Questions to Ask Before Choosing a Childbirth Provider
Childbirth and pregnancy are unpredictable. No matter how your birth unfolds, however, the provider you choose is the single most important factor in birth outcomes. Good providers respect your wishes, collaborate with you to choose the right treatment strategies, and know the signs of a brewing complication or emergency. Bad providers use coercive tactics, ignore your wishes, or miss red flags that signal complications.
Your provider works for you. Hiring a person to catch your baby and monitor your pregnancy is exactly like hiring any other employee. Interview them and trust your gut. Here are some important questions to ask.
Can you respect my values?
Every family has its own preferences and values. Some religions forbid blood transfusions, for example. Share your values about birth with your provider and ask if they can respect them. If they’re skeptical or argumentative, move on.
Do you share my philosophy?
There’s more than one way to have a healthy, safe birth. Some families prefer to err on the side of caution, opting for prompt interventions at the first sign of a problem. Others see interventions as an unnecessary risk, and adopt a wait and see approach. Many fall somewhere in the middle. Talk to your provider about how they manage risk. Share with them your own philosophy, and ask how your provider’s philosophy might play out if something goes wrong.
Who makes decisions?
The person giving birth makes decisions—not the doctor, not the spouse, not the hospital, not a lawyer, not anyone else. Good providers know this, and they don’t use coercive tactics to convince birthing people to change their minds. A person does not lose the right to control what happens to their body just because they are pregnant.
The American College of Obstetricians and Gynecologists (ACOG) strongly urges providers to respect women’s informed consent and refusal. And it’s illegal in Georgia to force a woman into a pregnancy intervention without a court order. Nevertheless, many women are coerced into medical interventions because their providers believe doing so is appropriate. The most effective strategy for preventing this is discussing it early and ensuring you have a provider who respects you as an autonomous human being.
Who makes medical recommendations?
The doctor or midwife’s job is to make medical recommendations, not to make decisions. Some doctors, in an effort to improve patient satisfaction, defer too much to their patients. They allow their patients to make decisions without fully informing them of risks or offering other options. Make sure your doctor is prepared to make informed medical recommendations. Ensure they know that, even if you are unlikely to accept a specific intervention they recommend, you still want to be told about it.
What will you do if we have a disagreement?
Some doctors believe that women who refuse recommended treatments deserve no treatment at all. This is a sexist and abusive idea that kills women and babies.In other area of medicine, it would be totally unacceptable. Consider the oncologist who refuses to provide any care at all to a cancer patient who refuses a specific drug. Or the cardiologist who refuses to provide emergency care to the patient who has declined open heart surgery.
What can I do to maximize my chances of a healthy birth?
Birth is never fully in anyone’s control. Nevertheless, there’s a lot you can do to improve your chances of a healthy birth. Good doctors make lifestyle and nutrition recommendations, talk to you about your specific risk factors, and ask you what a healthy birth looks like for you.
How do you handle billing, and how much will this all cost?
Most of us are socialized not to talk about money. This is a harmful norm that can result in shockingly high bills. Ask for clear and specific details about the costs of each procedure your doctor recommends. In many cases, it’s wise to ask for insurance pre-authorization.
How will hospital policy affect my birth?
Doctors, like patients, are often at the mercy of hospital whims. They may be penalized for not recommending specific procedures, or even forbidden from honoring certain patient wishes. For example, many hospitals require doctors to recommend c-sections if a woman has had three or more prior cesareans. Doctors who refuse to coerce women into surgery may face discipline. This puts doctors in an impossible position. It also turns otherwise exceptional physicians into arbiters of the hospital’s will. So ask your doctor how hospital policy might affect your birth plan or constrain your doctor’s options.
Who will deliver my baby?
It doesn’t matter how wonderful your provider is if they won’t be delivering your doctor. Ask for clear details about how delivery procedures work. Will your doctor be on call and available to you? Or will you be assigned one of many doctors in a larger practice? What if your doctor is sick or out of town? Is there a back-up physician, or are you at the whims of the doctor on call at the hospital?
Will you discuss your medical recommendations with me?
It’s not enough for a doctor to make well-informed medical recommendations. Truly exceptional doctors also discuss with their patients why they recommend a specific procedure. This allows you to assess the evidence for the procedure and ask questions about alternatives. Doctors who are unwilling or unable to discuss their recommendations may not be practicing evidence-based medicine.