General Principles
- Don't make assumptions about practice style or philosophy based on sex or type of practitioner. You cannot assume that a woman will be sensitive, flexible, and non-interventive and a man will not. You cannot assume that all midwives and family physicians work from the midwifery model and all obstetricians follow the obstetrics model. There are obstetricians who are excellent "midwives" and midwives who are obstetricians in midwives' clothing.
- Interview several caregivers. If the name is based on a personal recommendation, ask what the recommender liked about this practitioner because you may feel differently. Childbirth educators, professional labor support providers (doulas) and Le Leche League or other breastfeeding counselors often know which local doctors and midwives work from the midwifery model.
- Ask open-ended questions. Don't give away your own opinions. Examples of open-ended phrases include "What is your approach to ...," "When do you recommend...," "Why is it important to...," and "What is your opinion of..."
- Follow up on vague answers. Responses such as "I only do that when it is necessary" or "We'll have to see at that time" tell you nothing. Continue with "How often do you find it necessary?" or "Under what circumstances would______ be inadvisable?"
- Ask yourself, "Am I getting facts or feelings?" For example, if you ask about episiotomy and were told, "Which would you rather have: a nice clean cut or a jagged tear?" you got feelings. Compare that answer with "I do them about 15 percent of the time in first-time mothers, and I don't remember the last time I did one in a mother who had already had a baby. I do them when the baby is in trouble right at the end, or I may suggest one if I feel you aren't stretching well. Sometimes, but not always, I do them as a part of a forceps delivery."
- Ask yourself, "Would I feel comfortable asking this person a 'dumb' question?" Look elsewhere if the answer is no.
- If this book or your interview leads you to think you have chosen the wrong caregiver, remember that it is never too late to switch. And it is almost always better to switch than fight.
Specific Questions
- What is the likelihood that you will attend my birth? Many caregivers practice in groups and rotate call among the members. They won't necessarily share the same philosophy toward birth, so you need to speak with all of them. Caregivers also take vacations.
- Under what circumstances do you recommend inducing labor?
- How do you handle slowly progressing labors?
- What are your policies regarding monitoring the baby's heart rate in labor, IVs, drinking or eating in labor, breaking the bag of waters (amniotomy), epidurals, episiotomies?
- What are your reasons to do a cesarean? How often do you find it necessary? How do you try to avoid the need for cesarean?
Red Flag Responses
These behaviors will tell you that you have the wrong person, someone who wants to coerce rather than convince you. All the examples are real statements made by real doctors. I don't want to stereotype caregivers, but the fact is that these tactics are common among obstetricians, occasionally found in family practitioners, and almost never found in midwives.
- Scare tactics. "We can do that--if you don't care what happens to the baby." "Which would you rather have: a nice experience or a healthy baby?" You can have both. In fact, the things that make a nice experience also make for a healthy baby. "I can't be responsible if you insist on/won't do___________." "This is a premium baby; we don't want to take any chances." This one is used on older women expecting a first and perhaps only chold. The hidden assumption is that vaginal birth carries more risk for the baby than cesarean section, but in fact the opposite is true.
- Anger. "And where did you go to medical school?" "I can't take care of you if you don't trust me." Of course you should trust your caregiver, but that trust must be earned.
- Ridiculing your concerns, desires, opinions, or competency to participate in decisions about your care. "I see you've been reading those women's magazines." "You want natural childbirth? I think that makes about as much sense as natural dentistry."
- Patronizing you. "Don't worry about a thing; just leave everything to me."
- Vagueness. It's a bad sign when you can't pin a caregiver down enough to get at least ballpark estimates of personal statistics such as cesarean rate or percentages of women who give birth vaginally after a prior cesarean. It's also bad when the caregiver says you can do anything you want during labor and won't specify what situations might preclude that.
- Attempts to do-opt your partner. This may occur with male doctors and male partners. You'll know it is happening if the doctor addresses himself to your male partner and ignores you. The hidden message amounts to "You and I together will take care of the Little Woman," and it can be seductive to caring, protective, expectant fathers. This bodes ill for the labor, as the following story illustrates. A friend of mine doing labor support wandered out into the hall in time to overhear her client's obstetrician trying to talk her client's husband into persuading her client to agree to the episiotomy that she had refused. If not for my friend's pointing out that it was his wife's vagina and she had the right to decide whether it was cut, the obstetrician might have succeeded. Imagine how you would feel to suddenly find your husband and doctor in a league against you. Conversely, acting as if your partner is a fifth wheel isn't good either.