SM - Resources

  Resources: Care Provider Questions

NOTE: The questions below apply to many different situations. Many of the questions below deal with high-risk or medically specific issues. Not all questions will apply to your case. Also, these questions are all issues which your care provider should have a good answer for, whether or not they apply to you. If you have any specific concerns, please ask your care provider. Look for the icon for questions related to homebirth. Look for the icon for questions related to waterbirth. Categories: Background | Birth Options | Prenatal Care | Labor | Delivery | Postpartum Care

  Background

• What part of town are you in?
  Where are you located?
• How long have you been practicing?
• Why did you become a           ? (Midwife, MD, Doula, etc.)
• What are your credentials?
• Where did you attend school / training / apprenticeship?
• What is your contact info (emergency phone, etc.)?
• Do you have any vactions scheduled during my pregnancy or close to my due date?
• What is your fee?
  When is payment due?
  What is included in your fee?
  Do you accept insurance?
  Will you help me submit a claim?
• What is your childbirth philosophy?

  Birth Options

• Do you do homebirths?
• Do you do waterbirths?
• Do you do VBAC births?
• Do you do births in a birth center?
• Do you do breech births?
  What would you do in the event of an undetected breech?
  
  
• Do you handle twins? (or more?)
  What would you do in the event of an undetected twins (or more?)?
  
  
• Under what conditions would you transfer to a hospital and when?
• Do you have any issues with the use of parallel care?
• Do you use a labor assistant?
• Is it OK for me to have a doula present?

  Prenatal Care

• How many prenatal visits do you require?
  Where do you have your pre-natal visits?
  How long is each visit and what can I expect to happen there?
  
  
• What are your requirements regarding nutrition?
• What do you recommend for prenatal vitamins or supplements?
• Do you recommend the use of homeopathy?
  
  
• Which types of blood work or lab tests do you require?
  Do you do your own lab work?
  
  
• How do you handle Gestational Diabetes or diet-managed blood glucose levels?
  Do you require testing? Which test do you use? Would you consider alternative tests?
  Do you require blood glucose to stay below a specific level? (If yes) What level?
  
• Do you consider a diet-controlled gestational diabetic ineligible for homebirth?
  
• At what point do you consider transfer for blood glucose management issues?
  
  
• Do you require a test for Group Beta Strep (GBS)?
  If no, how do you monitor for GBS-related problems?
  If yes, what happens if the test is positive?
  Is this an automatic transfer of care issue?
  Are you willing to discuss alternative treatments to try to render mom GBS negative before the birth?
  
• If mom is GBS+, will you still permit a water birth?
  
  
• How do you handle high blood pressure?
  
  
• How do you handle symptoms of hypertension or pre-eclampsia?
  Do you have a limit for maximum allowable blood pressure? (often 140/90)
  How often to you re-test blood pressure?
  Will you allow mom to test at home to see if the level resolves?
  Are you more concerned with systolic or diastolic numbers?
  Does a slow, small upward creep concern you if mom is close to term and not experiencing other symptoms?
  
  
• Do you check for protein in mom's urine?
  How much is "too much"? (Trace?, +1?, higher?)
  How long would you allow constant elevated levels before considering it to be problematic?
  
  
• Edema - how much is normal?
  Is edema of the hands normal? Of the face?
  Is pitting edema an automatic transfer of care?
  How do you assess whether edema is indicative of a problem?
  
  
• How do you assess amniotic fluid levels?
  What are your thresholds for "too much" or "too little" amniotic fluid?
  Is the presence of meconium in the amniotic fluid cause for an automatic transfer?
  How much meconium is too much?
  
  
• What happens if membranes rupture (water breaks) early (say, 37 weeks)?
  Is this an automatic transfer of care?
  Do you wait for labor, advising mom on warning signs of infection?
  How long do you wait for labor? 24 hours? Days? Weeks? As long as it takes?
  
  
• What do you consider to be normal or expected weight gain?
  Is there any point at which you would consider a baby "too big"?
  Do you require pelvimetry to determine maternal pelvic shape/size?
  
  
• Who is your backup provider?
  Where are they located?
  Can I meet them? Should I schedule an appointment?
  
  
• Will you help me build a birth plan?

  Labor

• When do you typically arrive for a birth?
• What labor positions do you recommend?
• Do you have any time limits on how long a labor takes to progress?
  Do you place any limits on how long mom can push for?
  What's the longest you've ever allowed a mom to push?
  What problems (if any) have you encountered due to a prolonged labor?
  
• At what point would you consider transfer?
  
  
• How much fetal monitoring do you require (if any)?
  Over what interval of time?
  What instrument(s) do you use to monitor
  What do you do in the case of a contined slow heart rate?
  What do you do if the heart rate does not recover between contractions?
  
• Do you monitor during a waterbirth?
  
• If yes, what instrument(s) do you use to monitor?
  
  
• Do you require cervical checks during labor?
  If yes, how many and how often?
  Do continue to perform checks after rupture of membranes?
  Can a client refuse all cervical checks?
  
  
• Do you monitor mom for fever during labor?
  
• If fever is present, is this an automatic transfer to hospital?
  
  
• Can you catheterize?
• In the event of a transfer to hospital, do you accompany the family to the ER?
  If yes, what information do you provide to the attending physicians?
  Do you provide the mother's complete record?
  How do you identify yourself to the EMTs?
  
  

  Delivery

• How much maternal hemorrhage (bleeding) is normal?
  How much blood loss requires transfer?
  Do you carry herbals or medicinals for this?
  
• What do you try before resorting to a transfer to hospital?
  
  
• What do you do to help prevent or minimize the occurance of perineal tears?
  Can you suture a tear?
  Do you carry anesthetic to suture a tear?
  Do you ever recommend an episiotomy?
  
  
• How long do you wait for the birth of the placenta?
  Do you ever use cord traction?
  What other techniques will you use to assist the birth of the placenta?
  
• At what point would you transfer to a hospital for non-emergent placenta?
  
  
• When do you typically clamp and cut the umbilical cord?
  Will you delay clamping and cutting? For how long?
  Does it matter to you who cuts the cord?
  
  
• Are you certified in newborn resuscitation? Infant CPR?
  
• At what point does a slow-to-start baby require a transfer?
  Do you carry oxygen?
  
  
• Do you require use of eye ointment or Vitamin K for the newborn?
  Can clients refuse the use of eye ointment and Vitamin K?
  
  
• How do you handle a still-born baby?

  Postpartum Care

• Do you do postpartum visits?
  How many? When?
  
  
• ???