In the webpoll that I’ve been conducting over the couple weeks, I asked what readers think is the most important factor in avoiding a c-section. 47% of all readers said that the right provider is the most critical component in having a normal birth.
I agree with these readers. Although there are multiple factors that enter into normal birth, the wrong provider can sabotage the best-laid plans. For example, I frequently hear comments such as, “I trusted my doctor, but when it came down to brass tacks, he ignored my birth plan”, or “My midwife sounded as if she would support us in a normal birth, but she ended out being just as interventive as the physicians we’d interviewed”. Why do providers sometimes say one thing and do another?
- The provider may outwardly support your plans, but inwardly think “she’ll feel differently about it when real labor hits“
- The provider may have initially been in agreement with your birth plan, but not have a true understanding of the normal birth process, and feel s/he needs to intervene
- The provider may see complications developing with your labor, and believe that an intervention would be helpful
Many women interview several providers before deciding who will provide their prenatal care. Typical interview lists include questions about c-section and episiotomy rates, shaves & enemas, years of experience, etc. When asked a specific question, a provider may give a specific, satisfactory answer, but I believe it is much more telling to get down to basic philosophies. Although I have titled this post “In Search of Dr. Right” (in recognition that the vast majority of women in America still get their prenatal care from an OB), all of these questions are pertinent when interviewing any provider. Here is my ideal interview list:
1. What is your philosophy of pregnancy and birth?
- Wrong answer: What do you mean, “philosophy”? I don’t have a philosophy about birth, I just deliver the babies. (Yes, I actually heard a physician say this).
- Right answer: Unless there is a clear medical reason to intervene, I believe birth works best when allowed to take place without interference.
2. How do you define “normal birth”?
- Wrong answer: A birth that’s normal is any birth where you have a healthy mother and baby at the end.
- Right answer: A normal birth is one that unfolds without any interference in the natural, physiological process of birth.
3. Can you give me an example how you typically manage a normal birth?
- Wrong answer: I like to have the external fetal monitor for at least a part of every hour, break your water once you’re 3 or 4 centimeters dilated, and if you don’t progress at a steady pace, add a little pitocin to help you along.
- Right answer: Management? As long as birth is normal, I don’t do anything except watchful waiting and checking periodically to make sure baby’s heart rate is OK. I will be there to support you as much or as little as you desire.
4. How would you feel if I disagreed with you about a procedure you recommended during labor or birth?
- Wrong answer: “I’d wonder where you got your medical degree, ha ha!”
- Right answer: “I believe that it’s your body and your birth. You are the one that will live with the results of any procedure that is performed, and so you should be the one that makes the final decision. I’m just there to offer you my best advice.”
5. How long will you “allow me” to wait if I go overdue?
- Wrong answer: “I really prefer not to let my moms go past 41 weeks. But many women are sick of being pregnant before then, so we can get you delivered anytime after 39 weeks.”
- Right answer: “The evidence shows a small increase in complications when pregnancies go past 42 weeks, but again, this is your decision. I would recommend watchful monitoring of the baby to ensure everything’s OK, and support you in your decision to wait for labor.”
6. What position(s) will you allow me to use when giving birth?
- Wrong answer: “The only way I can safely deliver your baby is with you on the bed and the bed broken apart. I need to be able to see what’s going on in order to control the delivery”.
- Right answer: “Any position you’re comfortable with.”
7. How do you feel about IVs and continuous fetal monitoring?
- Wrong answer: “They are safety precautions to ensure you have a healthy baby”.
- Right answer: “Neither has been shown to be beneficial in a normal labor. Sometimes they are necessary, but only when there is a clear medical indication for their use.”
8. How do you feel about a woman eating and drinking in labor?
- Wrong answer: “For your own safety, I do not allow you to eat or drink anything in labor. You may have ice chips. You’d probably just throw it all up anyway.”
- Right answer: “It is your choice. The evidence does not show any benefit from restricting food or fluids while in labor. If you feel like eating or drinking, you are welcome to.”
9. What do you recommend a woman do during labor?
- Wrong answer: “Do? What do you mean? You just lie on the bed and we’ll do the rest”.
- Right answer: “I recommend being out of bed as much as possible; moving around helps the baby to move into the optimal position, as well as helping you be more comfortable.”
10. What are your thoughts on pain relief in labor?
- Wrong answer: “Lots of girls think they want to do it naturally, but change their mind once they feel a real contraction. Natural birth is for hippies. Modern women get epidurals. You wouldn’t get your teeth drilled without anesthetic, would you?”
- Right answer: “There are lots of methods of relieving pain without using drugs. Sometimes medication or an epidural can be very helpful. But most women, provided they are having a normal labor with a normally positioned baby, can manage the sensations of labor without pain medication. Have you thought of hiring a doula? Studies have shown that having a doula present can significantly reduce the need for pain medication.”
11. How do you feel about cesarean birth?
- Wrong answer: “It’s quick, it’s easy, and it preserves your vagina!”
- Right answer: “I’m thankful we have the ability to perform a safe cesarean section, but I believe there are many unnecessarily performed. My hope is that, if you need a cesarean delivery, there will be no doubt in your mind that we tried every alternative, and that it was absolutely necessary.”