Adriana Lozada shares eight great questions for sussing out your provider’s protocols and practices as your pregnancy advances, in order to help you figure out how much shared decision-making and agency you will truly have in your birth experience.
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Related Birthful episodes:
- Why Choosing the Right Care Provider is Crucial for Your Pregnancy
- Evidence & Eating During Labor
- Big Babies and Shoulder Dystocia
- Rethinking the Pushing Stage
- What Your Need to Know About Birth Positions
- How Long Should You Wait to Clamp the Cord?
- Informed Consent in Childbirth
- Pain and women’s satisfaction with the experience of childbirth: a systematic review, from the American Journal of Obstetrics and Gynecology
- Choosing a Maternity Care Provider: Collecting the Information You Need, by Childbirth Connection
- The BRAIN acronym for informed decision making
- Take a pledge for shared decision-making!
- The March of Dimes Perinatal Data Center provides access to statistics on parental and infant health arranged by U.S. state and region.
- The Center for Disease Control and Prevention (CDC) details cesarean delivery rate by U.S. state.
- The Birth Place Lab, in the Faculty for Medicine at the University of British Columbia is compiling data on inequity and mistreatment during pregnancy and birth via the Giving Voice to Mothers study.
- If you want to learn more about how your lactation goals will be supported, the Maternity Practices in Infant Nutrition and Care (mPINC) score for each U.S. state is made available by the CDC, and institutions who adhere to the Baby-Friendly Hospital Initiative guidelines can be found on Baby Friendly USA’s website.
- The data available can vary by state, but, for instance, in New York State, you can google “Cesarean rate+(name of your county)” and that will lead to results from your state department of health website (check out an example of one from NYS that lists Cesarean rates per hospital).
Eight Questions to Ask Your Care Provider (Especially in Your Second Trimester)
Adriana Lozada: Hello Mighty Parent or Parent-To-Be! Welcome to Birthful, I’m Adriana Lozada. So here we are, at the last episode of our Care Provider series, and this is going to be one of those short-yet-powerful episodes that I do by myself from time-to-time, to help close out the series.
Okay, so after talking to a whole array of providers, I wanted to leave you with a super helpful set of questions that can help confirm that your provider is a good fit for you, and also help you get a better idea of the protocols that you may encounter toward the end of pregnancy, so you can clarify if your provider really practices shared decision-making when it comes to your care.
All of these questions are great ones to ask during the interview process, and some of them are especially important to ask— or re-ask— as you get into your second and third trimester.
Truly, we can’t overstate how crucial it is to choose the care provider that is right for you, and the impact it will have on your birth experience. In fact, a systematic review of the research found four factors that make the greatest contribution to a person’s satisfaction during birth. These four factors are: having good support from care providers, having a high-quality relationship with their care providers, being involved in decision-making about the care, and having better-than-expected experiences. Now, establishing high-quality relationships with care providers? That takes time, especially if your appointments and prenatals with your provider are very short. That’s gonna take time for you guys to build a relationship.
Now, when you look online, many of the list of questions to ask your care providers focus more on getting information on what YOU should be doing, like what foods to avoid, or asking your provider about what exercises you can do, or how much weight you should gain. But there were very few questions about asking them what they’re gonna do for you and how they’re gonna do it.
So because being involved in decision-making about your care is something that you can assess on a constant basis and even during the interview process, I wanted to give you a list of questions that can help you figure out if things are being done just because, or because they actually make sense in your care AND whether you get to have a say— which of course, you should.
If you don’t have a care provider yet or you’re wanting to switch care providers, what you should ask them for is for an initial consultation instead of an intake, and that way the approach will be of answering your questions with ample time. So, the first question would be to ask them how many births they did last month and how many of those were “primary cesareans,” how many vaginal deliveries, and how many inductions? And that’s gonna give you a nice picture of what they tend to do more. So, if you’re looking for a vaginal delivery with non-induction, you’re gonna get a sense if that’s something your provider is really gonna support.
Then my second question is “Do you regularly work with doulas and who would you recommend?” If they say, “Oh, we don’t work with doulas,” or you get a sense that that’s not something they’re open to, they are then telling you that they will limit your labor support. And as we know from the research, having good support is really important, so that is kind of a red flag, especially when caregivers don’t spend a lot of time in the room and you are gonna need other people around you to give you that support. Not just your main care provider.
My third question is as your due date approaches, what can you expect? Do they have policies around going past 40 or 41 weeks? And some examples of that would be automatically sweeping your membranes at, say, your 39-week appointment, or that towards the end of your prenatal care you start getting cervical checks at every appointment, or that they tend to do inductions for due dates just because you’re however many weeks along, not because there’s a specific reason of why an induction is recommended.
