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Interviewing Obstetricians

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Life circumstances and changes in our choices can lead us to seek out a new obstetrician. The provider you used for your gynecological or fertility care may not be who you feel comfortable with for your obstetrical care. You may want a different experience if you are no longer a first time mom and longed for something different during your birth. Your insurance may have changed and no longer covers your original ob/gyn and hospital as in network. Maybe your friends or mommy group are raving about a different practice in town and you want to investigate. Whatever your reasons, feel open to the idea of interviewing a different provider.

This post is focusing on in hospital providers because the majority of women do give birth in hospitals and there are many articles and posts about interviewing home birth providers. It is also titled Interviewing Obstetricians because our country has a majority of obstetricians providing prenatal care. In hospital providers are typically obstetricians or certified nurse midwives but may include family practitioners in some areas.

You will begin by calling the office of the practice or provider you want to interview and asking for a pregnancy consultation or a “meet and greet”. This appointment will give you a chance to meet the provider and ask questions — it is not an exam. Having a list can help you focus and maximize the time afforded to you.

The list below is a starting point of questions you may want to ask and is by no means all inclusive to every scenario or your individual circumstances.

  • Is your practice suited to my wishes and desires for birth? (I want to go natural, I want an epidural upon request, is delayed cord clamping or immediate skin to skin encouraged and available?)
  • What sorts of prenatal tests do you offer or require?
  • What tools are available to help me achieve the birth I desire? (birth balls, peanut balls, squat bars, showers, tubs, wireless monitoring or intermittent monitoring, heating pads or a community microwave for hot packs, iv narcotics, nitrous oxide, anesthesiologists available all hours, etc.)
  • What are hospital policies regarding freedom of movement, nurse ratio to patient, triage, acceptance of doulas, photography rules, eating and drinking, and how would those change if medicine was used or not used?
  • Will I be staying in the same room I birth in or moving to a postpartum floor? (both scenarios have pros and cons).
  • What is your on call schedule like? Will I have a chance during my pregnancy to meet anyone who may be delivering my baby or can I request a specific provider to catch my baby?
  • Are there time limits on my labor or pushing if mom and baby are doing okay? What is your epidural/cesarean/natural rate (keep in mind that numbers may only reflect they are a higher risk practice or hospital, but this can lead to more questions about their philosophy.
  • How do you feel about up to date evidence based recommendations made by ACOG (American Congress of Obstetricians and Gynecologists)? Should an issue arise that requires a decision will we make time to discuss risks/benefits and discuss alternatives (barring an outright emergency).
  • What level NICU is available on site or would there be a transfer of baby if there was a serious problem?

Again, this list is not exhaustive and you may want to tweak or add more questions but it will hopefully get your thinking cap on so you can make the most of your interview. You may want to ask more details about postpartum policies or cesarean policies if those are important to you and depending on how much time you have with the provider. Whatever your list of questions becomes, listen carefully to the answers and then pay attention to what your intuition tells you as you process the visit.

Kimberly Sebeck, CLD, CCCE, HCHD  Knoxville Doula 2016

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What Would You Tell Ina May to Include in a Book?

I stumbled across a fabulous podcast with Ina May. The interviewer did not have a natural birth and felt as if there was missing information in Ina May’s books — at first I thought this was going to be simply a critical viewpoint of Ina May.. but it’s not.

If you have ever struggled with disappointment or a feeling of failure because you didn’t have the candle lit, in a birth pool, 100% intervention free birth — please listen to this.

At the end you are given options of how to let Ina May know what you would like included in her current or forthcoming books.

 

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“Why Didn’t You Just Become A Midwife?”

It’s an innocent question people ask me frequently when they find out I am a doula. “Don’t you want to deliver the babies?

No, actually I do not. I understand there are plenty of doulas who are on the path to midwifery or who will decide they want to become a labor and delivery nurse, OB/GYN, etc, but I am not one of them. While I can’t speak for everyone I can tell you the reasons why I am firmly committed to being a doula.

