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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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Knoxville Birth Resource Center (KBRC)

We have a vision to bring as many resources as possible to families in Knoxville. All things related to pregnancy, birth, and postpartum. Today we added in Delighted Doula who will be offering postpartum classes and services. Who knows what else we will add next?

If you are interested in more information about rental space and times at KBRC you can email me at kimberly.sebeck@gmail.com.

On FB: https://www.facebook.com/KnoxvilleBirthResourceCenter

kbrc

 

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Avoiding Traumatic Birth

We’re hearing a lot about traumatic birth lately. It’s always been around, but more women kept quiet about it or maybe didn’t realize there was any other way to give birth. With the explosion of the internet and social networking, women are discovering they had unnecessary, potentially or actually harmful, and often traumatic interventions and events on one of the most important days of their life — birthing their child.

Know your options!

Did you know that in the Knoxville, TN, area you have genuine options to help avoid a traumatic birth? Some are:

  • Natural Childbirth Classes (not hospital sponsored ones, but true learning experiences, such as Bradley or Hypnobirthing)
  • Doulas. Antepartum, birth, and postpartum doulas are available — and our numbers are increasing to give you options
  • Home Birth Midwifery
  • Free-standing Birth Centers
  • ICAN of Knoxville (International Cesarean Awareness Network) local meetings for support, education, and information
  • Knoxville Birth Network meetings, a division of Birth Network), also for information and support
  • Chiropractors and massage therapists (along with other professionals) trained to optimize pregnancy and birth

These are a few of the options available to help you avoid a traumatic birth in the first place, or recover and heal from a previous one or ones.

The question is: Are you taking advantage of these resources?

Every week, I get numerous emails or phone calls from women who say, “If I’d known inducing for non-medical reasons would have led to a cesarean section”, or “I thought about taking a class but didn’t find the time”, or “I thought about using a doula but we didn’t”, or “My doctor said I couldn’t VBAC (vaginal birth after cesarean), so I just scheduled another surgery” or “My doctor said my pelvis was too small/baby too big/ why even try labor”… and on and on.

The emails make me sad for many reasons. They make me sad a woman didn’t get the birth experience she wanted and deserved, but they also make me sad that the useful and wonderful resources available are not being utilized. This is not to say it is a woman’s fault if she is suffering from birth trauma–not all births will go the way we desire them even after making the most concerted efforts. However, if you’re on the fence about seriously exploring your options, your chances of ending up unhappy with your birth experience are going to be far greater.

Interview some midwives, interview some doulas, take childbirth classes. In the U.S., women regrettably educate themselves more about buying a car, or a purse, or finding a good daycare than they educate themselves about the birth of their baby. Interview different OB/GYN’s and hospitals, even. Don’t take your neighbor’s or sister-in-law’s recommendation just because they “liked” their OB/GYN or because he or she was “nice”. Ask questions. What is their cesarean rate? What is nursery and newborn policy? I cannot list here all the interview questions to ask different birth professionals, so research what you desire and make sure your birth team is in line with your desires.

If you have not yet seen some eye-opening films, take the time to do so. The Business of Being Born, Gentle Birth Choices, Pregnant in America are all good starting points. Have your significant other read, “The Birth Partner” by Penny Simkin, a book I advise all of my clients to read. Look into different information about doulas, which can easily be found on well-known and reputable sites such as DONA, CAPPA, and The American Pregnancy Association. Attend one of the often free meetings held by birth organizations.

We’re here to help you have the best birth experience possible.. please take advantage of what’s offered and make the time, make the investment so you don’t later send an email saying, “if only…”. Perhaps there will still be something you didn’t like or that was traumatic during your birth experience, but you will have the satisfaction and empowerment of knowing your options and having done your research. No one can tell you what is the best scenario for you, your baby, and your family. Invest in knowledge.