Another question you can ask is at what point they talk about the artificial induction of labor and what are some reasons for inductions— and that piggybacks really well on the previous question. Going past your due date is not a reason for an induction, and neither is necessarily the assumption that your baby is big. In fact, the research tells us that the perception of your baby being “big” leads to more cesareans than your baby actually being big, y’know, when you weigh them after they’re born and they’re like, “No, this baby wasn’t so big, but we thought they were big,” and so therefore there was an induction or a cesarean.
Another question you can ask is if during labor you’ll be able to move about freely and eat and drink. We know movement is really important in helping labor flow and helping baby move down the birth canal, so it’s really important that you are able to move about freely. And then there’s a lot of debate and research around eating and drinking during labor. It depends on what interventions might be in place, but if you are having a low-risk, non-interventive birth, you should be able to eat and drink. And if they are against that, then that requires a deeper conversation.
You can also ask them, number six, “What are some non-medical ways to encourage labor flow?” And if the only way they encourage labor flow is by augmenting your labor with Pitocin, then that might be a red flag, as well. There are many steps, many ways to encourage your labor to flow other than requiring an intervention that will probably then end up limiting your movement and adding more fluids to your body, and, y’know, you go down a little rabbit hole of interventions. So, yeah, ask them what are some non-medical ways that they can encourage your labor flow.
For number seven would be “Do you have a favorite position for the pushing stage?” and “In what other positions do people often push in?” If their favorite position for the pushing stage is lying on your back… that’s also kind of a red flag. You should be able to push in whatever position you like! And if they can’t come up with other positions then that is something to consider. A good shared decision-making answer would be, “There’s no one favorite position! People push in all sorts of positions and it would be whatever position you’re comfortable in. And also, we’re probably gonna try several positions because pushing can take a bit of time, and that involves movement.”
And my last question, number eight, is how soon do they usually clamp the cord after birth, and have they ever waited for the placenta to be delivered before clamping and cutting the cord? The reason why I threw that question in, even though it relates to things that happen after the baby is born, is because I find that shared decision-making might really be fine and go slow throughout labor, but when it gets to the point where baby’s already been born and baby is looking fine, a lot of things are done very quickly without asking questions and without your input. So, this might help suss that out. We know that delayed cord clamping is very beneficial for babies, but that “delayed cord clamping” can mean different things to different people. So a provider might be thinking that 30 seconds is delayed cord clamping, while you might be thinking that five minutes is delayed cord clamping… and there’s a disconnect. Getting behind the actual amount of time is gonna be helpful to you.
And my bonus question is to ask them If they’re doing any antiracism work individually, in their practice, or if any work is being done by the hospital or birth center where they work, because we know that racism is a key component of why we have such awful perinatal mortality and morbidity rates in this country. So that’s an important question to ask, especially if you’re a person of color.
Now, regardless of what answer they give you, listen to the language that is being used. Is there shared decision-making happening, or are you just being told what to do? Are the answers vague? Are they gaslighting you? Are they using scare tactics? Being patronizing, dismissive, or even getting angry? Of course, all of those things are red flags.
Continue to check in with yourself, especially as your due date approaches, to make sure they are still practicing shared decision-making in your care. If you find yourself, say, telling a friend that your care provider “won’t let you” this or that, see if you can substitute “I choose not to,” instead of “They won’t let me,” and does that feel truthful to you? If not, it’s probably not shared decision-making. And so explore that.
If you find yourself being coerced into interventions, two great questions to ask are, “Is my baby in danger?” and “Am I in danger?” And if the answer is not a definite “yes,” then you have time to explore your options. Remember to use your BRAIN acronym to figure out the benefits, the risks, the alternatives, and to get more information or use your intuition, and ask what happens if you do nothing, or what happens next if you agree to that (what is being suggested).
And this wraps up our Care Provider series! Next series we’ll be talking about Supporting Your Body During Pregnancy, so stay tuned for that.
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You can find the in-depth show notes and transcript of this episode at birthful.com, where you can also learn more about my birth and postpartum preparation classes and download your free postpartum preparation plan. Also, if you find this podcast is an invaluable resource for you, the best way to support us is by taking one of my perinatal classes, doula workshops, or trying out any of the wonderful products made by our sponsors. This is what allows us to continue doing this work.
Birthful is created and produced by me, Adriana Lozada, with production assistance from Aysia Platte. This episode was produced in part by LWC Studios. Paulina Velasco, Virginia Lora, Cedric Wilson, and Kojin Tashiro.
Thank you as always for sharing and listening to Birthful. Be sure to follow us on Goodpods, Spotify, Apple Podcasts, Amazon Music, and everywhere you listen.
Come back for more ways to inform your intuition.
Lozada, Adriana, host. “Eight Questions to Ask Your Care Provider (Especially in Your Second Trimester).” Birthful, Lantigua Williams & Co., November 23, 2022. Birthful.com.
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