Step Two: Your Care Provider - a team approach to birth

There is a range of attitudes and beliefs about birth. Your care provider's perspective of the birth process can have a HUGE impact on your birth. Is your care provider supportive and encouraging 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 medical degree  your care provider holds and their specialty (i.e. Obstetrician, Family Practice, or Midwife) should not be used to assume their perspective on birth.  Some midwives practice "managed" care, while 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 during your birth. You want someone you trust, who is on the same page and will openly support your choices during your birth.  Note: these questions are best used to have an open dialogue, not to grill your care provider.  You may wish to choose one or two that are the most meaningful to you and ask for a longer appointment time to discuss your goals and desires for 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 doens't tell you the whole story, but it can help you better understand your risk of having a cesarean.  Read more about C-section rates on childbirthconnection.org)

· What percentage of patients have episiotomies? What is your suture rate? How do you help women avoid tearing?  (Again, this can help you better understand your risks.   You can learn how likely they are to provideperineal 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 having pain relief is not supportive of natural birth. There are many alternatives to anesthesia or narcotics to help a woman cope with labor.) 

· What percentage of patients have natural, spontaneous childbirth? (The higher the number, the more supportive your provider likely is. Unfortunately, for many care providers this number is quite low.)

· 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 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 quickly do you clamp and cut the cord?  How do you feel about delayed clamping?  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?)