With many hospitals and private obstetricians requiring you to book pretty much as soon as a pregnancy is confirmed, the temptation is strong to just get into whoever you can and be grateful you got in to anyone at all. After all, caregivers are all pretty much the same, aren’t they?
There are some key differences between midwifery and obstetric models of care. Just as no two accountants or lawyers practice in the same way, maternity care givers are also a diverse bunch. Amongst other things the way they care for women in pregnancy and labour is influenced by their training, their own previous experiences, and their hard wired beliefs around birth. This means its generally a good idea to talk with a few in early pregnancy, and make an effort to find a care provider whose approach aligns with yours.
This list is focused on specific, key questions that will help you identify a care giver who is genuinely supportive of natural birth – but it’s by no means comprehensive! If you’re looking for this type of care, it’s helpful to understand what a potential care provider views as a “hands off” situation, and when they believe intervention might be needed. These questions should give you a feel for where your midwife or obstetrician stands, and can be a jumping off point for exploring your own feelings about intervention in your birth as well.
1. What’s your approach to post dates pregnancies? At what point would the care giver recommend you consider induction or other intervention to start labour? In Queensland, 24% of women will be induced, and a further 19% will have their labour augmented (ie. be given an intravenous drug during labour to regulate or strengthen contractions). Most commonly, inductions are scheduled when a pregnancy lasts beyond the estimated due date. Caregivers will vary as to how far is too far for them – anything from a couple of days, to a few weeks. If you’d like to avoid induction where possible, finding a care giver with a more relaxed approach can mean you and your baby navigate the final days of your pregnancy without pressure.
2. What’s your caesarean rate for normal, uncomplicated pregnancies? If a prospective care provider is evasive or vague on this question it may be a red flag. Our caesarean rate in Australia averages around 30%. While private hospitals don’t have to publish their data on an individual level, as a group they consistently report rates above this. Asking about the rate for uncomplicated pregnancies removes any confusion that may be caused by the inclusion of high risk pregnancies (these would usually be attended by obstetricians).
3. What’s your approach to the management of gestational diabetes? Gestational diabetes is being diagnosed more frequently in women with no prior risk factors, and in recent years the cut off point for diagnosis has been dropping. Around 8% of pregnant women will be diagnosed with gestational diabetes, most around the 28th week of pregnancy. If you’re one of them, the way your care provider routinely manages a GD diagnosis can have major implications for your pregnancy and labour.
4. Under what circumstances, if any, would you be likely to perform an episiotomy? Fortunately episiotomy rates are declining, but they’re still unacceptably high, especially among first time mothers. A care provider with a high episiotomy rate may be one who is quick to intervene generally. If this is your first baby, you could ask how many first time mothers in their hospital or practice receive an episiotomy to get a clearer picture.
5. What will happen if my baby is breech at term? This is a loaded question and the answer will tell you quite a bit! It’s highly unlikely that your baby will be breech at term, but asking your care provider what they’d usually do in this situation can be enlightening. Obstetricians and midwives who don’t view breech position alone as an automatic indication for caesarean are very likely to be a low intervention, hands off care provider for a woman with a head down baby.
6. When would you recommend routine continuous monitoring of my baby in labour? Continuous monitoring during spontaneous, normal labour in low risk women has been shown to increase the likelihood of caesarean without improving outcomes for babies. If your pregnancy has been normal and you labour spontaneously and unmedicated, intermittent listening with a doppler has been shown to be as safe – and won’t increase your risk of surgery. Nonetheless, some care providers insist on continuous monitoring for all women, regardless of their risk status. If you want to use the shower for pain relief and be able to move around to manage pain, this might be something to ask about.
Depending on your priorities for your own birth, this list barely scratches the surface of what you might need to ask a potential care provider. Can you think of anything else it would be important to know? If so, email me, I want to hear them!