Resources:

www.pennysimkin.com
www.knoxvillehomebirthservices.com
www.cappa.net
www.ican-online.org
www.dona.org
www.birthnetwork.org
http://www.facebook.com/group.php?gid=170751447099
www.doulamatch.net
www.thebusinessofbeingborn.com
www.waterbirth.org
www.icpa4kids.com
www.knoxvilledoula.com
www.bradleybirth.com
http://www.americanpregnancy.org/labornbirth/havingadoula.html

All Rights Reserved, 2011, Kimberly Sebeck, CLD, CCCE, Knoxville Doula

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Holiday Babies and the Pressure to Induce

Sadly, one of the issues surrounding pregnant women who are due around major holidays like Thanksgiving, Christmas, and New Year’s, is a pressure to schedule an induction. There can be many factors regarding this, such as your personal caregiver being out of town for certain periods of time, hospital staff trying to contain overflow, even wanting or hoping to get a tax deduction before the year runs out.

If you are one of these women due around the holiday season, consider carefully the risks of non-medical induction. If you are pressured into an induction with a medical sounding reason, be sure you ask your “Informed Consent” questions:

What is the procedure being recommended? (Such as, what type of induction would be used?)

Why is the procedure being recommended? (Is your doctor planning a trip to see family? Are the common, yet medically unreliable reasons of  “baby’s getting too big”, “fluid is too low”, “we don’t want you going post-date” being used? If so, research, research, research in order to make an informed decision!)

What are the risks of the procedure? (Failed induction, distress for the baby, greater (up to 2x) risk of surgical interventions such as cesarean, forcep/vacuum delivery, an early full-term or even pre-term baby?)

Is the reason for an induction considered an emergency? (True emergency reasons for induction of labor are very, very rare and do not include scheduling a week or more ahead)

What happens if we just wait and see? (This will also help you determine if there is a true medical need)

What alternatives could be used? (Walking, sexual intercourse, acupressure/acupuncture, certain herbs — with any and of all of these, again, do your own research and weigh the risks and benefits)

Hopefully, early on in your visits with your caregiver, backup plans and caregivers were discussed and preferably, you have met one or all of the caregivers who may be on call should your own doctor or midwife be unavailable. If this hasn’t happened, make it happen.  Be certain to have a copy of your birth plan in your chart, and extras to bring to the place of birth.

A doctor or hospital’s schedule shouldn’t dictate when your baby is born or your having to assume a higher risk of medical interventions and surgical birth. You can always politely decline the offer of scheduling your baby’s birth for non medical reasons.

Best of wishes to you through the holiday season!

For more information, please go to www.ican-online.org. As always, these statements are not intended to replace decisions made by you and your health care provider.

All rights reserved, 2010, Kimberly Hall Sebeck, Knoxville Doula

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Birth Provider and Place Recommendations

Research -- read reviews, interview.

Research — read reviews, interview.

Often I am asked to give a recommendation for an OB/GYN, midwife, birthing center, hospital, etc. While I am happy to share my opinion in most cases and offer valuable resources for certain issues (such as seeking VBAC friendly providers or high risk/low risk practices), remember that who I may choose as my health care provider may be very different from who you would choose and feel comfortable with.

No matter who makes a recommendation to you, or is covered by your insurance, remember to do your own research! It’s perfectly acceptable to “shop” for a provider, merely call them and schedule an interview appointment.  Don’t feel pressured into an exam or tests on your first appointment.

Some things to consider:

You will only give birth a few times in your life. Choose your birth team carefully and wisely. Most people put much more time and effort into researching a car than they do the place they will give birth, or who will be with them at their birth.

Your insurance may not be the best indicator of where you should give birth. Again, how much would you spend as a down payment on a car? There are things in life that cost money — and are worth it. Haggling with your insurance may even be an option.

Do you have special considerations? Are you seeking a VBAC (vaginal birth after cesarean)?  Are you needing an excellent surgeon for a medically necessary cesarean section (surgical birth)? Do you prefer a male or female health care provider? Are you comfortable with a practice who has many doctors or a solo provider? Can you meet their backup doctors or midwives who could very well be on call at the time of your labor and birth? Does their view on birth fit your own philosophies and ideas?

