Episode 30: Ten Questions for Your OB or Midwife

(I've created a handout for this topic with the 10 questions to ask your OB or Midwife -- you can access it here!)

Why is this topic important?

To be completely real with you, aside from the way your body is built and the way your baby's body is built, your medical care provider is the variable that will have the biggest impact on your birth experience. Discuss these ten questions with your medical care provider to ensure they are exactly who you want helping you have your baby. 

There are no 'right' answers to these questions (just as there is no one 'right' way to birth your baby!). There are two purposes to asking these questions.

1. To ensure your medical care provider's perspectives, values, and philosophies about birth are in alignment with your own. 
2. To learn how your medical care provider responds to you asking these questions. Are they respectful and happy to discuss? Yay! That's a great sign! Alternatively, are they irritated, defensive, or acting like their time is more important than yours? Big red flag. (Although, real talk, due to short prenatal visit times you may have to ask these questions over a series of multiple prenatal visits, but this can be discussed respectfully with you!) 

What do you do if your medical care provider's answers are concerning to you? You have two options:

1. Go shopping and find another medical care provider. 
2. Use the rest of your pregnancy to build a birth plan in collaboration with your medical care provider.

If insurance limitations or a lack of options in your area mean you have to stick with your problematic medical care provider, start NOW and use the rest of your pregnancy to build your birth plan in collaboration with them. We talk about this often in the Brave Journey Birth Preparation Program. Your birth plan is a working document meant to be a communication tool built together with your medical care provider prenatally. It's a means of building a healthy collaborative relationship.

I'm not going to lie, sticking with your problematic medical care provider and working to build a collaborative relationship and birth plan that works for both of you is the harder road, by far. But I acknowledge that for some folks that's your only option and I want you to have the tools you need to work within your limitations. 

Because of the positive impact this can have on your birth, I welcome you to share this resource with any pregnant people you think might benefit.  

Simply share this link above with your friends, family,  and colleagues.

Here’s the link again to get instant access to your free pdf 10 Questions to Ask Your Medical Care Provider. 

Feel free to reach out to me with any questions - see you next week!

Full Transcript:

Hello, and welcome to your next Brave Journey free weekly video, where I pick a topic related to birth and postpartum. And I talk about it. This week we are talking about your relationship with your medical care provider,  your relationship with your obstetrician or your midwife. And specifically, I'm going to give you 10 questions that you can ask your medical care provider to ensure that they are who you want to have helping you have your baby.

I cannot overstate the influence that your medical care provider will have. The experience aside from your natural born physiology, the way your body is built and the way your baby's body is built, aside from those variables, your medical care provider will have the most, the next most impact on your birth experience. And the birth facility that you're birthing in, both variables will have an impact on your birth experience.

So it's essential that you know everything you need to know about your care provider and that you are your values and perspectives on birth are in alignment with their values and perspectives on birth. And let's switch  it. Let's ensure that their values and perspectives on birth are in alignment with your values and perspectives on birth.

I'm Cara Lee, I'm a birth doula. I'm a childbirth educator and let's get started.

So first off there is no one right answer to these questions. There's just like, there's no one right way to give birth. The answers to these questions that you want to hear are  that your medical care providers perspectives and values on risk and medicine and the birth process are in alignment with your own.

And you, everybody watching this video is going to have a different perspective on medicine, on risk, on birth as a natural physiological process. And what kind of a medical care that you would like. So it's essential that the answers that you receive. It's.  What we're looking for is, are they in alignment with your perspectives and how are they, how are the questions themselves received?

What is your medical care provider's response to you sitting there and asking them some not tricky. You'll see these questions are not that tricky, but you're asking them questions about that. You are, you are ensuring that the person that you want to have helping you have your baby.

And that the facility that you're planning to birth at is the facility where you want to have your baby. So if your medical care provider receives these questions with respect and respectfully offers you their own perspectives and thoughts and responses, then yay. Yes. I mean that already is a really good sign.

If your medical care provider is defensive. Or irritated by your questions. If they seem that if they're questioning why you're even asking them anything, because let's be real. There's a lot of ego that goes into medicine, whether you're a midwife or a doctor, ego and personality are at play. So if they get defensive or aren't respectful of you or treat you like your time is not as valuable as their time

Then that's a red flag. And I want to be clear in our modern medical world most obstetricians in particular and midwives in the hospital context, do not have hours to sit and talk with you. That's just not the way their practice is set up. So to be real and respectful of their time.

Perhaps you end up asking these questions a few every, every, every, uh, visit every prenatal visit. Um, but you know, and we have to be realistic, but also we want your medical care provider to be listening respectfully to you, and answering your questions. And if now, hopefully early in your pregnancy, they're not respectfully answering your questions.

