in their own
healthcare delivery. Nowhere is this more obvious in healthcare than in obstetrics where as a labor and delivery nurse, I have
seen care providers of all types routinely bully, control, and dominate their patients. Your care provider should be a competent
guide through the process. He or she is not your daddy. They can’t tell you what you will or won’t do throughout your
pregnancy, labor, and birth. They can suggest what they think is best, but the final course of action should be up to you.
Finding the right care provider for your pregnancy and birth
I had a long conversation with my friend, Pam, the other night. She is in her final month of pregnancy, with her first baby,
who is in breech position. Her physician is suggesting a cesarean. If attempts to turn the baby are unsuccessful, she will
consider a homebirth in order to avoid the surgery. I urged her to let her doctor know her thinking. Woman are often
unwilling to have a frank discussion with their caregivers about their wants and desires. I reminded my friend that she
selected this provider (or group of providers) and that she is paying them to be competent partners in this process. During a
crisis is not the time to start doing things behind their backs but tell them exactly what you plan to do and why and listen to
their feedback (but take it with a grain of salt- they don't have the final say- you do). I think this approach is important
because it preserves the integrity of the relationship. Physicians and midwives are not mind readers. They need to know and
understand what type of care clients desire, or what they don't want and why. Otherwise they'll just continue to think women
are happy with the care they are getting.
Think about this question: What is the role of your pregnancy and birth care provider? Is it to manage your pregnancy, labor
and birth for you? Is it to take care of you during pregnancy and birth? Is it to deliver your baby for you? Is it to ensure that
you have a healthy baby? May I make the audacious statement that all these things are in your own power to do. When I hear
statements like, “my doctor won’t LET me do that” or “my doctor says I can TRY that and see how it goes” it tells me how
out of balance the care provider is with the care receiver. It is not the proper role of any physician or midwife to tell you how
to have your baby (or where, or when). Receivers of health care must adopt a more pro-active consumer role in their own
healthcare delivery. Nowhere is this more obvious in healthcare than in obstetrics where as a labor and delivery nurse, I have
seen care providers of all types routinely bully, control, and dominate their patients. Your care provider should be a competent
guide through the process. He or she is not your daddy. They can’t tell you what you will or won’t do throughout your
pregnancy, labor, and birth. They can suggest what they think is best, but the final course of action should be up to you.
This does not mean that a caregiver does not have the right to
define their parameters for care. If a midwife only wants to take
vegetarian mothers as clients, that’s her prerogative. If you
happen not to be a vegetarian and really want this midwife to
care for you, then you have a choice to make. The same is true
for physicians. If their parameters of care include routine
epidurals, episiotomies for all their patients, routines IVs, etc.
then that is their place of comfort in giving care. If you don’t
want any of those things, you’d be much better off finding a
different physician than trying to convert this one to your way
of thinking, because you’re asking them to take themselves out
of their comfort zone to care for you. It’s important that as
consumers of healthcare, women understand the pressures that
come to bear upon care providers.
Consumers greatly underestimate the role litigious threat has had
on healthcare. One of the reasons obstetrics has become so
defensive in practice is because the threat of a lawsuit hangs
heavily over their heads. Now some medical lawsuits are well
deserved, others frivolous, yet taken together their impact has
changed healthcare, and not for the better. Obstetricians are
more likely than physicians in any other specialty to be sued for
malpractice. This alone has changed the way they approach
birth- the way they approach you. Midwives don’t get sued
nearly as much, but they are still confronted with the ever
growing threat. If you think your relationship with your
caregiver is built on trust- well, this may be an idea whose time
has passed. Trusting patients is a luxury most physicians find
they can no longer afford. Many malpractice attorneys and
nurse-attorneys make their livings teaching healthcare
professionals how not to get sued. It boils down to defensive
practice. This translates into taking all precautions, ordering all
the tests, acting the moment something appears amiss. If all else
fails, there is always the penultimate medical intervention for a
birth at risk- perform a cesarean section. This, among other
reasons, is why the cesarean rate has risen to 30% and above.
