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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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Cesarean Rates – With a Grain of Salt

Note: This post is not about your medically necessary cesarean, or even one you chose. The author of this post respects all births and philosophies.

As more education and advocacy spreads about high rates of cesareans many natural birth advocates will encourage women to ask for their doctor and/or hospitals cesarean rates. Sometimes it is hard or impossible to find these rates as they are not always maintained by each physician, hospital, or even in public records. It is usually easier to find your state or region’s cesarean rates.

What is a woman to do when she searches and cannot find anything but internet reviews and anecdotal accounts?  What if she asks her obstetrician and they say they do not know what their cesarean rate is? What happens when a woman finds out that the hospital she has chosen to birth at or the obstetrician she is using has a 30%, a 60%, a 25% rate of cesareans? What does it all mean?

Information is always useful. But consider a few things.  If your state or regions cesarean rate is 30% but a certain hospital has a cesarean rate twice that — it could give you pause. Or you may consider if they only accept high risk women and are staffed by all or mostly high risk women’s specialists. Perhaps your provider is a large supporter of women who are attempting VBAC (vaginal birth after cesarean) and this skews their overall cesarean rate because there is always the chance a previous cesarean will result in another cesarean for the same woman. Large hospitals may not have accumulated statistics any more recent than a few years ago or even longer.

A rate will not guarantee you will have the information about choosing a hospital or provider.

Some suggestions for finding out deeper information are to ask these questions:

  • Ask your ob/gyn if they can provide a recent cesarean experience concerning their philosophy on birth. Was it due to a time limit? Was baby or mother not faring well?
  • If the birth facility itself has a seemingly high cesarean rate ask if this is due to specialists, high risk situations, hospital policies, or something else?
  • Has the doctor or facility implemented any measures since the most recent statistics that could help lower the chance of an unnecessary cesarean? Such as welcoming doulas, adhering to ACOG recommendations about reducing non medical inductions and considering active labor as beginning at 6 cm instead of the outdated 4 cm, utilizing midwifery care, and updating the tools provided to laboring women?
  • Does your hospital or doctor keep current on certain methods that can reduce unnecessary surgery by providing peanut balls for women with epidurals, having wireless monitoring for mobility, water labor options, etc.?
  • Does your hospital or doctor support VBAC?
  • Does your provider speak with compassion and understanding when you ask these questions or are they defensive or minimizing your concerns?

I hope some of these questions have helped to show that a rate is not always just a rate. Again, information is useful. It is a good starting point to ask more questions to make sure your provider or place of birth is in line with what you want for your birth options. Ultimately labor and birth is an unknown and you can only do the best with the information you have at the time.

Happy birthing!

All Rights Reserved, Knoxville Doula, Kimberly Sebeck 2016

 

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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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July 2011 Events

ICAN of Knoxville will be holding their regular monthly meeting on Wednesday, July 6th, at 6p.m. Location is the Earth Fare in Turkey Creek. Topic: “Home Birth in the Hospital” and the speaker is Kendra Smith, ICAN of Knoxville Co-Leader. Cost of the meeting is free, however, donations are accepted on behalf of the 501c non-profit organization. Childcare is not provided, but babes in arms welcome, as well as partners or family members. For more information about the organization, go to www.ican-online.org. For ICAN of Knoxville questions, please email icanknoxville@yahoo.com

 

Classes scheduled for July:

Comfort Measures/Refresher Course. Stages/phases of labor and birth, comfort measures, partner involvement, affirmations, and more. Handouts provided.
Date/Time: Saturday, July 9th, 10 am – 2 pm
Location: Upper Cervical Health Center, 1508 Coleman Rd, Suite 107, Knoxville, TN 37909
Cost: $50.00 per couple unless you are a doula client of mine, then it is included in your fees
Pre-Registration Required: Email beautifulbirths2003@yahoo.com

Prep for VBAC (Vaginal Birth After Cesarean). Had a C-section? Pregnant or planning to become pregnant in the near future? Come to this class to learn about the safety of VBAC, facts, statistics, along with preparing for a successful VBAC. Topics are: informed consent, comfort measures, choosing a provider, emotional component of a previous c-section, etc.
Date/Time: Tuesday, July 26th at 5:00 pm
Location: Upper Cervical Health Center, 1508 Coleman Rd, Suite 107, Knoxville, TN 37909
Cost: $50.00 per couple, unless you are a doula client of mine, then it is included in your fees
Pre-registration Required: Email beautifulbirths2003@yahoo.com
You do not need to be currently pregnant to take this class! This information can help you decide how to best proceed with pregnancy, choosing providers, and planning for VBAC. Partners strongly encouraged to attend.

