In the United States, we have a different association with our doctors or providers compared to other developed countries. We almost feel as though we’re there to obey everything they say because a lot of us subconsciously look at them as authority figures. Nevertheless, this is not the case. We need to be asking our providers questions and interviewing them to see if they are a good fit for our wants and needs.
In other developed countries, such as the Netherlands, it is evident that your provider works for you. They can’t fire you as a patient, but you can fire them as a provider. Here in the U.S., either party can fire the other.
Additionally, we should be interviewing our OBs and midwives before continuing care because your maternity care provider and the place you give birth are the two greatest influencing factors to the outcomes of your birth.
Furthermore, out of all of the developed countries in the world, the U.S. pays the most for our healthcare and we have the worst maternal health outcomes. We need to demand care that meets our wants and needs.
To start demanding optimal care for you and your baby’s health, you should interview your maternity care provider and avoid settling for them being “very nice.”
“Nice” is a great expectation for your neighbors, but your midwife or OB, needs to be much more than that.
Where should you start?
1. “Tell me more about…”
Ask your OB or midwife to tell you more about:
- Their practice. Ask what they love most about it.
- “How do you normally manage…” Some ideas could be, going past 40 weeks, gestational diabetes, suspected big baby, etc.
- “How did you become so passionate about this specialty?”
These questions are perfect to get to know why your provider is motivated in this specialty and if their views match what you’re looking for in your pregnancy, birth, and postpartum experiences.
2. “What do your typical appointments look like?”
Asking this question should help you figure out how much time your provider takes in each appointment and what they normally do in each appointment.
3. “What is your philosphy about birth?”
Some maternity care providers believe birth is a medical event that is safer when managed with medical technology, while others believe it’s safer the less it is interrupted. Take a look at the medical model of care vs the Midwives Model of Care™ (Coming soon!).
4. “What are your views on…”
You may want to ask about their views on:
- Baby ultrasounds
- VBAC (vaginal birth after cesarean)
- Induction at 39 weeks
- Going past 40 weeks
- Giving birth upright
- Or whatever else may fit your specific wants, needs, or situation!
5. “What is your experience with…”
This is a way you can ask what their experiences are with things such as:
- Intermittent auscultaion
- Physiologic birth of the placenta (no pitocin, unless medically necessary)
- Unmedicated births (If you have an OB they definitely have lots of experience with epidurals and cesareans, so if that’s what you’re planning for, I wouldnt worry!)
- Delayed cord clamping
- Anything else you’re thinking!
6. “How many of your patients give birth with an epidural?”
We know homebirth midwives have a lot of experience with unmedicated births and we know that OBs have a lot of experience with medicated births.
Therefore, if you’re planning an unmedicated birth with an OB, be sure to ask them this question to see how familiar and comfortable they might be with you going unmedicated.
It’s also important if you have a nurse-midwife in the hospital setting to ask how many of their patients have epidurals, as a nurse midwife’s experiences can vary depending on their place of work and background in birth work.
Are you wondering about the different types of midwives in the U.S.? Check this post out to learn about their differences! (Although, I hope one day the U.S. can have just one type of extremely well-rounded and physiologically-driven midwife with authority and training in the home, hospital, or birth center setting).
7. “What are my other options for pain relief?”
All hospitals have varying options of options. Some things you can ask about besides an epidural include:
- Nitruous oxide
- TENS machine
- Opiods
- Hydrotherapy
Additionally, how likely is it that these options will be available if you want them?
For example, when I was planning for my labor and childbirth in a hospital with my first daughter, they only had two labor rooms with a tub and it was solely random if I would get a room with one.
8. “What are my options regarding positions while I’m pushing?”
Whether you’re having a medicated or unmedicated birth, pushing upright overall has more benefits than lying on your back.
aside from on their back. Some providers believe they cant access the baby to catch them safely which simply isn’t true.