  1.  I have the unique role of supporting the laboring mother for weeks. Weeks, you say? How is that possible? Well, when a woman is close to her estimated due date there will be those signals and signs that labor is impending. As a doula, I get the texts and phone calls about a mucous plug coming out, or a night of contractions. Sometimes there aren’t any noticeable signs and instead I offer words of encouragement and reminding her to trust her body as to when it will be time for baby to be born. Of course a midwife will be seeing the mother during these weeks as well but usually in a prenatal appointment office setting. When it is time for baby to come I often come to the home and help decide when it is time to go to the hospital or birth center, or call the home birth midwife.
  2. The odds of me having two women in labor are incredibly slim. I am able to focus fully on the mother, partner, and their particular birth experience. When on call midwifery schedules and nurse shift changes, I am still there and this birth is my only concern at the moment.
  3. Speaking of only concerns — my only concern is supporting a mother and her partner. I don’t have to chart. I don’t have to worry about other patients in another room laboring or waiting for me back at the office. I don’t watch the fetal heart rate monitor — ok, well, I do, but it’s not my concern and liability to do so. I don’t have to code certain procedures or happenings for insurance and liability purposes. If something is happening that is veering from your ideal birth experience, I can suggest alternative methods that follow your birth plan as closely as possible.
  4. After the baby is here I am the one to snap photos, help you breastfeed, make you a peanut butter and graham cracker snack (with postpartum punch to wash it down!), get your cozy socks on your feet, find your chapstick, congratulate your partner, and tell you how awesome you are. Of course there are midwives and nurses who do the same amidst their other tasks (stitches, anyone?) but your comfort is my primary concern, not if you need repairs or assessing blood loss.
  5. I have spent many years, almost two decades, learning how to be the best doula I can be. I’ve done workshop after workshop, read hundreds of books and professional articles, attended hundreds of births, learned and learned through study and experience. I’ve invested in education and tangible tools that maybe your hospital doesn’t have (peanut balls, rebozo, heating pads). I am a very experienced and qualified doula. I am not more than a midwife.  I am not equal to a midwife. I am not less than a midwife. Any comparison is silly.  We do not share the same role even if a few things overlap during your pregnancy and birth. And I firmly believe that doulas are crucial components for the way our society births.

Yesterday I was chatting with someone I had just met. She asked me why I didn’t become a midwife. I simply said, “Because I love being a doula.” Later in the day I met with a potential client who told me she definitely wants a doula for her current pregnancy, because last time she had a midwife and as much as she loved her she regretted that she had mistakenly thought she didn’t need a doula. That doesn’t mean the midwife wasn’t amazing, caring, thorough, professional — as a midwife. Midwives and doulas aren’t the same even though we are both working for your birth experience to be a positive one.

Obviously I am only speaking for myself. I have doula colleagues who have gone on to become a midwife because they do want to deliver babies and do well woman visits and provide a far larger range of care. I applaud them and congratulate them on their serving women and families in that capacity. I, however, will remain a doula and know that it is a vital role.

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All Rights Reserved, 2015, Knoxville Doula, Kimberly Sebeck

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It Comes Down to Priorities and Perceptions

From Birth Anarchy

From Birth Anarchy

It can seem like a lot to come up with out of pocket, true. I had a guy at Dollywood’s Splash Country tell me yesterday he spends $750 just on the family’s season passes for the year. My biggest suggestions is always if you know you are planning a family to start saving for the birth options that mean the most to you. My blog contains financial suggestions from myself and guest bloggers on how to afford the birth you want.

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Birth in Knoxville and East Tennessee — Exciting!

I’m writing a quick blog out of the gratitude in my heart for all of the amazing things that have happened recently in Knoxville for birth and options involving pregnancy and birth. I say recently because I started professionally being a doula and childbirth educator in 2000 — and things were very different then. There were a handful of amazing doulas, some childbirth educators, Lisa Coomer, CPM, and of course the Lisa Ross Birth and Women’s Center. We were here, but sometimes our time and resources were limited.

What’s changed?

Now in Knoxville and East TN we have a lot more doulas and childbirth educators! There are placenta encapsulation services offered by East TN Placenta Medicine. There is a re-opening of Cutie Tooties Cloth Diaper store this weekend — and the owner, Emelie, is opening up her classroom to many birth professionals. Some of the offerings are regular Breastfeeding and Newborn Care Classes, Meet the Doula events, Comfort Measures Classes, a Breastfeeding Circle with regular meetings… just so many events so that any mother and family in the area can explore their options. Carry Me Close is a business by a mom and midwifery student — she offers hand made baby-wearing carriers and custom makes them and meets with you to show you how to wear them. Another mama sews cloth sanitary pads and much more. ICAN of Knoxville and Knoxville Birth Network are fairly recent (in the last 2 years) but more people are becoming aware of the regular meetings and support offered through these networks and local volunteers.

Some people have made remarks about how there is more “competition” for doulas. I do not ever feel that way — years ago if my schedule was too full or I was not available for a birth due to travel, it truly hurt me to turn someone down, and I worried about those who were not aware of the then available resources.  Now I firmly believe that any woman who wants a doula has not only the option of having one, but finding the very best fit for her and her family. Now there are so many  more options for classes! Today’s schedule is hectic enough without having to worry about taking time off for classes, or missing the only one offered in a month, or before a due date. It’s nice for me, too — getting to network with birth professionals, help one another, provide and receive support and bounce ideas off of one another.

