I got this from a friend on FB.

www.themidwifenextdoor.com

1. When labor and birth are progressing without complications noted, what routine procedures do you perform? I suggest avoiding the word “interventions”, because many practioners do not consider IVs, breaking the water, continual monitoring, etc., to be interventions. Some truly believe these things must occur in most labors in order for birth to happen in a normal, timely way. Some, sadly, have never seen a birth without interventions.

2. How do you prefer to monitor the baby in a labor that has no complications? I recommend the term “labor without complications” rather than “normal labor”, because many providers consider any labor that ends in a vaginal delivery to be normal labor. The optimal answer to this question would be a preference for intermittent monitoring without requiring the woman to be attached to a fetal monitor, in order to allow for optimal movement during labor. Avoid practitioners who believe that continual fetal monitoring in an uncomplicated labor is optimal. In a low-risk labor without complications, the standard practice of twenty minutes continual monitoring every hour has not been shown to have any benefit. I recommend asking the practitioner open-ended questions, rather than yes or no questions, such as “can I have intermittent monitoring”, because it gives you a better feel for the practioner’s personal philosophy. Although your practitioner may agree with everything you request, if it is contrary to their personal philosophy of practice, things are likely to change when you are actually in labor. Once you are in the midst of having a baby, you are not in a good position to debate the merits of procedures your provider is recommending. What’s more, if your provider is telling you that your baby is in distress, you are likely to agree with whatever is recommended to you, simply because you care about your baby. That’s why it’s so critical to lay the groundwork to find a supportive practitioner early in the pregnancy.

3. What position do you prefer your patients to use for giving birth? The correct answer here is, “Whatever position she chooses”. If the provider starts telling you why semi-sitting or reclining on one’s back is the ideal birth position, RUN! If the provider tells you that you can choose any position you like, ask him or her to share with you what position the women in their last several deliveries have used. If it’s reclining on the back, you can be sure that even if this practitioner is willing to deliver babies in other positions, s/he is not encouraging women to move about freely and find the best birth position for them.

4. How would you handle it if we had a difference of opinion about a procedure you were recommending to me during labor? The answer to this question should give you a clear idea of the provider’s need to be in control. While we all recognize there are rare occasions when an emergency does not allow time for much discussion, this is not the norm. It’s important to know how your provider will respond if you don’t want a procedure s/he is recommending to you in a non-emergent situation.

5. What were the reasons for the last few non-scheduled c-sections you’ve done? This should give you a pretty clear picture of normal practice for the provider you are interviewing. If the last several c-sections they have done were all for “failure to progress”, “failed induction”, “failure to descend”, etc., you would do well to consider another provider. There should be few c-sections done for any reason involving “failure”. Most cases of failure to progress are actually “failure to exercise patience” on the part of the provider. The majority of non-scheduled c-sections done by a practitioner who support non-interventive birth should be for reasons that are truly emergent, such as placental abruption, a pathologic fetal heart rate pattern, etc. You might also consider asking for details about c-sections done for stuck babies. How long was the woman allowed to push or to “labor down” with an epidural? Was she held to the outdated Friedman’s curve, or was she given every opportunity to give birth on her own? While it can be difficult to judge the provider’s actions when you were not there, you are trying to get a picture of the provider’s philosophy of practice.

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