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How to find the right one for you.

Questions to ask when choosing an Obstetrician?


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25/06/2018

How to find the right one for you.

Choosing an obstetrician for your birth is a big decision and one that you may want to research. Many people choose an obstetrician on the recommendation of a friend or family member, but this doesn't mean that they will be the right OB for you. The amazing Kelly from BellyBelly has compiled an excellent list of 12 questions to ask when considering the right obstetrician for you:

 

 #1: What Are Your Philosophies And Beliefs About Birth?

This question is the most important question you could ask a health care provider, as it will give you an idea as to how they see birth and how much control they believe they should have in the process. Do they see birth as: A medical process which needs to be monitored and managed continuously? A process which is fraught with potential minefields and requires preventative procedures? Or; A natural process where nature should take its course before interfering?

 

#2: How Much Choice Do You Feel I Should Have In The Decision Making Process?

You’ll have a much better experience of childbirth if you’re involved in the decision making process and are given options. Birthing women who feel they have no control or are not involved with decision making tend to have a less positive experience of childbirth, and are more likely to experience depression and anxiety. It can also impact your experience of motherhood, by influencing how you feel about your body being capable and strong. It’s very important to choose someone who you feel will involve and inform you throughout your pregnancy and birth, without wanting to race you out the door in five minutes. You’re not a number.

 

#3: What Are Your Thoughts About Pain Relief During Labour?

Another great indicator of how a health care provider views the birth process. Do they assume you’ll have pain relief like everyone else, or will they support and encourage natural pain relief methods? Will they fully inform you about any side affects for you as well as your baby? Will they encourage you to accept pain relief, or recommend against it if you are close to birthing your baby? What they say about pain relief and if they think you will quickly succumb to it says much about what they think of the birthing process and how supportive they will be.

 

#4: How Do You Feel About My Birth Plan? Do You Forsee Any Problems?

If you haven’t yet put together your birth preferences (birth plan) it’s a good idea to take a rough one with you when you interview an obstetrician. It can always be altered later, closer to the date, but it’s important for the person who is to be your primary health care provider to see what you have in mind for the birth – and it’s important for you to find out what he or she thinks about it, before it’s too late. There’s nothing worse than being in a situation where you need to make a quick decision and you feel like you don’t have enough time to discuss it or change your mind. When you’ve finalised your birth plan, ask the obstetrician to sign the end of your birth plan in agreement, so when you present it to the hospital or when you face deviations to your plan, you have something signed to show hospital staff or the obstetrician.  

 

#5: What Are Your Thoughts On Electronic Monitoring, And When Do You Think It Should Be Used?

Intermittent doppler monitoring is standard care during labour, however some hospitals prefer to use more restrictive monitoring, which can affect the way you plan to labour and give birth. Some hospitals have continuous electronic fetal monitoring and others have intermittent electronic fetal monitoring. Continuous CTG monitoring involves you being stuck in one position, usually on the bed, and can be detrimental to the progress of labour. A Cochrane review states that where continuous CTG was used, there was: “…no significant differences in cerebral palsy, infant mortality or other standard measures of neonatal well-being. However, continuous cardiotocography (CTG) was associated with an increase in caesarean sections and instrumental vaginal births. The real challenge is how best to convey this uncertainty to women to enable them to make an informed choice without compromising the normality of labour.” “Data for subgroups of low-risk, high-risk, pre-term pregnancies and high quality trials were consistent with overall results. Access to fetal blood sampling did not appear to influence the difference in neonatal seizures nor any other pre-specified outcome.” Researching all the choices you make for your birth plan is the key. It shows you actually understand and have researched what you have planned. You’re less likely to stick to a birth plan if you haven’t researched the reasons why you want those choices.

 

#6: What Is Your Induction Rate And When Do You Think An Induction Should Be Considered?

Obstetricians have varying preferences for induction. Some will put induction on the table only a few days after your estimated due date. Some prefer to induce 7-10 days after your estimated due date (post-dates). Others will wait until two weeks post-dates, and some will allow more if baby and mother are well (you may need to agree to come in for monitoring for short periods of time). Of course, if there is no medical reason evident, you can always say no. The problem with inductions when not medically necessary is they trigger the cascade of interventions. While it might sound harmless to start labour earlier with a little bit of artificial labour hormone, it actually doesn’t work the same as natural oxytocin – it doesn’t even cross the blood brain barrier. You might change your mind when you realise it significantly increases your chances of an epidural (requiring a catheter and i/v fluids), and may also require forceps, vacuum or even a c-section. Find out the induction rate of both the health care provider and the hospital. Unfortunately some don’t like to tell you, which would say to me that they aren’t proud of it. Knowing an induction policy before you choose a health care provider can help you avoid interventions that you perhaps aren’t hoping for. Also, make sure you’re informed about the risks of inducing labour without medical necessity. We know the benefits, but many women are not told about the risk of inductions, and it’s one of the quickest ways to derail your birth plan because it means you will become high risk.

 

#7: What Is Your C-Section Rate And In What Situations Will You Recommend One?