Birth has not suddenly become more dangerous, the practice of
delivery babies has.
This is why it is so important to know your own philosophy of
birth AND your care provider’s philosophy of birth. It will be
far more productive to find a caregiver that agrees with your
philosophy of care than to try to convert someone because you
like them. Don’t just hope you’ll be the exception or that things
will go well- you won’t be and they won’t. Liking your
caregiver is not sufficient criteria for choosing him or her.
As consumers you’ve got to do your homework. Get referrals
from friends and family, asking them WHY they think this
person is so great. Listen to their birth stories- do you want
yours to mirror theirs? Google them and find out about them, go
to those rating sites and see if someone has left comments about
your particular caregiver. Ask your caregiver directly for client
testimonials or references. Ask directly for their cesarean and
induction rates. (If they won’t give them to you, that’s a red
flag). Your ultimate goal should be to find the caregiver, be it
physician or midwife, OB or family practice, that is right for you.
Sherry L. Payne RN BSN
From Winter 2008 Issue V
define their parameters for care. If a midwife only wants to take
vegetarian mothers as clients, that’s her prerogative. If you
happen not to be a vegetarian and really want this midwife to
care for you, then you have a choice to make. The same is true
for physicians. If their parameters of care include routine
epidurals, episiotomies for all their patients, routines IVs, etc.
then that is their place of comfort in giving care. If you don’t
want any of those things, you’d be much better off finding a
different physician than trying to convert this one to your way
of thinking, because you’re asking them to take themselves out
of their comfort zone to care for you. It’s important that as
consumers of healthcare, women understand the pressures that
come to bear upon care providers.
Consumers greatly underestimate the role litigious threat has had
on healthcare. One of the reasons obstetrics has become so
defensive in practice is because the threat of a lawsuit hangs
heavily over their heads. Now some medical lawsuits are well
deserved, others frivolous, yet taken together their impact has
changed healthcare, and not for the better. Obstetricians are
more likely than physicians in any other specialty to be sued for
malpractice. This alone has changed the way they approach
birth- the way they approach you. Midwives don’t get sued
nearly as much, but they are still confronted with the ever
growing threat. If you think your relationship with your
caregiver is built on trust- well, this may be an idea whose time
has passed. Trusting patients is a luxury most physicians find
they can no longer afford. Many malpractice attorneys and
nurse-attorneys make their livings teaching healthcare
professionals how not to get sued. It boils down to defensive
practice. This translates into taking all precautions, ordering all
the tests, acting the moment something appears amiss. If all else
fails, there is always the penultimate medical intervention for a
birth at risk- perform a cesarean section. This, among other
reasons, is why the cesarean rate has risen to 30% and above.
Birth has not suddenly become more dangerous, the practice of
delivery babies has.
This is why it is so important to know your own philosophy of
birth AND your care provider’s philosophy of birth. It will be
far more productive to find a caregiver that agrees with your
philosophy of care than to try to convert someone because you
like them. Don’t just hope you’ll be the exception or that things
will go well- you won’t be and they won’t. Liking your
caregiver is not sufficient criteria for choosing him or her.
As consumers you’ve got to do your homework. Get referrals
from friends and family, asking them WHY they think this
person is so great. Listen to their birth stories- do you want
yours to mirror theirs? Google them and find out about them, go
to those rating sites and see if someone has left comments about
your particular caregiver. Ask your caregiver directly for client
testimonials or references. Ask directly for their cesarean and
induction rates. (If they won’t give them to you, that’s a red
flag). Your ultimate goal should be to find the caregiver, be it
physician or midwife, OB or family practice, that is right for you.
Sherry L. Payne RN BSN
From Winter 2008 Issue V
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| The Birth Project |
| Thoughts on Birth |