Choosing or changing care providers

How do you influence your birth experience?

Step one: Your choice of care provider

There is a range of attitudes about birth. Your care providers perspective on the process can have a HUGE impact on your birth. Is your care provider trusting of the natural process or does he/she prefer the medical approach of a "managed" birth? How do you tell???

Ask questions. Some examples are listed below with an explanation of what your care providers answers may mean. Please note, that the title of your care provider (Obstetrician, Family Practice, or Midwife, etc) should not be used to assume their perspective on birth (medically minded vs. physiologically minded). Some midwives practice "managed" care either dictated because of rules from their partners (Obstetricians or Family Practice Doctors), from the location where they attend births or from state laws. Some physicians practice "midwifery" like care and are very trusting of the natural process. It is up to you to find out what your care provider believes and how they typically practice. Your don't want to be in a position to have to fight for your preferences or try to change your care providers mind. You want someone who is on the same page and will openly support your choices during your birth.

Here are some questions to ask your care provider:

· What is your after hours procedure? (Will you be able to talk to your personal doctor/midwife or just the person on call?)

· What percentage of your patients births do you attend? (How individual is the care they offer? Do they make an attempt to attend most of their patients births themselves.)

· How many partners are in your practice? (If there are 10 doctors who rotate call then your not likely to know the person attending your birth. This also means that you are more likely to encounter someone who does not have the same philosophy about birth).

· What percentage of patients have a cesarean section in your practice? (This is a huge indicator of their trust in the natural process. The more interventions are used, the more likely a woman is to have a cesarean section. The World Health Organization recommends that the cesarean section rate be between 5-15%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006). Some practices have rates of 50% or more!!! The U.S. national rate for 2007 was 31.8%) Read more about C-section rates on childbirthconnection.org

· What percentage of patients have episiotomies? What is your suture rate? (This tells you how patient a care provider is during the pushing phase. It also tells you how likely they are to provide perineal support, to assist you in finding the best position to avoid an episiotomy and to avoid interventions that increase the chance of having an episiotomy [such as epidurals, forceps or vacuum extraction]).

· What is the most common choice for pain relief amongst your patients? (A provider who encourages pain relief or even chastises a woman for not have pain relief is not supportive of natural birth. There are many alternative to anesthesia or narcotics to help a woman cope with labor.)

· What percentage of patients have natural, spontaneous childbirth? (The higher the number, the higher your chances are of having a natural birth. Unfortunately, for many care providers this number is quite low.)

· What percentage of patients how have had a previous cesarean have VBAC's? (The option for a VBAC or Vaginal Birth After Cesarean, has been nearly eliminated for many women because of fears of malpractice and/or hospital bans on this type of birth due to liability. Check our ican-online.org for more info on VBAC's).

· What is your protocol for postdates (i.e. “overdue”)? What percentage of women are induced in your practice? (Do they routinely induce at 40, 41, 42 or 43 weeks? If the policy is to induce all patients at 40 or 41 weeks, then you greatly increase your chances of having a cesarean due to fetal distress or a failed induction.)

· What is your protocol for preventing and managing a breech? (Their knowledge of optimal fetal positioning techniques can help you reduce your chances of having a breech baby. Their willingness to attend a vaginal breech birth speaks to their skills, patience and understanding of the process of physiologic birth.)

· What is your protocol for preventing and managing a posterior position? (Again, knowledge of optimal fetal positioning techniques can help you avoid this presentation. Avoiding interventions [such as induction, augmentation with pitocin, artificially rupturing the membranes, etc] can reduce complications with a mal-positioned baby.)

· How many vaginal twin births have you attended? (The higher number the better! This rate shows your care providers trust in the natural process and their willingness to be flexible.)

· How much time is allowed for the natural delivery of the placenta? What do you do it this limit has expired? (Assuming a natural birth has occurred, what approach is used during 3rd stage? Is the natural process respected or is there a standard protocol? Is the mother encouraged to nurse and release her own naturally occurring hormones to help expel the placenta? Speaks to their attitude about birth.)

More steps to come soon!