It’s also very important to realize it’s never too late to change providers. Emergency rooms cannot turn you away and will provide a doctor on call if it were to come to you choosing to dismiss your provider. This may not be a better case scenario, but it is an option.  As you take childbirth classes and educate yourself, you may realize the provider you started with is not a good fit for your wishes. Ultimately, switching to a provider more in line with your desires will do everyone a favor.

No matter who recommends a provider, please do your own research. Ask questions in the community and directly to the provider.  Research online with an open mind to reviews.  Understand that not everyone will have a good experience with a certain doctor or midwife, hospital or birthing center — is this due to a difference of birth philosophy, payment issues, or even personality or is there a more serious reason someone had a bad experience. I know many doctors who excel in certain areas such as high risk but would not be the best candidate for someone seeking a low or non interventive birth plan.

Your pregnancy and birth experience is special. Treat it as such.

All Rights Reserved, Kimberly Doula Sebeck, Knoxville Doula 2010

http://www.knoxvilledoula.com

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ACOG Releases Less Restrictive Guidelines for VBAC

Today, ACOG, the leading voice concerning all things obstetrical, issued a press release for less restrictive guidelines for VBAC (vaginal birth after cesarean). You can read this press release here:

http://www.acog.org/from_home/publications/press_releases/nr07-21-10-1.cfm

This is a great step in the right direction. Make sure your own midwife, OB/GYN, nurse practitioner, childbirth educator, etc, have seen this release. Why not print off a copy and take one to your OB/GYN, particularly if you have had a previous cesarean section?

We are making changes in safer, less interventive, and less restrictive options for pregnant women.

For more information, you can read about cesarean birth, pregnancy, VBAC, interventions and more at:

www.ican-online.org

All Rights Reserved, Kimberly Sebeck, Knoxville Doula 2010

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Birth the Way You Want

Trust your instinct

Trust your instinct

Two days ago I attended a birth in a hospital.  The mother was committed to going without pain medication, as she had been given an epidural in her previous and first birth due to abnormally and dangerously high blood pressure.  She chose to birth in a hospital this time because she was transferred from a freestanding birth center previously and felt if there was a chance of being transferred this time, she may as well birth at a hospital. She achieved her goal of birth without pain medication, despite being induced with Pitocin, having an IV, and nearly continuous electronic fetal monitoring.

Some of the highlights of her labor experience were:

Staying active, either by walking, rocking, or using the birth ball
Utilizing a soothing, hot shower for pain relief
Assuming positions to ease the pain sensations as well as optimize fetal positioning
Massage and double hip squeeze
Emotional support and encouragement from her husband and myself
Believing in her ability to birth without pain medication — even when labor became intense
Exercising her voice, by vocalizing with contractions and by communicating with her support and medical team
Having the Pitocin turned completely off once her own oxytocin took over

Many natural birth advocates will tell you how hard it is to labor in a hospital, particularly with any sort of intervention.  Especially with Pitocin, a synthetic form of oxytocin. How then, did this mother accomplish her goal of minimizing interventions, not allowing these to spiral into an experience she was unhappy with?

Some tips:

Choosing a provider wisely. A compassionate and open-minded OB/GYN was chosen and communicated with.
Choosing the right support people. For this mom, her husband and a doula were key for her experience.
Asserting the need for informed consent and the right to deny or accept certain interventions.
Belief in the body’s ability to birth without a pain medication.
Being brave enough to ask for additional help and encouragement, especially during transition.
Instinctually following body cues to move, vocalize, grunt, rock, squat, and more.

As a doula, I do not judge where a woman chooses to give birth. While it can be harder to birth naturally, without intervention,  or pain medication free in a hospital, it is not impossible. I have witnessed many women give birth the way they wanted to in a hospital. Finding the right provider is essential; selecting the proper support people invaluable.

Wherever you choose to give birth, believe in your ability to birth the way nature intended.  Communicate honestly and firmly with your provider. Make informed choices about any sort of intervention, whether it is during pregnancy, labor, birth, postpartum and whether your birth place is a hospital, a free standing birth center, or at home. Trust your instincts!

http://www.knoxvilledoula.com