Questions to Ask Before Birth

With all the choices that are available, how do you decide what kind of care and which person will be most appropriate for you? You can start by asking questions to help determine whether the caregiver you are considering provides the kind of care that you need or want.

Begin by shopping over the phone and talking with the office nurse or, in some cases, speaking directly to the caregiver.
  • Ask about the background and training of the caregiver and how long he or she has been in practice.

  • Ask about any limitations on the scope of practice of your caregiver. Midwives, for example, do not provide prenatal testing and some do not provide prenatal care.

  • Ask in which hospitals the caregiver has privileges.

  • Ask how much time is scheduled for each prenatal appointment. Your caregiver should allow at least 30 minutes for each appointment -- longer if you are undergoing a procedure such as an ultrasound. You should also expect to wait since the caregiver may be called away at any moment to deliver a baby.

  • Find out who sees you for your prenatal appointment if your caregiver is called away during office hours. Sometimes a colleague or the office nurse sees you. Some doctors employ nurse practitioners or midwives to do checkups or even perform uncomplicated deliveries. If this is the case, be sure you understand and are comfortable with the arrangement. In both instances, the substitute caregiver may not be willing or able to answer questions about policies, philosophies, and usual practices. Sometimes, in a busy practice, a woman comes in several times without seeing her own caregiver. This can be very frustrating, especially if she has questions that only the caregiver who will be present at the delivery can answer.

  • If the caregiver is involved in a group practice, find out how likely it is that your own caregiver will see you during your prenatal appointments. In some group practices, you meet all members of the group. In others, you may see only one, but one of the others may attend your birth.

  • If the caregiver is in a group practice, the members probably take turns being on call at night. If you go into labor on a night when your caregiver is not on call, ask whether your caregiver will come in or will the partner on call perform the delivery? If one of the partners may deliver your baby, you will need to make sure you are comfortable with the other members of the group and they have the same attitudes toward childbirth as your doctor. Otherwise, the delivery you've so carefully planned may change at the last minute. Some groups are so large that the chances of a woman having her own caregiver during the birth are really quite small. If you do not like that, and there are no other overriding reasons for choosing such a group, you might decide to look for a smaller group or an individual practitioner.

  • Ask if your partner is welcome to attend prenatal appointments with you.

  • Before you make an appointment, inquire about finances. Be sure your insurance will cover the caregiver's charges, and find out how and when payment is expected. Find out what happens to the charges if there are any complications.
If your phone conversation with the office nurse or caregiver gives you a positive impression, make an appointment with the caregiver. (You do pay for these appointments.) Plan to use this appointment as an interview rather than a first prenatal visit. (The latter includes an extensive physical examination and many costly laboratory tests.)

Make it clear when setting up the appointment that you are in the process of choosing a caregiver and would like the opportunity to meet with this person and ask questions. The charge for such an appointment is usually less than an initial prenatal appointment. It is a good idea for the baby's father to accompany you so that he can ask questions and form an opinion about the caregiver as well.

Learn how to prepare for childbirth properly by making informed decisions.
©2006 Publications International, Ltd.
Qualified caregivers will answer any questions
you might have about childbirth.

During such an initial interview, come prepared with a list of questions for the caregiver regarding your pregnancy and the delivery. The caregiver should be willing to answer any questions and to discuss the type of care you will receive. He or she should be flexible about issues that are important to you, but if the caregiver believes that something you want will compromise your care, he or she should be willing to explain why. Some examples of topics you may want to discuss follow.

Important issues during pregnancy include nutrition, exercise, illness, and monitoring the baby's development.
  • Discuss with the caregiver what you should eat. How many more calories will you need? Will you need to increase your intake of certain nutrients? (Your caregiver may recommend vitamins and possibly calcium supplements.) How does the caregiver feel about your drinking coffee or other caffeinated beverages?

  • Discuss how much exercise you should get. Does the caregiver recommend an aerobics class?

  • Find out what you should do if you become ill. What medicines can you take and what should you avoid? A doctor monitors a pregnancy with blood and urine tests, ultrasound studies, and amniocentesis. Discuss which tests are appropriate for you.
You should make many of the decisions regarding delivery beforehand. For example, you need to decide where you want to give birth -- in a regular delivery room, in a birthing center, or at home. Your caregiver can explain the differences.
  • Ask the caregiver how he or she feels about a birth plan prepared by you.