A 2017 Cochrane review and meta-analysis found:
- 25% less likely to have a forceps or vacuum-assisted birth
- 25% less likely to have an episiotomy
- 54% less likely to have abnormal fetal heart rate patterns
Although, with giving birth upright this study found a 20% higher risk for a second-degree perineal tear. Still, strong evidence shows that natural tears heal easier and are less traumatic to your skin and tissues than episiotomies.
9. “Are there any tools you will have to help me during labor and birth?”
These would be tools such as:
- Birth ball
- Peanut ball
- Birthing stool
- Birth bar
- Tub
- Shower
- And more!
Similarly to asking about options for pain relief, I recommend asking about how many they have available to ensure you can use what you’re interested in if you aren’t able to bring your own.
10. “What are some scenarios when you would suggest an induction?”
Some scenarios you may be curious to hear your provider’s thoughts on include:
- Your BMI
- “Due date”
- How many high blood pressure that fall in the range of gestational hypertension
- Suspected big baby (A “big baby” is typically considered 8lbs, 13oz+)
- And more!
11. “What is your cesarean birth rate?”
This question is great to ask your OB or midwife if you would like to avoid a cesarean.
Ensure the OB or midwife is telling you exact rates and not something like “It’s really good”, or “It’s really low”.
Furthermore, if you’re getting induced I recommend asking their induction rate as well to get an idea of how many may end up with inductions since we know inductions do increase your risk of having a cesarean birth.
12. “What is your induction rate?”
If you’re interested in avoiding an unnecessary induction, asking this question along with question #10 will help you identify and talk to your provider about how many of the inductions she has done with clients were medically necessary.
13. Training and CEUs
Seeing as OBs aren’t present during your birth, yet, only at the end if they end up being the ones there, I feel like this question is more applicable for midwives. (There’s no way to know or interview nurses beforehand).
Whether you have a certified nurse-midwife or a certified professional midwife, they will be with you throughout your labor and birth.
Some training you may want to ask about include:
- Shoulder dystocia
- Breech
- Lactation
- And any others you may think of!
More Questions for Your Homebirth/Birth Center Midwife
These remaining questions are specific to out of hospital midwives which can include:
- Certified Nurse-Midwives (CNMs)
- Certified Professional Midwives (CPMs)
- Traditonal/Unlicensed Midwives
- Certified Midwives (CMs)
14. “What is your transfer rate?”
Asking this question will allow you to know how many of the midwife’s clients who plan a homebirth end up transferring to the hospital.
15. “What were the transfers for?”
Next, ask what the reasons are for and the rates broken down. This may include things like:
- Wanting medical pain relief
- Postpartum hemorrhage
- NICU team
- And other options
16. “What is your cesarean birth rate?”
This question will tell you how many of the midwife’s transfers resulted in a cesarean birth.
17. “Do you have hospital privileges in case of an emergency?”
Regarding CNMs and CMs, “All states but one (Maryland) have laws or regulations that explicitly or implicitly allow CNMs to admit patients to a hospital. Five states similarly allow CMs to admit. Thirty-four states allow CNMs to be included on a hospital’s medical staff, while four states allow CMs to be so included.” The American College of Nurse-Midwives (ACNM) states.
“The more serious issue is the willingness of hospital boards and medical staff to credential midwives, give them admitting privileges, or include them on the medical staff. Even where state laws allow these actions, individual hospitals may not, or may allow privileging only with physician supervision, or may allow partial participation in the medical staff (e.g., not being able to vote on issues before the staff).” ACNM concludes.
I currently don’t have much information on the hospital privileges that CPMs might have. However, I do know in some states, such as Lousiana, they are able to follow into the hospital and do some things with their clients such as position changes, etc.
If you have more information about hospital privileges for Certified Professional Midwives in the U.S. please leave a comment below!
19. “What labs/testing do you require?”
There are many prenatal tests typically done throughout pregnancy, such as:
- Urine tests
- Blood tests
- Group B streptococcus infection screening
- Glucose screening
- Ultrasound exams
- Chromosomal and neural tube defect screenings
- rubella.