What's it going to be like if you are ending up facing some complications, or even if not complications, but just some complexity at the end of your pregnancy or as you're laboring. So if they're irritated by these questions now, It's just not a good sign. Or defensive, not a good sign. So again, the purpose of these questions is to make sure that your care provider is in alignment with you and has the same values and perspectives around birth, and to ensure that they are respectful of you when you have questions like this.

So let's get through these questions. I have the handout, there's a handout available for you. I'm going to make it available for you on my website I'm going to go through these questions now. And I, I have them here in front of me. The first question we have is what are your beliefs- this is to the obstetrician or midwife -about and philosophies about birth.

And if they say they don't have any, that's not true. Every birth worker, whether a medical care provider or otherwise has a belief and philosophy about birth. So what are theirs? How do they come to this birth experience and what are their beliefs on this?

The next question is how much choice does obstetrician think that you, the birthing person should have in the decision making process. So are they somebody who thinks that birthing people shouldn't be active participants in the birth room or that as they are the trained expert, that they should be making the decisions and just telling you about it. That's good to know now. If that doesn't match your perspective of you wanting to be the boss of the birth room.

And I have a bias here in that, I really believe that it's your body. It's your baby. And you get to call the shots. So, this is my bias, right? So if you ask me my philosophies and beliefs about birth, that you hired this person to help you have your baby. And you're the boss, they're the expert. They have expertise and they have knowledge and training and years and years of education. And they've helped other people through this process. But you were the only one who knows what it's like in your body. And this is your baby. Nobody else's, maybe your birth partner, but this is your body, your baby, your birth experience. So you get to call the final shots. That would be my perspective. But maybe that is not yours. So obviously here's my bias.

Next question. What are your thoughts? This is you asking the OB, what are your OB's thoughts on pain management and labor? If you, as the birthing person are going into your labor saying, I think I'd really like to have an epidural.

For some magical unicorn reason, which sometimes it happens. I have a really quick and easy birth. Um, maybe you're going in saying I do not want to use pharmacological pain relief, an epidural or otherwise, at all. If I can at all avoid it, I have this reasons. Lots of people have lots of different reasons. And, and this is your perspective. If that's your perspective and your medical care provider says that they hardly ever help anybody have their baby, who's not on an epidural. You know, that's a misalignment. Similarly, if you are wanting to birth at a birth center that doesn't allow epidurals at all, and you're talking to your midwife saying, you'd really like to have an epidural in your labor. That's not in alignment. You can't birth at a birth center and expect to have an epidural. You'll have to be transferred to the hospital.

So these are the, the reasons you asked these questions. There's not really a right answer. You just want to make sure you're in alignment.

Let's see the next question to your OB. What are the routine policies and procedures at, in your practice in the OB practice or at the birthing facility. Now, obstetricians and midwives, midwives have to follow the practices and policies of the birthing facility as well as their own practice.

So the birthing facility may have an expectation that every single birthing person that checks in is on an IV. They may have an expectation that every single birthing person that checks in is on continuous fetal monitoring. And in the Brave Journey Birth Preparation Program,, the full program, we go through all of these interventions and talk about the benefits and risks. And the benefits of continuous fetal monitoring. Um, outcomes are the same as intermittent monitoring. If you are a low-risk birthing person. So if you're automatically going to have to have continuous fetal monitoring, because that's a facilities, um, policy, that's something to be at the very least aware of. So you can modify your expectations, or you can start shopping and looking for a different medical care provider.

This next question to ask for medical care provider is when do they typically recommend induction? And this is a good time to start talking about induction. You want to be thinking about this early in your pregnancy because it's something, what was the data? It's, it's such a high percentage of birthing people by the end of their pregnancy are facing discussions and recommendations for induction from their medical care providers.

So this is likely something that you will be navigating. It's a high likelihood. So it's good to know. Now, what are your medical care providers perspectives on induction. And when do they normally recommend an induction?

Similarly with the cesarean, and ask your medical care provider? What is your cesarean rate?

This is a valid question. If they don't know or they can't tell you, you can look it up somewhere, do the research. This is an important question. There's been a lot of studies out there that will indicate that your your medical care provider's cesarean rate has, will impact your likelihood of having a cesarean.

So in our country, 25% of low-risk birthing people gave birth via cesarean in 2020. But if you're in a birthing facility where they have a much higher cesarean rate, your likelihood is higher than that. If that makes sense. So ask, just talk about it. Make sure you're in alignment. This is just a really important thing to know about your medical care provider.

Okay, next question. Families centered cesarean practices. What family centered cesarean practices practices are available in your obstetrician or midwives practice and at the birthing facility. So midwife wouldn't be performing the cesarean, an obstetrician would, but sometimes there are shared practices.

So what are the family centered cesarean. And I can refer you back to a former episode on family centered cesarean practices, whether or not you will be birthing via cesarean. It is on all of us to ensure that every single hospital, in the world, but I can focus on the United States because I'm here in the United States provides family centered cesarean practices.

