Adriana Lozada shares what you should know about your provider’s protocols and practices, in order to help you figure out how much shared decision-making and agency you will have in your birth experience.
What was the most illuminating question you asked your care provider during pregnancy? How did you know had found your perfect match? Share your insights with us on Instagram @birthfulpodcast.
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Related Birthful episodes:
- Choosing Your Care Provider, with Robin Elise Weiss
- Big Babies and Shoulder Dystocia, with Rachel Reed
- Rethinking the Pushing Stage, with Whapio
- Informed Consent, with Cristen Pascucci
- 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
Get engaged in your healthcare by looking up your regional and local hospitals and care providers, and the third-party scores they receive on different measures related to quality of care.
- 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
Adriana Lozada: I’m Adriana Lozada and you’re listening to Birthful, and I’m here today on my own, just like I am every other week, taking about 10 minutes or so to talk to you one on one about a topic that I want to dive deeper into. So, for this week what I’ve done is I’ve compiled a list of eight questions that you can ask your care provider to suss out some of the hospital and provider protocols that you may encounter towards the end of your pregnancy, and to understand if they are really practicing shared decision making when it comes to your care.
So, choosing the right care provider is crucial. We know that that’s crucial for having a wonderful birth experience. 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 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.
Looking online, I found tons of questions about what you should be asking your care providers, but they focused more on what you should be doing, like what foods should I avoid, or asking your provider about if you could exercise, or how much weight you should gain. But there were very little questions about asking them what they’re gonna do for you and how they’re gonna do it. Being involved in decision making about your care is something that you can assess on a constant basis and even in the interview process, and so to help you with that, here is a list of questions that are gonna help you figure out if things are being done just because, or because they actually make sense in your care and whether you have a say.
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, right? 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 shows that the perception of a big baby is the higher indicator. It’s a higher risk to more cesareans than babies actually being big when you way them after they’re born. 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 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, I suggest you ask them if they have a favorite position for the pushing stage, and what other positions do people often push in. If their favorite position is with having people on the bed on their back, that’s also kind of a red flag, and if they have no other favorite positions, you should ask them why.
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, because even if they might say they do delayed cord clamping, that might be 30 seconds when you were expecting five minutes. So, it’s a good question to ask.
And then as a bonus question, ask them about any hospital policy or any practice policy that they might have around COVID, so you can get a heads up of how that’s gonna affect your care. And you can also ask them if they’re doing any anti-racism 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? Do continue to check in with yourself, especially as your due date approaches, to make sure they are still practicing shared decision making.
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 what is being suggested.
Is there a question you think I left out? Email it to firstname.lastname@example.org or comment on this week’s post on Instagram, @BirthfulPodcast.
Lozada: Birthful was created by me, Adriana Lozada, and is a production of Lantigua Williams & Co. The show’s senior producer is Paulina Velasco. Virginia Lora is the managing producer. Cedric Wilson is our lead producer. Kojin Tashiro mixed this episode. Thank you for listening to and sharing Birthful. Be sure to subscribe on Apple Podcasts, Amazon Music, Spotify, and everywhere you listen, and come back next week for more ways to inform your intuition.
Lozada, Adriana, host. “Eight Questions to Ask Your Care Provider.” Birthful, Lantigua Williams & Co., December 2, 2020. Birthful.com.
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