1 Due Dates:
As a doula, I believe one of the biggest red flag questions you should be asking your OB is, "How do you feel about due dates? How far over my due date are you willing to let me go?" This one is important because it lets you know where your care provider stands on induction. One of the biggest wrenches I see thrown into my client's birth plans are medically unnecessary inductions. It's called an ESTIMATED due date for a reason ladies. You're not a Thanksgiving turkey with a pop out timer! If you are having a healthy normal pregnancy then I see no reason to be medically induced and every reason for you to wait for spontaneous labor.
Let's talk about how due date are calculated.
"Estimated Due Dates are traditionally considered to be 40 weeks and 0 days after the last menstrual period" (Rebecca Dekker). Yes, you read that right, your menstrual period and ovulation are counted as the first two weeks of pregnancy. If you deliver on your due date, your baby is actually only 38 weeks old, not 40 weeks. Keep that in mind ladies!
Whether you are hoping for a totally natural labor, or an epidural half way through, or if you just want to wait and see, having free movement during labor will help you tremendously. Trust me, there is nothing more frustrating than being in the heat of labor with uncomfortable belts wrapped around your tummy. So, ask your care provider, "How do you feel about fetal monitoring? Will I be able to have intermittent monitoring or doppler monitoring?" Again, if you are having a normal healthy pregnancy, this shouldn't be much of a problem.
If you aren't sure what intermittent monitoring or doppler monitoring are, let me tell you. Intermittent monitoring is when 2 monitors will be placed on your belly held on with stretchy belts, 1 to monitor the baby's heart rate and 1 to monitor your contractions. The nurse will monitor you for 20 minutes to get a good read on your baby's heart rate then the nurse will take the belts off for 40 minutes of free movement.
A doppler is even better. It's a hand held device with a small wand that the nurse can use to listen to your baby's heart rate. Some of the pros to using the doppler are:
"Comfortable for the mother
Everyone in the room can hear the fetal heart beat
Can be used in many different laboring positions
Can be used underwater
Allows for more personal space
Does not require wearing uncomfortable belts
May calculate and display fetal heart rate values" (Rebecca Dekker)
3 Pushing Positions:
As a doula I see my clients end up pushing on their backs more often than I would like. I strongly believe that a woman should always be able to choose her own pushing position and have the option to try a few different ones to see what works best for her. Even if you have an epidural you still have options when it comes to pushing. So, ask your care provider, "How do you feel about pushing positions? Are you comfortable delivering my baby when I'm on my hands and knees?" The evidence is on your side ladies! As long as you are having a healthy normal delivery, how you push should be up to you.
"Researchers believe that giving birth in an upright position can benefit the mother and baby for several physiologic reasons. In an upright position, gravity can help bring the baby down and out. Also, when someone is upright to give birth, there is less risk of compressing the mother’s aorta, which means there is a better oxygen supply to the baby. Upright positioning also helps the uterus contract more strongly and efficiently and helps the baby get in a better position to pass through the pelvis. Magnetic resonance imaging (MRI) studies have shown that compared to the back-lying position, the dimensions of the pelvic outlet become wider in the squatting and kneeling or hands-and-knees positions. Finally, research has shown that upright birthing positions may increase maternal satisfaction and lead to more positive birth experiences". (Rebecca Dekker)
I'm happy to say that this particular trend seems to be going out of style in most practices, at least here in Las Vegas. In my 4 years as a doula I've only seen it used 3 times. Once when it was medically necessary and twice when the OB was (in my opinion) simply being impatient with the pushing stage of labor. "I mean come on! She has only been pushing for 30 minutes! Give her a chance!" So, ask your care provider, "What do you think about episiotomys? Do you believe it's better for me to tear naturally instead of getting an episiotomy?" Again, the evidence is on our side ladies.
"Research has shown that moms seem to do better without an episiotomy, with less risk of infection, blood loss (though there is still risk of blood loss and infection with natural tears), perineal pain and incontinence as well as faster healing. What's more, episiotomies are more likely than spontaneous tears to result in third or fourth degree perineal tears, where the tear passes through to the rectum taking longer to heal and sometimes causing fecal incontinence." (Heidi Murkoff)
5 Delayed Cord Clamping:
So you would think that simply waiting 3-5 minutes after the baby is born to clamp and cut the cord wouldn't be that big a deal right? Wrong. As a doula I've found that this can be one of the hardest things to get the OB to do. So, ask your care provider, "Do you believe delayed cord clamping is beneficial? Will you wait until the cord stops pulsating before you clamp and cut it?"
"Delayed cord clamping is beneficial for term and preterm infants. In term infants, delayed cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes. In preterm infants, delayed cord clamping is associated with significant neonatal benefits, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage." (ACOG)
Although all these benefits are obviously beneficial, most OB practices and hospitals still hold policies to clamp and cut the cord at 30 seconds. Watch this short video of the master herself Penny Simkin as she explains the importance of waiting for the baby to get all his blood before you clap and cut the cord. WATCH HERE
I hope you find these questions helpful while you are looking for the right OB for you. Remember, it's never too late to change your care provider, you need to give birth in a place where you feel safe and with people that care for you. If you like this post check out My 5 Must Have Items for Perineum Care After Childbirth! Or if you want to stay in the loop on all my blog posts just click HERE!