These are, these are simple. They don't, they have nothing to do with medical risk. It's just culture in the hospital. And they can have a huge impact on a cesarean experience. So it's important to know what, which of these are available in your birthing facility. And if they're not, to start advocating for it, now.

And there's. I have some former episodes on that. We also talked about this at length in the Brave Journey Birth Preparation Program, the full course.

Next question. How do you typically manage the third stage of labor? So this is asking your medical care provider. How do they manage pushing. Now, some medical care providers really like to coach people in what's called, um, Uh, provider directed, pushing, which is where they'll they'll count and tell you when to push and tell you when to breathe and just count like 1, 2, 3, 4, you know, push, push, push, push, push, inhale, push, push, push, try to get three, sometimes four pushes a contraction. That's provider directed.

Birther directed is where you push based on your own internal sensations, and often are exhaling and breathing normally versus the provider directed often will invite you to hold your breath and push the energy downward. So just find out what does your provider generally do? Most providers have helped people push their babies out, um, like a zillion times in their career. That's a very specific number, but they're going to have a way that they like to do it. So it's good to talk about and just know.

Next question. This is a tricky one and you may want to just save this one all on its own for if you have short prenatal appointments, but how does your medical care provider address and resolve the traumas that they witnessed on their job? Now, when we're pregnant, we may not want to think about this too much, so manage your own triggers.

Recognize that your medical care provider is grappling. Birth and death are intertwined and your medical care provider is likely witnessed trauma on their job. And it is important for you to know how aware they are of that in themselves and how they resolve that, and what practices they have in place. Because this is going to impact how capable your medical care provider is, is of being present with you in your actual ,circumstances versus their heart and mind and body being caught up in the trauma of a birth they just attended down the down the hall five minutes ago. It's hard. And I say this with a huge amount of compassion and as a former trauma worker myself it's so it's hard. This is a really hard question. But we should be asking this of everybody in the medical field, to ensure that when they are grappling with trauma, they're not carrying that into your room. Because they may be more likely to see and react with fear or emergency anxiety and rush and, and, um, this kind of energy, which is just the opposite of the necessary energy of birth. Birth needs, steadiness confidence. We talked about this when we talking about the hormones of labor. Um, so really just be aware of where your medical care provider is with this.

And then the last of the 10 questions, it's pretty logistically clear, who is your medical care providers backup and will you get to meet them? So in all likelihood, this person who you're talking to in your prenatal appointment, isn't necessarily the person who's going to be there to birth. Unfortunately. Especially if they're in a group practice. So you want to know who the other people are, and you want to be talking to those people too. If you're at a small practice and you'll have a chance to get to know people more, if you're in a larger practice then you'll have a lot of people to try to get to know, but it's important to know who is your medical care providers backupand will you get to meet them? So those are the ten questions.

Now, what do you do if your medical care providers answers are not in alignment and a whole bunch of them make you concerned. Well you have two options. One is to go shopping and find a different medical care provider.

And sometimes that's easier said than done. Sometimes because of your own financial limitations or your limitations in your insurance, or simply being in an area that doesn't have very many medical care providers or options, you may not have very many other options and it may not be easy to shop for another care provider.

I've tended to work in areas like San Diego county, Phoenix, that where you have so, so, so many medical care providers to choose from that the second you don't like the one you're with you should just go bam over and find another one. Because it is just, this is so important, but I know it's not that easy for, for some folks in other places or with limited financial means.

And I want to acknowledge that. As somebody who is completely limited by my own insurance situation, when I was having my first baby. Um, that's your first option, go shopping and find another medical care provider.

Your second option. It is to start now, the second, you're seeing these red flags, to collaborate with your medical care provider and creating a birth plan together.

I'm using the words "together", "collaborate", "work with". So this is a time where you're like, oh crap, we are not on the same page and I don't have any other options. So your other option is to try to collaborate and work with your medical care provider, to come together to some sort of an agreement. To make it clear what your, as a birthing person's perspectives are on birth and risk, and the way that you'd like to approach this. And to hear where your medical care providers coming from and try to find some middle ground.

And this is why in, in the Brave Journey Birth Preparation Program, we have a whole section on birth plans and templates. Because your birth plan is a, is a, is a living document is a working document. And it's a way to create a plan with your medical care provider.

You work on it through your pregnancy together, so that by the time you walk into your medical care facility in labor, and you hand it to everybody in the room, you've already talked about it with your medical care provider. These are just reminders. And so you can use your birth plan, in creating this collaborative process, but that that's the harder road. I'm not going to lie. That is the harder road, but I fully acknowledged that some people don't have a choice.

So, so if you're seeing a lot of red flags, your two options go shopping or collaborate and work on a birth plan together and try to find some middle ground. Okay. So that's it today on our discussion about your relationship with your medical care provider and 10 questions you can ask to try to determine whether your medical care provider is the person that you want to have helping you have your baby.

Thank you for listening. And I will see you next week.