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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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Choosing Where To Give Birth Is Not One Size Fits All

Who will you choose to care for you?

As with most options and choices in pregnancy, childbirth, and parenting, the choice of where to give birth is a tough one for many to make and is subjected to your own anxieties and others criticisms. Tell family that you are having a home birth and you can receive a reaction of mouth hanging open and disbelief to outright animosity and threats they will not attend your birth or call the authorities on you. Mention elsewhere that you are birthing in a hospital and inevitably someone will pipe up that you should watch a popular DVD about the birth business and warn you everyone and anyone who steps in the hospital will end up with an unnecessary cesarean section (and wear a gown someone died in the day before). Unassisted birth? That’s not something you can discuss unemotionally at your local playgroup.  These reactions can be bewildering, stressful, and even hurtful. Couples may find themselves arguing over the pros and cons of where to give birth.

I’m not going to tell you which is better. I trust you. I trust you to make the best choice for yourself. I trust that with the wealth of evidence based information available these days that you can think for yourself and calculate the risks and benefits. There is a lot of misinformation out there as well as rabid opinions on both sides so be careful when you’re on your search and rely on trusted sources and your own thinking ability and intuition.

The fact is, there is no OSFA (one size fits all) answer. If everyone had to have a hospital birth or everyone had to have a home birth we wouldn’t have any choice at all. There are women who feel going to a hospital will subject themselves to unnecessary interventions or inhibit the natural birth process (and that’s okay to come to that decision). There are women who feel giving birth at home is unsafe or anxiety producing (and that’s okay to come to that decision). There will be women who plan for one or the other and end up unexpectedly birthing their baby in their bathroom before ever getting to the hospital and there will be women who painstakingly plan for a home birth or birth center birth and risk out beforehand or are transferred during labor. There will be women who feel disappointed if their birth plan and place of birth go according to plan and decide to do it differently the next time and there will be women who have nothing go according to their plan and adjust their choices accordingly.

But Kimberly, “I hear some people saying, “what about rogue midwives with no real training and greedy obstetricians who can’t wait to slice women open to get to their round of golf?” Those are absolutely valid points but that in actuality comes down to who you are choosing as your provider. One surgery happy obstetrician does not mean the entire hospital is that way (but it could). One irresponsible midwife with no accountability does not mean there aren’t very well trained and competent midwives (but it could). Do your research. I say this over and over. Choosing a provider in line with your childbirth wishes is one of the most important things you can do. I cannot stress this enough. When you have a good provider you can have confidence in the suggestions and care they give you, as well as any backup plan or transfer of care that may come along. If your provider cannot find the time to sit down and have a real conversation with you without just giving canned answers (‘I never have to transfer to a hospital”, “so long as everything is ok”, “let’s just play it by ear”) that may be a red flag that you need and deserve to find a new provider who can make the time to answer the hard questions. Listing all the important questions will have to wait for another blog but a starting point would be to ask if they follow the advice of their own certifying organizations (ACOG — American College of Obstetricians and Gynecologists or MANA (Midwives Association of North America) for example) as well as complying with any state or local laws.

Sadly, not all areas like the one I live in have a multitude of hospitals, midwives, midwives in a hospital setting, home birth providers, freestanding birth centers, etc. to choose from. For those of you in such a difficult circumstance, I feel for you. Planning your birth may be choosing between two less than optimal choices. Until we have more collaboration between hospital providers and home birth/freestanding birth center providers some of us will struggle with gaps in care. In that situation hiring a doula is even more important to ensure a smoother and happier experience.

In some ways it can seem unfair that expectant parents have to put so much work into researching providers, hospitals, out of hospital options, cesarean rates in the area, laws and policies instead of just joyfully preparing for their new little one. Ultimately though, all the research and knowledge leads to a greater involvement in yourself and a sense of empowerment and pride in your choices.

I wish you the best birth possible, wherever you give birth.

 

All Rights Reserved, Knoxville Doula, Kimberly Sebeck, 2014

My Website

 

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How to Afford Your Doula or Midwife on a Shoestring Budget– Guest Post

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Please enjoy this guest post from Sarah Haselton, a doula in Linden, VA. We met when she lived in Knoxville, TN and while I was sad she moved I also knew she would serve many families in VA.

I found myself pregnant in August of 2012, shortly after moving in with my husband’s parents. It could not have been worse timing! My husband had just started a job working at Wal-Mart and I had left all of my contacts behind in Tennessee to start a new life closer to family. We were flat broke, no DIRT broke. We had zapped all of our savings between working on getting my husband through college and poor spending choices at the beginning of our marriage. So on a wing and prayer we moved in with my husband’s parents with $2000 in our pockets and our few possessions we couldn’t bare to part with. Thankfully we didn’t get rid of our daughter’s baby clothing, bedding or various baby related items. (More on that later.)

