During 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.