Wednesday, March 6, 2013

What Should You Ask YOURSELF About Your Care Provider?

It is wonderful to talk about all the right questions to ask your CARE PROVIDER (I have written about those a time or two) but this guest post by Ashleigh Trimble talks about the questions you should ask YOURSELF about your provider.

She is so right.  While birth involves things measurable it also involves many things that cannot be measured, and one of those is instinct.  

Always listen.

Oh- and if you need a great birth class in Arlington, TX contact Ashleigh.  She is a fabulous teacher and you won't regret it!  She is also a doula and one smart mama!




Every woman planning a natural birth can give you a list of questions they ask their care provider at the beginning of pregnancy. Questions like: 

“What is your caesarean rate?” 
 “Are episiotomies common or rare in your practice?” 
“How often do you participate in a natural delivery?” And my favorite, 
“Will you LET me...?” “get out of bed, give birth in water, eat and drink in labor” 

After this initial interview, you may be confident in your choice of provider, but as you get closer to the birth, most moms know their provider well enough that all the clinical questions become trivial and you start to ask yourself more emotional questions about your provider.

 “Do I feel comfortable with this person at my birth?” 
 “Do they make my partner and I feel safe?” 
“Do they make my partner feel involved?”
 “Can I trust them?” 

Don’t discount your instincts when you start considering these kinds of questions.
I recently heard a local OB speaking specifically on the topic of Vaginal Birth after Caesarean and other special situations. He asked pregnant moms in the group a little about what they were looking for in a care provider. There were several pregnant moms planning for VBACs and two moms expecting twins and preparing for natural births. What he said to them really got my attention. He said if a Dr. tells you that your body can’t do something, referring to VBAC, breech, twins, or any number of variations of labor, it doesn’t always mean that there is something wrong with your body. It means that Dr. has not been trained to handle that particular variation. 

That Dr. may be right, that variation may be dangerous in their hands. I had never heard anyone say it that way before, but it reminded me how important it is to trust your care provider and how important it is to trust your own instincts when evaluating your provider. 

Many variations, included those above, can be determined during pregnancy, but some won’t be apparent until late in pregnancy or even during labor. When something deviates from the typical path, it can turn out three ways: 
-no big deal
-deviation that needs attention
-emergency. 

Can your provider tell the difference between those three? 

This is important for a hospital birth because the interventions are so readily available. If your intention is to avoid interventions then you want to feel confident that your provider will only recommend one when it is absolutely necessary, not because it is the fastest or easiest option. This is an equally important question with an out of hospital provider. If you don’t know how your home birth midwife responds to variations of labor, you should. 

 It makes a huge difference in your response to labor if you are confident that your midwife is capable of identifying variations in labor, not overreacting or disturbing you if it is minor, calmly taking swift action when appropriate and for a serious complication, distinguishing the difference between things she can handle versus things that require another level of skill. Trusting that your provider has a good awareness of this will set you free to labor, instead of worry. 

During labor is not the time to question if they have your best interests at heart. After the birth is not the time to wonder if the recommendations they made could have changed the outcome. Pregnancy is the time to really evaluate these issues. 

Are they willing to talk through variations of labor and tell you how they respond? Do their answers to these scenarios genuinely reflect the way they practice or are they working hard to give you the answers they think you are looking for? 

Another way to judge this is to evaluate their responses to common questions and concerns you raise during pregnancy. Do they overreact to seemingly small issues, rushing straight to strict medication regimens and interviews with specialists before asking you for more specifics or without offering and describing alternatives? 

On the other hand, do you have a hard time getting them to seriously consider something that you are concerned about and end up always on the phone with their assistant? Their behavior in either of these scenarios is probably the way they will respond to your concerns during labor. Ideally, their initial attitude about the concern should match yours and this should be followed up with thorough information and choices. 

Do you trust their medical training and skills? Do you trust that they have a good awareness of their skills and their limitations? Do you feel confident that during labor, you can depend on their judgment? 

Your instincts should also tell you something about whether your provider respects you and the birth process. Everyone who may be present at your birth: partner, doula, nurse, doctor, midwife, should go in believing that you are going to birth the way you believe you are going to birth. It’s not helpful to have people in the room who mock your desires or doubt your capabilities and determination. 

Are they comfortable with the natural birth process? Or do you find that they are always talking about risk and making suggestions for ways they can assist? You can easily identify a lack of confidence in a provider who begins questioning your plans early in pregnancy. It will become even more obvious after 30 weeks or so. 

When you talk about labor with your provider, do you leave feeling like your body is capable of having a baby? Like you are capable of being a mother? Or do they talk to you as though you are not intelligent enough to handle your own body, much less parenting? Do they talk to you about your birth and your baby or do they refer to statistics and dismiss your questions by talking about other people and other babies? 

After a few visits and interactions it should be obvious if a provider is trying to mentally prepare you to surrender to your body or mentally prepare you to surrender to their skilled maneuvering of your body. 

Do you feel that they listen to you? 

Do they respect you? 

If a care provider tells you outright, or even implies, that you are carrying around some variation that makes a natural birth impossible, know that you should not assume that you can still follow whatever research you have found that says otherwise and have this provider at your birth. You need to know that they mean what they say. Their words are revealing that they are not capable of handling the variation. It may be that there is a need to pause and consider changes to your expectations or you may need to consider another provider.

Based on your provider’s response to common questions and concerns you raise during pregnancy, as well as their attitude towards you during your pregnancy, you should develop a sense of whether you can trust them and whether they believe the same things that you believe about your body’s capabilities. As much as we like to have concrete tangible ways to judge our choice of providers, sometimes your feelings about a provider can tell you a lot. 

Trust your instincts. Trust your hesitation. It doesn’t hurt anything to get a second opinion or test out a different provider relationship. The choice of provider can make a huge impact on your birth for both you and your baby. 

Ashleigh Trimble
Arlington, TX

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