OB Saga Continued

After my meltdown, I got busy. I found a potential new OB at my current OB’s practice in interested in and 3 others affiliated within the medical group, but at other locations. The furthest is about 35 minutes away from my office and the closest is about 20 minutes.

Also, I’m waiting to hear back about whether he is moving away or just going to another medical group in the area. But for now, I’m trying to get my ducks in a row to stay with my current medical group, just in case. After searching lots of lists of interview questions, I found the one that’s really gets down in the nittty gritty of what I actually want to know (I already know how office appointments and L&D on-call staff works) and want to see if any of you vets have additions? Or comments on these questions?

1. What Are Your Philosophies And Beliefs About Birth? This open ended question is the most important question you could ask an ob gyn, as it will give you an idea as to how they see birth and how they may try and control the process. Do they see birth as: A medical process which needs to be monitored and managed continuously? A process which is fraught with potential minefields and requires preventative procedures? Or; A natural process where nature should take it’s course before interfering?

2. How Much Choice Do You Feel I Should Have In The Decision Making Process? Women (and their partners) tend to have much better experiences of birth when they are involved in the decision making process and are given options. Those who feel that they have no control over or are not informed or involved with decision making tend to have a less positive experience of birth and may even end up depressed or with post traumatic stress disorder. So it’s very important to choose someone who you feel will involve and inform you throughout your pregnancy and birth, without wanting to race you out the door in five minutes.

3. What Are Your Thoughts On Pain Relief During Labour?

4. How Do You Feel About My Birth Plan? Do You Forsee Any Problems? If you haven’t yet put together your birth preferences (birth plan) it’s a good idea to take a rough one with you when you interview an obstetrician. It can always be altered later, closer to the date, but it’s important that the person who is to be your primary carer can see what you have in mind for the birth – and its important for you to find out what he/she thinks about it before it’s too late. There’s nothing worse than being in a situation where you need to make a quick decision and feel like you don’t have enough time to discuss it. Ask the obstetrician to tick or initial each point in your plan and/or sign the end of your birth plan in agreement, so when you present it to the hospital or when you face deviations to your plan, you have something signed to show the hospital or the obstetrician.

5. What Are Your Thoughts On Electronic Monitoring And When Do You Think It Should Be Used? Intermittent doppler monitoring is standard care during labour, however some obstetricians and/or hospitals prefer to use more restrictive and invasive procedures of monitoring which can affect the way you plan to labour and give birth. Continuous CTG monitoring which involves you being stuck in one position, usually on the bed, and can be detrimental to the progress of labour.

6. What Is Your Induction Rate And When Do You Think Induction Of Labour Should Be Considered? Obstetricians will have varying protocols on induction, from inducing only days after your guess date, some 7-10 days post-dates, some 2 weeks, and some will allow more if baby and mother are well.

7. What is your caesarean section rate and in what situations will you recommend a caesarean section?

8. How do you feel about mothers being separated from their babies after a caesarean? What about immediate skin to skin contact if all are well?

9. What is your episiotomy rate and in what situations would you perform one? These days it is not common to find an Obstetrician who will do routine episiotomies, however they are still being performed during the birth.

10. How do you feel about vaginal breech birth? If you support it, what conditions do you have?

11. How do you manage the third stage? The third stage is the birth of the placenta. It may seem like something irrelevant, but there are some very important things here that affect your baby, remembering that the placenta has been the baby’s life support system for nine months and contains building blocks for your baby’s body. Firstly, in order to streamline and hurry things along after your baby is born, just about all hospitals and obstetricians will clamp and cut the cord right away, then give you an injection to expel the placenta (and also prevent haemorrhage which is an increased risk if you have a high intervention birth or induction). You can ask to be given this only if you do show signs of excessive blood loss or if you have had an induction, but for normal, healthy birth, haemorrhage rates are low. In a normal pregnancy and labour, there is no reason to hasten delivery of the placenta either. When you are given this injection, which is similar to what they use to induce labour with a drip (syntocinon) and make the uterus contract, it means that the cord needs to be cut straight away. Why is that undesirable? Because there are several studies now which show that where the cord is left unclamped until it has stopped pulsating (i.e. all the blood has gone from the placenta to the baby), there are less cases of babies with anaemia, blood transfusions and other blood conditions. The baby will get months of iron stores from this valuable blood supply and of course, all it’s precious cord blood and stem cells. If you cut the cord early or donate the cord blood, your baby doesn’t get to keep those super valuable cells – and it’s alot of blood volume for a baby. A physiological third stage is something you can ask for if you want the third stage to be completely natural.
Source: http://www.bellybelly.com.au/pregnancy/questions-ask-obstetrician/

Also, I’d like to forgo the bath at the hospital and just have the nurse do a wipedown.

Thanks for your help and your support in getting me through this!

5 thoughts on “OB Saga Continued

  1. Those are some great questions! I would also maybe ask about delayed cord clamping if that’s something you think you might want (there’s been some awesome research recently proving the benefits and my own OB now likes to wait 1 minute after birth before cutting the cord). Also mentioning your infertility history and that you may need a little extra TLC through the whole process could be helpful — you can see how they respond and if they seem to understand the emotional aspect of infertility and loss. Good luck, friend!!!

    • The delayed cord clamping isn’t there?!? Eeep thanks! Yeah I’m totes wanting to do that. And good point to mention infertility, though my chart says pregnancy through IVF, it’s a good idea to actuality discuss it.

  2. Hi! I’ve eeriky peeked at your blog for years but only recently followed…

    I agree…good questions. You might get a lot of what you wanna know with 1, 7, 8, and 9. That about summed ut up for me.

    As a follow up, Im not sure if its worth asking the doc to distinguish between what they believe vs what the nurses at the hospital will do. I was lucky to have a hospital and doctors group on the mort natural side of things and after taking their birth class I felt confident that interventions would truly only be done if they were really needed and not for the doc’s convenience but for my baby’s safety. I was fortunate enough to have no compmications either time but I would have to wonder, after my own experiences, how easily a hospital or birth center can change the type of care they give a patient based on their doctor’s philosophy. Just a thought. I hope you have a smooth easy labor no matter what!

    • I know my hospital is not more natural-focused, but the fact that they have the best NICU in the area was mostly the reason I wanted to deliver there (most hospitals life-flight to there and I didn’t want to be stuck in one hospital/birthing center while baby was in another of something happened) so I know the doctor I have will have certain protocols they must follow, but I’m hoping to get one that allows patient input in the decision-making process as much as my current provider. Thanks for the insight and support!

  3. Great questions. With respect to #8, I would give more latitude to their answer because the truth is this depends largely, if not entirely, on hospital policy. I have looked into it quite a lot as I know that I will have a c-section and while your OB can have a certain philosophy, it really depends on whether the hospital prefers to whisk away the newborn for a more thorough check up after EVERY c-section, whether they treat emergency c-sections different than planned/elective ones, etc.

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