Monday, April 16, 2007

Question About Questions

Tomorrow we visit an OB (who we see for gyn stuff), the first of three visits this week to potential care providers for Co and Embryo-O. Any questions we should be sure to ask? (I thought the pregnancy books would have something to say on this topic, as all the wedding books had lists of questions for potential venues...alas, the two we bought did not.)



oneofhismoms said...

Ask them if the hospital has a birthing center. Ask what their philosophy on natural child birth is (if that's the way you want to go.) Ask them how they feel about epidurals. Also, this one is VERY IMPORTANT, I'd ask who will deliver the baby if the person you interview is not available. We had our son delivered by a stranger who didn't even know I was her life partner and who was c-section crazy because we didn't ask this question. I hope I'm not scaring you. Sorry! I'm just... I just don't want that to happen to anyone else.

Also, I don't know which urban center you live in, but if it is anywhere in the vicinity of Brooklyn, NY, I suggest you hook yourselves up with the park slope queer parenting yahoo list serve. It is great to have a little network of gay families to throw questions out to and occasionally meet. Good luck.

nycphoenix said...

babycenter*com has a question checklist for ob/gyn and I know I googled "questions to ask a midwife" and got back something

SandraMort said...

Everyone has different priorities for their needs. Thinking about what you want and putting that down on paper is a better way to get the list than a book, IMO.

For me, some of the big questions were:
1) How important is start weight/keeping weight gain within a specific range of numbers/what happens if you go outside those numbers? How uncomfortable/inexperienced are you with plus size mothers?

2) How do you feel about skipping (XYZ) tests and procedures that I had no intention of having.

3) What do you perceive your role in the pregnancy and birth as being? Do you work with volunteer/student doulas/LC?

4) What dates do you consider normal and what do you do outside that range? What is the protocol for postdates pregnancy if mother and baby are both tolerating the wait well? Do you require NST/BPP and how often?

5) Do you require/strongly recommend the GTT, and do you do it yourself or send it ouot to a lab? If you do it yourself, do you feel comfortable using jelly beans, juice or other forms of sugar instead of glucola (notoriously hard to drink and keep down). If you do it at a lab, will they let us use alternate forms of sugar for the test? Is having the form of the test where you eat a normal meal offered as another option?

7) Who may come to the birth and who can be banned from the birth?

I'll add more as I think of them, it's late.

SandraMort said...

Oh, yes. Statistics.

How many of their mothers transfer from birth centers to the hospital? (If you go that route)

How many of their mothers wish for unmedicated brth and how many get it?

How many of their mothers who did not choose an elective cesarean end up getting them? What's the overall section rate?

How does the hospital support new mothers in breastfeeding? Are IBCLC's offered, or just LC's? Can you rent a pump if mom or baby end up staying at the hospital longer than anticipated?

How many of their moms get episiotomies?

How did the drs and/ot their partners feel about their own birth experiences?

SandraMort said...

Does hospital p olicy permit bringing in (comfort measures of your choice -- check The Birth Partner for ideas that appeal to you). It's a given that candles won't be allowed, though.

Food and drink in labor will be limited, yes or no, and if yes, in what way?

Will your doctor expect continuous fetal monitoring, a 20 minute strip per hour or will they use a doppler to work with you where you happen to be when the ctx come?

Will you be expected to deal with student drs/nurses and can you refuse their presence?

Assuming everyone is healthy, how soon can you leave?

How many people may be with you in labor? How msny visitors for how long?

bri said...

I have learned a lot about NYC hospitals through urbanbaby chatter and listservs and the like. They all suck in some way (usually in the recovery/postpartum nurse arena) but I have been happy to see listserv people talk about how their experience at my hospital was better as far as encouraging EBF and breastfeeding right after birth if possible and rooming in and all that stuff. Most people say it was sort of normal and expected there, rather than having to fight for it at lots of hospitals. I think it's because they are the only ones that have a birth center, so even if not delivering IN the birth center, they have a sort of better attitude, I guess. Anyway, that was important to me so I looked for an OB that would be able to deliver in the birth center even though I have no intention of going to the birth center - just wanted the vibe. Oh, and the first time around I was letting location be a factor and this time I decided the doctor and hospital were more important and I have not been disappointed. If more than half my friends can get a car service from Brooklyn to all areas of Manhattan while in labor, so can I!

Sheila said...

All of what Sandra Mort brought up is important, but it's also worth thinking about how you phrase the questions to get that information. Asking under what circumstances they would do x or y, rather than how many often they do it, will give you a sense of their philosophy rather than setting up an adversarial relationship before you even get started.

Any doc knows there is a right answer to "how many" and isn't going to enjoy feeling like you are second-guessing her/his medical judgement before it's been offered, although if they're compassionate they'll understand where your questions are coming from. I also think it's more useful to get a feel for the provider's philosophy than it is to get a run-down of statistics. The statistics only tell you how their philosophy plays out in the L&D suites--so why not ask about the philosophy itself? And in the end your pregnancy is going to be what it is, without regard to what's happening in the next pregnancy over.

Take episiotomies, which are justifiably vilified. The most non-interventionist midwife in the world is going to perform an episiotomy once in a blue moon, and it might be your kid she's saving when she does it. The thing you need to know is whether a provider sees it as "just a little snip to speed things along, it's easier to repair than a tear (you don't want to tear, do you?) and you'll hardly feel it anyway" or "unnecessary surgery that encourages much more serious injuries to the perineum, heals worse than a natural tear, complicates recovery, and should be avoided except in a true crisis." (Bonus points for learning about this one up front, b/c someone with the latter philosophy will have practice and skill in easing the birth of the head to avoid tears.)

It's fine to state your philosophy up front: if you feel that you want the security of a hospital but an unmedicated birth, state that and ask how they would be able to support you in getting the birth you want, being explicit that you assume low-risk and no complications. If you know you want an epidural but want to minimize the use of Pitocin, state that and ask how they can support that. This does mean doing your homework before you go in, but I'm pretty sure you've done plenty of that.

One thing it's worth asking about is non-separation. This is different from rooming-in. (All hospitals at least offer rooming-in now, though the policies differ.) Non-separation means that all of the baby's initial stuff--bath, measurements, tests, etc.--happen in the room with you, not in a separate nursery. Usually this is not automatic b/c the l&d facilities and nurses aren't always prepared to handle this. Typically after a bonding period (which may be fairly brief!) the baby is whisked off and may be returned quickly or else not for hours, depending on how many other births have happened that day. The whole practice is an expression of the hospital culture's belief that it is their baby, not yours, and they should take care of it, not you--what do you know, anyway? But non-separation is just what it sounds like and I think it's important to insist on it to minimize the way hospitals can mess up your early mothering. Not that I'm speaking from experience or anything like that.

Sandra said...

Sheila is right. I'm not so good at the non-confrontation thing, especially with OB's, who I have a grudge against to begin with. I walk into MW interviews with a list of "I do not consent to, I will not, I require" type statements and if they don't like it, I'm in the wrong place. Obviously not everyone is as um.. hardline about these things as I am. :) Being mellower does have many benefit, I'd imagine, but I'll never get there! LOL