1. Look at the data
Did you know that where you give birth and who you give birth with may be two of the most important determinants of birthing vaginally or by cesarean? “While being overweight, diabetic, or older can make it more likely for a woman to have a C-section, the biggest risk factor is ‘the hospital a mother walks into to deliver her baby, and how busy it is,’ [said] Neel Shah, M.D., an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School” in a 2018 Consumer’s Report article.
While no person should ever feel responsible for their birth outcomes – their providers and hospitals are. It is your provider and your birth place’s responsibility to ensure you receive the highest quality care, including following best practices designed to optimize maternal and neonatal health outcomes and prevent unnecessary cesarean births.
What can you do? Look at the data. Organizations, like The LeapFrog Group, track the performance of a hospital’s maternity care by looking at five key indicators: early elective deliveries, cesarean births, episiotomies, processes of care, and high risk deliveries. These indicators help consumers know if provider and hospital policies align with best practice standards. Don’t know what some of these words mean? Sign up for a childbirth class early! Use your new knowledge to choose a birth place that will set you and your baby up for optimal birth outcomes. If you are already working with a provider and decide they may not be the best fit – you can typically switch providers as late as 36 weeks as long as you bring a copy of your medical records with you to your first appointment.
2. Consider midwifery care
If you are a low-risk pregnancy, choose a low-risk provider. The American Public Health Association and the World Health Organization recommends midwives as the primary maternity care providers for the majority of women. Certified midwives (C.M.s), certified nurse midwives (C.N.M.s), and certified professional midwives (C.P.M.s) are health professionals that provide a range of women’s healthcare services during pregnancy, childbirth, and the postpartum period. All C.N.M.s, C.M.s and C.P.M.s complete accredited education programs, pass national certification exams, and provide care for low-risk births in hospital settings, birth centers and sometimes in homes. All midwives practice the Midwives Model of Care – a practice framework that recognizes pregnancy and birth as a normal life experience, monitors the physical, psychological and social well-being of persons under their care, emphasizes education and hands-on support, the minimal use of interventions, and the referral of high-risk patients who require obstetric care. You can find a list of local midwives who serve the DC, MD, VA region on the Birth Options Alliance website.
3. Talk to a doula
Birth doulas work at all the hospitals in your area and have experience working with a variety of providers and settings. While your friends may have insight from their own personal experience, doulas have perspective gleaned from their professional training, experience supporting a variety of births, and from relationships with the larger birth worker community. Join us at one of our free Meet the Doula sessions to learn more!
4. Ask questions
Take some time to think through what is important to you and then ask any potential provider some thoughtful questions. Start by exploring your own expectations for birth.
What kind of birth are you hoping for?
What’s most important to you?
What does your ideal birth look like?
Look through the questions below and select ones that will help you determine if a potential provider will be willing and able to support you in achieving that birth. You can also compare your provider's responses to best practice recommendations from the American College of Obstetrics and Gynecologists and the World Health Organization. While the birth we desire isn’t always the birth we end up with, it is helpful to have a provider or group of providers that share a similar mindset of the birthing process and will hear and come alongside you to help your birth be as close to the one you imagine as possible.
Everyone has different priorities, expectations, pre-existing health considerations and health histories. You may already know that you want to use pain medication and prefer a more medically directed environment. Or you may already know that you want to birth without pain medication and prefer a more self-directed environment that facilitates movement. What is important for you may not be important for someone else. Look through the following questions and pick the questions that are most relevant to you:
Questions for your provider
What hospitals are you affiliated with? Where would I deliver?
Are you a part of a practice with several doctors? If so, who would attend my birth if you are not on call, out of town or unavailable? Do they have the same birthing philosophy as you?
How do you accommodate patients’ birth plan preferences?
Are you comfortable working with a doula if I decide to hire one?
When laboring what are your policies about eating and drinking during labor?
What are your views about pain medication during labor? About unmedicated childbirth?
What percentage of your patients' births without the use of drugs or other interventions?
What is your c-section rate?
Do you perform VBACs (vaginal birth after c-section)? What’s your VBAC success rate?
What are the reasons you would recommend an induction for your patients?
Should my waters release in early labor, what is your position in allowing my body to progress without the use of augmentation drugs? If I want to labor at home as long as possible, do you see a problem with my laboring at home while my water has broken?
Should my labor be long after water breaking, what would you recommend to help avoid a cesarean?
How do you support movement and mobility during active labor? Do you have mobile monitors if necessary?
What is your thought on episiotomies and do you do them regularly?
What percentages of your first time moms do not tear or have small tears?
What do you do to support or prepare the perineum during pushing?
Are you open to spontaneous pushing in lieu of directed pushing?
Are you trained and experienced supporting birth in a variety of positions? (i.e. what if I wanted to push during stage 2 on my hands and knees, or squatting beside the bed?)
What systems or policies do you have in place to prevent or respond to emergencies after birth?
How do you support infant feeding?
Questions to ask yourself after meeting
Did you like the provider’s style of communication and bedside manner?
Did the provider listen to your concerns and answer all your questions? Did you feel rushed during the interview?
Did the provider’s views on pregnancy, childbirth and medical care align with your own? Did they align with international and national best practice guidelines (see the ACOG and WHO links above)
Were the nurses and office staff friendly and helpful?
How long did you wait before being seen?
Was the office conveniently located?