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Questions for Clients to Ask Obstetricians

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These are easy to read and understand and are beautifully presented.

If it's possible, it's better to have the answers for the last set of questions in the OB's own handwriting, because then you're much more likely to get an honest answer. That's why the form asks the OB to jot down the statistics.

The questions that reveal attitude are the ones about how they work co-operatively with you to decide on the best care for you and your baby. Especially the postdates question. If they are not flexible about this, then they're not looking at the individual picture. They should at least mention doing a biophysical profile, which is a relatively nontraumatic assessment of the baby's condition, especially the condition of the placenta, and the amount of amniotic fluid.

Then there are the questions that assess how much energy and intelligence they put into helping you avoid suboptimal situations, e.g. postdates, breech or posterior position. (Breech is when the baby is head-up. Babies usually turn head-down by 36 weeks, i.e. 4 weeks before due date. Posterior is when the back of the baby's head is against your spine - really the lowest part - the sacrum. This is "back labor" and is considerably more painful and more difficult. An ounce of prevention is worth a pound of cure, but few OBs do much of anything about this. Perhaps this one will be different. Even if a posterior baby can't be encouraged to turn in early labor, once the cervix is dilated enough, a skilled practitioner can use their fingertips to lift the baby slightly and spin it around so it's in the more favorable position. I've never heard of an OB who knows how to do this, but you never know.)

Questions about twin and breech vaginal births help to assess both the rigidity of the OBs protocols and their experience. Again, if they have never learned to attend breech births or don't ever do so, it means they're not looking at the individual situation.

It's essential to ask what the OB does to prevent unnecessary resuscitation of a normal newborn by an overly aggressive neonatal team. You can't pick the neonatal people beforehand, and they are often very aggressive, unnecessarily putting a tube into the baby's stomach and suctioning it out.

Stripping membranes is something that many OBs are now doing routinely, without permission. This is a procedure whereby they force their finger inside the cervix and (gently, one hopes) pull it down, both to separate it from the amniotic membranes and to stimulate it, hoping to put it into labor. Sometimes they poke a hole through the amniotic sac, which causes major problems because their protocols then require delivery within 24 hours, whether or not you're in labor. This is a real problem at 36 weeks, which is when some of them start. It can sometimes be appropriate and can be a very effective way of getting labor started, if necessary. But it can also be very painful (which can prevent sleep that night, which then becomes a real problem if you actually *do* go into labor the next day, having had no sleep the night before). There are better ways.

You might consider asking for some references from former clients. I think this isn't routinely done with OBs, but it should be. Then again, if you've grilled clients waiting in the waiting room, this might not be necessary.

Many people have learned to ask OBs about their episiotomy rates, but not about their suture rates. However, I think it's very indicative of an OBs commitment to the best possible outcome - it's not rocket science, but you have to be interested in order to learn how to get those low suture rates. High suture rates mean that their attitude is "Well, we can always suture", which often accompanies an attitude of, "Well, we can always do a cesarean".

What is your commitment to attending my birth? Will you guarantee to be there unless you're at another birth? What % of births are you unable to attend?

What % of your clients experience pregnancies that are completely normal with labors that involve no IVs, no drugs, no operative deliveries (cesarean or forceps/vacuum), no episiotomies, no suturing, and where the baby is not suctioned beyond the back of the throat and does not leave the mother's arms for the entire first hour?

How often will I see you? What do your checkups consist of? What are your guidelines concerning weight gain, nutrition, prenatal vitamins, and exercise? What are your standards for pre-eclampsia?

What is your protocol regarding postdates?

Is it different for first-time mothers? What do you recommend to avoid a postdates situation?

What would be your response if I chose not to be induced according to your protocols?

Do you ever strip membranes? Do you always provide full informed consent before doing so?

What is your protocol for preventing and managing breech?

What is your protocol for preventing and managing a posterior position?

Do you have experience in manually turning a posterior baby in labor?

How many vaginal breech births have you attended? How many vaginal twin births have you attended?

Is there a limit to the number of support people I have in the room with me? Do you limit what we want during labor? (Food, positions, water, etc.)

Do you wait until the cord has stopped pulsating before it gets cut?

Stanford neonatal teams have a reputation for being very aggressive and resuscitating babies regardless of need. What are Stanford's rates of Suctioning baby's stomach? Visualizing the cords? Intubating?

What do you do to help prevent unnecessary medical treatment of the baby?

How much time do you allow for the natural delivery of the placenta? What do you do if this limit expires?

Please jot down your current rates for:

Is there anything about my health or situation that disqualifies me as a homebirth candidate? Can you give me a reference for that?

This Web page is referenced from another page containing related information about For Parents - How to Get the Best Care


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