  • If the person you are considering provides home birth or birthing-center care, ask about backup arrangements -- which hospital and physician are used if transfer or consultation becomes necessary.

  • Ask if the caregiver recommends childbirth preparation classes. If so, which ones?

  • Ask what interventions and diagnostic screening the caregiver normally uses during labor.
If you have strong opinions about the medical treatment during labor and delivery, discuss them with your caregiver. For example, some women do not want an intravenous line, anesthesia, or an episiotomy (a surgical incision to enlarge the external opening of the birth canal and make delivery easier). Questions involving delivery procedures include the following:
  • Does the caregiver recommend that all women receive intravenous fluids?

  • Do all women receive electronic fetal monitoring?

  • Are women free to walk, move, and take a shower throughout the early stages of labor?

  • What are the caregiver's usual recommendations regarding the use of medication and anesthesia?

  • Does the caregiver usually perform episiotomies?

  • When does the caregiver normally arrive during labor and how much time does he or she spend by the bedside during labor? If not the caregiver, who provides professional support and care during labor?

  • If you desire natural childbirth, does the caregiver encourage natural or prepared childbirth?

  • What are your caregiver's opinions about inducing labor? You might ask how often and for what reasons labor is induced, and what precautions are taken to avoid prematurity with induced labor.
Other questions might be related to the caregiver's level of skill and training and his or her ability to detect problems both before the baby is born and immediately after (during the neonatal period). You also will want to know any limitations on the scope of practice of your caregiver. For example, only some family physicians and no midwives perform cesarean sections. Few physicians attend out-of-hospital births. Midwives do not provide care in complicated labors, nor do they use forceps. Some midwives cannot give pain medication during labor. Some midwives cannot perform episiotomies or repair lacerations.
  • Ask who will provide any care you need beyond the scope of the caregiver's practice.

  • If you are planning a home birth, ask when your caregiver normally arrives during labor. You will want to know what equipment your caregiver carries for normal care and for emergencies and what his or her policies are on transfer to the hospital if problems arise. Can the caregiver continue to provide your care in the hospital or remain as a support person and advocate while an obstetrician takes over the management? Or does he or she not accompany you to the hospital?

  • If your caregiver is a physician, discuss cesarean sections. Does he or she perform them routinely for certain types of problems? Will you remain awake during the surgery and be given the baby immediately after the delivery? How long will you have to stay in the hospital if you need a cesarean section and everything goes well?
Other questions might center on the father's or support person's participation throughout labor and birth (even cesarean birth) and the events immediately following birth.
  • Are other support people also welcome? If you want the child's father or other children there, be sure your caregiver and the hospital agree.

  • Ask about the routine care of the newborn immediately after birth. Does the newborn usually stay with the parents, or is the baby taken to the nursery very soon after birth? For how long? For what reasons? Can some newborn procedures be delayed, especially those that interfere with the contact that allows bonding to take place between parents and baby? These include the use of eye ointments (which can blur the baby's vision), the use of nursery heaters to maintain body temperature, and the immediate admission of the baby into the nursery for routine procedures, such as weighing and measuring. Some of these can be delayed, which would give the parents time to admire and cuddle their new baby, if the baby's condition permits.

  • What about circumcision? Ask if your caregiver recommends it and, if so, why? Does he or she perform circumcisions?
By the time you finish discussing all of these topics, you should have a good idea how well you like the caregiver. Do you feel at ease with him or her? While you may not agree on every subject, you should feel confident you can develop a working relationship, and you can discuss a problem and reach a compromise that will be satisfactory to you and your partner and the caregiver.

Finding a caregiver may be easy, or it may require a search. Because the caregiver plays such an important role, it is worth the effort to find someone you like as well as trust. Only in this way can you be sure that your pregnancy and delivery will be as safe and joyful as possible.

Now that you have to tools to find a caregiver that's right for you, go to the next page to find out about the pros and cons of giving birth in a hospital.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.