Tuesday, July 5, 2011

Choosing a Provider in Pregnancy

So, you’re pregnant….now what??

Well, one of the first things you are going to need to do is choose a provider. In South Dakota there are limited options, especially with insurance concerns and current laws restricting certain providers, but even so, there definitely *are* options. It’s just a matter of figuring out what’s most important to you and who will provide those things. So, following is a list of questions you should ask each provider you interview to ensure you are both on the same page.*

  1. Is there a limit to the number of people who can accompany me during my birth? How do you feel about a labor support professional such as a doula or massage therapist joining my birth team?

  2. Will I be able to eat and drink in labor?

  3. If I were interested in having a natural, unmedicated birth, how would you feel about it?

  4. What comfort measures do you recommend?
    a. Freely changing positions and walking around
    b. Water therapy (shower/tub)
    c. A doula
    d. Epidural
    e. Narcotics (Stadol/Demerol)

  5. What would you recommend I do if my water breaks before contractions have begun? How long after my water breaks would you recommend induction if my labor doesn’t start on its own?

  6. What are your protocols regarding my due date, i.e. inducing labor at 40 weeks? 41 weeks?

  7. Do you believe in active management of the first stage of labor? For example, would progress of less than one cm per hour call for artificial rupture of membranes (AROM) or Pitocin? If everything is fine with me and my baby, will I be able to labor at my own pace and for as long as I need?

  8. If you feel that labor has to be stimulated what methods to you recommend?
    a. Herbs
    b. Nipple stimulation
    c. Castor oil
    d. Intercourse before spontaneous rupture of membranes (SROM)
    e. Enema
    f. Acupuncture
    g. Stripping of membranes
    h. Artificial rupture of membranes (AROM)
    i. Pitocin

  9. What is your protocol regarding the following procedures and how often do you perform them?
    a. IVs
    b. Continuous versus intermittent fetal monitoring
    c. Internal fetal monitoring
    d. Artificial rupturing of the membranes (AROM)
    e. Epidural
    f. Assisted vaginal delivery (forceps/vacuum)
    g. Episiotomy

  10. What is your cesarean rate? What factors do you believe contribute to that rate? What is your VBAC rate? What are your standard protocols for VBAC mothers?

  11. Will I be able to choose the position in which I will push and give birth, such as side-lying, all fours, or squatting?

  12. What are your views on delayed cord clamping?

  13. Can my baby remain with me at all times from the moment of birth? Do you support skin-to-skin contact between me and my baby immediately after birth?

Once you are in labor, it will be too late to convince your provider to do things the way you want them done. Make sure you have the same or at least similar birth philosophies before then!

Remember…no matter what, it’s your choice. You don’t have to choose a particular provider just because your mom, sister, or friend had him or her. Also, if you feel like you need to change providers in the middle or even late in your pregnancy you have every right to!

*Most questions taken from the National Guide to a Healthy Birth - #3 of a series 2011/2012 by Choices in Childbirth

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