Grateful is how I would sum it up. Go get the pregnancy and birth experience you want and deserve!

p.s. I apologize for not putting links in to the great resources I mentioned, but I’m out the door for an event — I will try to add these later, or simply search on Google or Facebook.

 

All Rights Reserved, 2011, Kimberly Sebeck, Knoxville Doula

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Denied VBAC

A friend told me a story today that has had me thinking ever since I heard it. Her friend was choosing a VBAC (Vaginal Birth after Cesarean) for her second birth. She had arranged with her OB/GYN to attempt a VBAC when labor began. She went into labor and after some time (I do not have all of the details) headed to the hospital in the middle of the night. Her doctor was not on call. The doctor on call refused to allow her to continue laboring, refused to attend a VBAC, refused to stay on the hospital floor in the middle of the night, refused medical liability, etc.

Off they went to surgery. For absolutely no medical reason.

This story makes me sad and angry and disappointed. I don’t want to point blame here at all; instead I want to offer encouragement and some possible options to avoid this type of situation. It would be very easy to start pointing fingers and put all of the blame on the OB/GYN, who may have never had any experience with VBAC, or who had multiple other obstetrical patients taking up their time. I don’t know, nor do I feel the need to defend him or her.

So what other suggestions or options can we come up with for this? Well, a lot of them would be preemptive, such as having a provider who will attend your birth no matter what, supports VBAC, has only a few back-up doctors/midwives that you have met and who also fully support VBAC.  For whatever reasons, though, this didn’t happen and the plan changed due to a provider not being available.

As for arriving at the hospital with some laboring to still happen, a few suggestions immediately came to mind:

1.  Ask for a second opinion. See if there was another doctor working at the hospital who you could transfer your care to.
2. Refuse another surgery. Outright refuse to sign the papers. Hopefully the on call doctor would transfer your care — perhaps to someone more sympathetic and VBAC friendly. Be aware there could be consequences to this but legally no one can force you to have a cesarean without a court order.
3. Leave that hospital. Go to another hospital and see if a more VBAC friendly doctor is on call at the time. Go in through an emergency room and speak to whoever you need to speak to — head of OB/GYN department, on call doctors, etc.

I know some of these will sound extreme to many, particularly if the thought of birthing in a hospital seemed the safest route. It may not sound pleasant while in labor to run around and find a provider who will support you the way you want, need, and deserve. Please know I am not dispensing medical advice or advocating one particular course of action or finding fault with personal choices. Obviously the preferable choice would have been for everything to line up, ducks in a row, planets aligned, for this mother to labor the way she chose — with an OB/GYN provider, in a hospital. Unfortunately, it didn’t. Too many women are finding similar “switch and bait” actions when they are going for a VBAC — a provider who changes tune in the last trimester, a  provider on vacation who doesn’t have backup who provides similar care, a list of things that must happen exactly so in order for a “trial of labor” to happen for a woman wanting a VBAC.

Because of this, I do strongly encourage you to ask hard questions from your provider. Who will provide backup? Is your provider planning any vacations around your guess date? Can you meet the backup and ask the same questions? What other providers could you transfer to late in pregnancy or even last minute? What are the required protocols for a trial of labor for a VBAC? How does your hospital offer a second opinion or second provider in case the on call doctor cannot or will not support you in your birthing choices? If you have a midwife and are planning a home birth, ask where care would be transferred to in the event of further required intervention? Will she be able to go with you and help you navigate a change of birth plan?

Other suggestions: Hire a doula. Have a birth plan that is discussed, approved by, and signed off on by your provider. Know your rights.

This is not an exhaustive list, as this post was typed rather hurriedly. Any other suggestions?

ICAN can help you find VBAC friendly providers as well as scores of information to shape your idea of birth, including questions to ask providers.

 

 

All Rights Reserved 2011, Kimberly Sebeck, Knoxville Doula

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Happy International Day of the Midwife

A big thank you to all the midwives around the world who are working to improve the health of families.

What is the Midwifery Model of Care? Midwives Alliance of North America describes it this way:

“The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. The Midwives Model of Care includes:

  • monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle

  • providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support

  • minimizing technological interventions and;

  • identifying and referring women who require obstetrical attention

The application of this model has been proven to reduce to incidence of birth injury, trauma, and cesarean section.”
http://mana.org/definitions.html#MMOC

Did you use a midwife? Remember to thank her today! Do you know a great midwife in your community? Give her public thanks in a comment here!