 

Can’t make these dates? I offer in-home and private classes as well and can work around your scheduling needs. Have a suggestion for a class? Let me know!

All Rights Reserved, Kimberly Sebeck, CLD, CCCE, Knoxville Doula

 

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ICAN of Knoxville, a Look Back and Looking Forward

While organizing my files for ICAN of Knoxville, our local chapter of International Cesarean Awareness Network (www.ican-online.org), I find myself feeling exceedingly grateful for the support shown by attendees, speakers, volunteers, other local doulas and birth workers, etc.

Here are some of the great topics that have been covered in our monthly meetings:

Chiropractic Care for Pregnancy and Improved Birth Outcome. Speaker: Franya Peterson, D.C.

Informed Consent.

Emotional Recovery after a Cesarean. Speaker: Rev. Angie Collins of Awakened Light Healing.

Tips for Physical Recovery after Cesarean.

General Support Meetings.

Birth Story Night (one of our biggest turnouts). Speakers: YOU, the attendees, with each of your stories to share.

Movie Night: Pregnant in America.

Exercise in Pregnancy. Speaker: Becky Fox

Breastfeeding after Cesarean: Speaker, Sherri Hedberg, ICBLC and RN.

Cloth Diapering and Baby-Wearing (our biggest turnout). Speakers: Mary Rodio, of Knoxville Holistic Moms Network, and Robin Alley, student midwife and baby carrier creator/educator.

We’ve had a lot of fun, a lot of emotional sharing, along with knowledge, and what I hope is a safe place for support. If you haven’t joined us yet, please come to one of our meetings. They are held each month on the first Wednesday of the month, at Earth Fare in Turkey Creek, from 6-7 p.m. Ok, we rarely get out at 7 because of socializing, but we do try to keep the topics to one hour. The meetings are free, however, we do accept donations on behalf of our 501c non-profit organization and welcome local individual, business, and professional subscribers.

Some of our upcoming topics planned are:

Homebirth in the Hospital
The Truth About Epidurals
Unexpected Outcomes
Craniosacral for Newborns and Infants

Is there a topic you would like to hear about? Please let us know at icanknoxville@yahoo.com, or leave a comment below. Do you have a topic you would like to share? Please let us know that, too. Are you available to volunteer, either on a one time basis or ongoing? Make some copies for events? Post a flyer at work or in your business? Donate a service or product to fundraisers?  We’d love to see you personally involved.

Our ICAN of Knoxville fundraiser will be this Saturday. The title is: Pampering and Wellness Day. Please see the Facebook event for all the details! http://www.facebook.com/event.php?eid=132652926808967  . We would love to see you there!

Thank you!

 

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Women are Strong and Amazing

Really.

Last night ICAN of Knoxville held a “Birth Story Night”. Several women showed up to share their birth experiences, and despite the differences, one common thread showed through:

Women are strong and amazing.

We had birth stories of home birth ending up in transfer to the hospital and being a cesarean birth after cesarean, twins birthed vaginally, placental abruption requiring transfer from a birthing center to a hospital but resulting in a labor without an epidural, short labors, long labors, disappointments, triumphs, and so on.

I valued hearing every single story and detail. I valued seeing a room of women bonded together in their shared love for their babies and partners and themselves. I valued watching the expression on their faces as they described how they made a decision about where to birth, or an intervention, or a complete change in their original birth plan. It was quite apparent how much thought and heartfelt participation was involved in their decision making process.

Repeatedly, the phrase, “If I had known….” was used. My thoughts on that are we can’t know every single scenario that might take place, nor can we know what would have happened had another option been chosen. We make the best decisions with the information we have at the time... and try to make peace with the decision and potentially learn something for next time, or to share with a friend or family member.

To all of you, thank you for sharing such intimate details of your life and my hope is that you felt supported, encouraged, and empowered. Pat yourselves on the back, look at yourself in the mirror and congratulate and celebrate your amazing strength and obvious love for your children.