- hepatitis B and hepatitis C.
- sexually transmitted infections (STIs)
- human immunodeficiency virus (HIV)
- tuberculosis (TB)
- And more!
This can be a great question if you’re looking to avoid any prenatal tests or ensure your provider is able to provide you with the tests you desire.
20. “Will you be able to change to a home birth if I cant make it to the birth center in time?”
If you end up having a precipitous (fast) labor, ask if your midwife is okay with having a home birth as your “plan B” if you prefer the birthing center as your “plan A”.
This is a crucial question if you’ve had precipitous labor before, (giving birth in less than 3 hours or regular contractions), as most of the time each baby you give birth to comes faster!
Provider Red Flags
Red flags are signs that this OB or midwife isn’t a good fit for you and can not or will not meet your wants and needs:
You Spend More Time in the Waiting Room Than You Do in Your Appointment
If you’re looking for personalized care plus a provider who has time to educate and answer your questions, someone who seems rushed doesn’t ask if you have any questions and leaves the room after 5-10 minutes, they won’t be a good fit for you.
They Brush Off Your Questions
A provider who doesn’t seem to take a question you have seriously or answer in an honest and comprehensive manner will not be a good fit if you’re looking for empowering pregnancy and labor experiences.
They Tell You You’re Looking Into Too Much
If your OB or midwife ever suggests that “You’re looking into too much”, or to “Stop looking everything up” this is a big red flag for someone who wants to make informed decisions and be involved in the decisions regarding you and your baby.
They Dont Like Doulas or Suggest They Are Unnecessary
If your provider says they don’t allow doulas, or says something along the lines of “They’re not worth the money”, “You won’t need one”, “She needs to know her place in the labor room”, etc. then this is a sign your provider might not have your best interests at heart.
Doulas are proven to be very beneficial for labor support. Check out 7 Reasons You Need to Hire a Birth Doula!
They Dont Comprehensively Explain Benefits vs Risks
As I mentioned above, an OB or midwife who comprehensively explains the benefits and risks of all decisions you have in your pregnancy, labor, and childbirth is crucial.
Remember the acronym B.R.A.I.N. for making informed and empowering decisions.
Only when you are provided with the benefits, risks, alternatives, following your intuition, and asking what happens if you don’t do an intervention now, or what happens if you wait later, you will be able to make informed decisions.
They Dont Value Your Birth Plan
If your provider says or gives any look at you that makes you feel like they might not support that you have a birth plan, this is another red flag. This may indicate she or he isn’t taking your preferences, decisions, and questions seriously or into much consideration.
You have a right to make decisions in your care and creating birth plans can help you look into your options and firmly communicate what you want with your birth team.
Using The Word “Let”
Some examples of an OB or midwife using the word “let” include:
“I’ll let you go to 41 weeks until inducing”
“…let you skip the first-trimester ultrasound”
“I’ll let you try for a VBAC”
If your provider uses the word “let” I’d advise you to run for the hills!
By using the word “let”, your provider is implying that they have more control over the decisions in your pregnancy and birth than you do which is not true. We don’t want someone like this to be your provider and that’s why these interview questions are so important.
Your labor and birth experience is a memory you’ll likely remember many details of for the rest of your life and it’s crucial to have a provider you trust and who will work with you for your comfort and goals.
You got this! You are encouraged, educated, and empowered.
Do you have any more questions or maternity care provider red flags to add to my lists? Let me know in the comments below, I’d love to hear from you!
Sources
Selective versus routine use of episiotomy for vaginal birth
Position in the second stage of labour for women without epidural anaesthesia
American College of Nurse-Midwives: Hospital Credentialing and Privileging
ACOG: Routine Tests During Pregnancy
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DISCLAIMER: This post is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding you or your baby’s health. Please read my Medical Disclaimer for more info
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