This is a question you need to ask both your healthcare provider and the hospital. Similarly to inductions of labour, they may not be forthcoming offering a figure, but finding out the answer to this question can be very helpful, and may possibly save you from major surgery and a 6-week recovery, if you end up having a c-section. The World Health Organization states 10-15% of c-sections are medically necessary, and after that number, it doesn’t save more lives. However, many hospitals are now sporting c-section rates of up to 70% in Australia and the United States. If a health care provider isn’t telling you their c-section rate or can’t give you an estimate, then I would think it’s a rate they didn’t want you to know. Transparency is super important.

 

#8: What Mother Centred Options Do You Offer For C-Sections?

What happens in theatre will be up to the anaesthetist or the obstetrician. It may be beneficial if you can speak to the anaesthetist prior to your surgery date, if you’re having an elective c-section. In order to perform a c-section as quickly as possible, things are often done to save time. Once your baby has been born, the normal process is to give you a quick look of the baby (after someone else has checked over the baby and wrapped it up) and then baby is given to your partner for a cuddle. Usually, all the weighing and other procedures will be done after you’ve been sent to recovery, alone. However, if you find the right obstetrician and if it’s not a life-threatening situation, you can have a more special, bonding experience. There are some obstetricians who allow some or all of the following during and after a c-section, where mother and baby are not in danger:

 

#9: What Is Your Episiotomy Rate And In What Situations Would You Perform One?

These days, it’s uncommon to find an obstetrician who performs routine episiotomies for all births. If you find one who does, run! However, many episiotomies are still being performed during childbirth. Find out what percent of births result in episiotomies being performed by the healthcare provider, and and how they feel about it’s use. When will he or she do one? Do they prefer you to tear naturally or have an episiotomy, and why?

 

#10. Do You Support Vaginal Breech Birth?

If So, What Conditions Do You Have? This is something most women won’t have to worry about, but this is a very important question. For some women, their babies will be in the breech position during pregnancy. While most babies will turn when given the chance, some babies stay bottom down. If your baby is breech, most obstetricians will recommend a c-section before your due date, usually around 38 weeks of pregnancy. However, there are some breech savvy obstetricians who are skilled in vaginal breech birth. Some work in breech birth clinics too – you just have to do your homework to find them. It’s also good to know that on the Royal College of Obstetricians and Gynaecologists website, there’s a statement about vaginal breech birth, supporting this method of birth. It has certain conditions, but it’s a great start. It’d be wonderful if more obstetricians could ‘skill-up’ in breech birth and if it was taught in medical school. If the health care provider supports breech birth, find out out what conditions they have. Some will support you on the condition of performing an episiotomy or continuous monitoring, an epidural etc. You can negotiate in some cases, just make sure you have their committment. Some variations of the breech position are more favourable for a vaginal birth (for example, frank breech), so your baby’s position may be the single deciding factor in being able to have a vaginal birth, or not. A health care provider who is supportive of breech birth is more likely to have a flexible and supportive philosophy of birth, so even if your baby isn’t breech, you’re probably on a winner.

 

#11: How Do You Manage The Third Stage Of Labour?

The third stage of labour is the birth of the placenta. It may seem like something irrelevant, but there are some very important events that can affect your baby. Firstly, in order to hurry things along after your baby is born, some obstetricians (or hospital midwives if the doctor can’t make it) will clamp and cut the cord right away. Then, they may give you an injection of synthetic labour hormone to expel the placenta. The injection is done to prevent a possible haemorrhage, which is an increased risk if you have a high intervention birth or induction. You can ask to be given this only if you do show signs of excessive blood loss or if you have had an induction, but for normal, healthy birth, haemorrhage rates are low. 

For a normal labour, there is no reason to hasten delivery of the placenta – most of the time it will come out on its own – either when you stand up, or when you breastfeed your baby, which stimulates natural oxytocin. Some health care professionals have been known to knead the woman’s belly or pull on the cord (risks the cord breaking and needing manual placenta removal), when they simply haven’t given it enough time. It’s not the most pleasant thing for a new mother to go through either. When the cord is left unclamped until it has stopped pulsating (i.e. all the blood has gone from the placenta to the baby), the baby is less likely to experience anaemia, blood transfusions and other conditions.

The baby will benefit from months of iron stores due to this valuable supply of blood, which contains precious cord blood and stem cells.

 

#12: What Do You Think About Doulas?

No matter if you want a doula or not, it’s a great question to gauge how much the health care provider supports you to have a normal birth. Years of studies from around the world have repeatedly shown that the support of a doula helps to reduce the incidence of intervention (c-section, forceps, vacuum, pain relief and more) and helps to shorten labour, while having no adverse effects. 

Some health care providers have had bad experiences with doulas, and some have been known to refuse them. Just like any profession, there are some who aren’t very professional (by doing your research, you can avoid most problems with anything). If the obstetrician doesn’t allow or support the use of doulas, ask why. But know that there are many fabulous doulas helping women to have supported, empowered births.

 

Content republished with permission from BellyBelly – read the original article here.

 




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