So knowing I wanted to have a home birth in order to increase my odds of having my coveted VBAC I started doing research well before I was pregnant. I knew I wanted to be a doula also and felt like knowing the birth workers in my community was a great place to start that journey. So, like I did while I lived in Knoxville, I started calling around and asking questions. Somehow I was placed in contact with a few midwives and shortly there after I found myself staring at a positive pregnancy test. To say I was shocked (okay not that shocked, we weren’t exactly as careful as we should have been!) is an understatement.

When faced with this new life we had to make some tough choices. Choices that involved money. That dreaded “M” word has followed us around EVERYWHERE for the last 5 years! Luckily I have a spouse who understood how important it was to me that I had a positive birth experience the second time around. He also understood the value of our birth team and that the peace of mind that came with that team was priceless to me. I’ll admit that when we were faced with a $3500 bill just to give birth when going to the hospital would have been paid 100% by Medicaid, we thought twice, thrice and four times. Like I said though, it was that important to me. Later my husband admitted that seeing the peace our team gave me was worth it to him as well.

So, you may be asking, how does one on such a small budget afford midwifery care or even a doula. Well, here are some ideas I have for you (many of them I implemented myself!) I am living proof that if something is deemed important enough, you just find a way to make it work.

1. Call your insurance company.

Yes, I know this sounds silly, but bear with me on this thought. You NEVER know what your insurance will pay in for your birth. Some states even have ways of helping get a doula paid for through Medicaid. Virginia is one of them! There was some investigation work on my part, but it CAN happen! It never hurts to submit a claim, the worse they can tell you is NO!

2. Recycle Cans

Many states have programs that will allow you to recycle tin cans for money. It may not be a lot of money, but something is better than nothing. Bonus, you help the environment AND if you walk along the road collecting can get a decent workout doing this!

3. Consign old baby items

Our daughter was crazy blessed with clothes. I’m serious! My daughter had an insane amount of clothing, some items she never even wore! I found a high end consignment shop and went through her baby clothes. I chose my favorite items to keep, kept the gender neutral items (We knew we would have more children in the future. This just made sense to us.) and the rest got shipped off the the consignment store. It made our very first payment to the midwife!

4. Do odd jobs

I know this is tough, especially if you already work full time or are busy taking care of small children already, but it can be done, even while pregnant. Consider doing an elderly person’s laundry, babysitting for a couple looking for a night out, mowing lawns, or picking up housekeeping for a while. Now I understand this isn’t realistic for some people, but for those of you that it is, ask around. I found some odd jobs through members of our church and even mowed one of neighbor’s yards, granted only one time, to help pay for our bills.

5. Cut out unnecessary spending.

I know, easier said than done. Trust me, we enjoy that meal out FAR too frequently, but when it came closer to my due date and my bill wasn’t paid in full we were more cautious about this action. I got rid of extras as much as we could.

6. Use a tax return

Ultimately THIS is what paid the cost of our birth team for us. We had to wait a while after the birth of our son (only about two weeks) to pay our balance in full, but our midwife was understanding about WHY we had to wait this long. She knew we were hard up for money and never pressed the issue. She knew we meant it when we said we would pay her in full.

7. Ask your friends and family to donate

Gofundme.com has a great program out there to help families fund projects. What better way than to tell your family that instead of items you don’t need for your baby, to donate to your birth. You might be surprised what people will give you. Especially if it is a small “bill” like a doula!

8. Set up a payment plan

Just like any major expense that a young couple can have, your birth team is an investment. Setting up a payment plan with your doula can help you to pay the balance in full and also give you some accountability. Not only this, but it can make the goal seem far more attainable if you break your payments into smaller chunks. Often times seeing a payment in a manageable sum can get you over that mental block of cost.

9. Sell unnecessary books, movies and items.

When I found out I was pregnant I realized how much STUFF I had just laying around. Even with moving across state lines into a smaller space I still had a lot of stuff that wasn’t needed. I found online garage sale sights to sell my items to and those extra dollars added up.

10. Use work bonuses

Some employers issue bonus checks to their employees. If your employer is one of these, consider using your bonus to invest in your birth. You WON’T be sorry!

Bottom line is there are ways to afford your doula if you really want it. Instead of making excuses, find a way to make it work. My husband and I worked very hard to make the most of our small sum of money monthly and until recently had been living off of that small budget with the help of family. We knew how important our birth was and we knew we wanted to make it work, even if it meant giving way to some of the more luxurious items.

 

You can find Sarah Haselton at https://www.facebook.com/lifesblessingsdoulaservices  or http://doulasarahheselton.wix.com/lifes-blessings and if you are in her region of VA you would love to utilize her services.

All Rights Reserved, Kimberly Sebeck, Knoxville Doula, 2014
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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