Posts Tagged ‘maternity’

Picking Your Care Provider – Interview Questions

Thursday, July 28th, 2011

Being an active participant in your pregnancy and birth journey begins with choosing your provider. You can begin the search for the right provider fit prior to becoming pregnant, in early pregnancy or anytime before your baby is born. So much of how your pregnancy and birth unfold are directly related to your care provider so this is really a key element. Every provider is not the right fit for every mother and vice verse. If you already have an established provider relationship, these questions can be used as a re-interview tool.

When asking these questions, take care to really listen to the answers. If a provider will not meet with you prior to you becoming a patient, that can be a red flag.

______________________________________________________________________

Begin by expressing your overall idea of what your best pregnancy, labor and birth looks like to provider.

  • What are your core beliefs, training, experience surrounding pregnancy and birth?
  • Why did you choose this line of work?
  • What sets you apart from other maternity providers?
  • How can you help me attain my vision for pregnancy, labor and birth?
  • If I have a question, will you answer over the phone, by email or other avenue outside of prenatal appointments?
  • How much time will you spend with me during each appointment?
  • What routine tests are utilized during pregnancy? What if I decline these tests?
  • What is the average birth experience of first time mothers in your practice?
  • How do you approach the due date? What do you consider full term and when would I be considered overdue?
  • What are your patient intervention rates? (IV, AROM, continuous monitoring, episiotomy, etc.) Cesarean rate? VBAC rate? Induction rate? What induction methods are used? When are forceps/vacuum used? These numbers are tracked.
  • What positions are you comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing? Water? How often do patients deliver in positions other than reclined or McRoberts positions?
  • How do you feel about me having a birth plan?
  • What if I hire a doula? Do you have an interest in who I work with or restrictions? If yes, why?
  • Do you have an opinion on the type of childbirth or breastfeeding class I take? If so, what and why?
  • Are you part of on call rotation or do you attend your own  overall? Will the back-up or on-call CP honor the requests we have agreed on?
  • Are there any protocols that are non-negotiable? If you cannot refuse – you are not consenting.
  • What if I choose to decline a recommended procedure or intervention in labor or post birth, how will that be viewed?
  • When will I see you during labor?
  • What postpartum care or support do you offer?
  • Will I be able to get questions answered or be seen before the 6 week postpartum visit?

Points to ponder afterward:

  • Did you feel immediately comfortable and respected at the interview? If already with a CP, do you feel comfortable, respected and heard at each appointment?
  • Were there red flags or white flags?
  • Was or is care provider willing to answer questions in detail without being annoyed?
  • Is choosing your care provider based on your insurance or lack of insurance?
  • What are you willing to do in order to have the birth you really desire? Birth location?
  • How much responsibility are you willing to take for the health care decisions for you and your baby?

Wish List In 2011

Sunday, January 2nd, 2011

A clean slate. A fresh start. Hope and dreams reactivated. Passions toward change are stirred. All of this by the calendar rolling over from one year to the next. It is not just  anew year though, it is a new DECADE to set precedent in. To make a mark. Oh the possibilities and opportunities that are ours to reach for and accomplish.

In the spirit of all of this, I decided to make an #in2011 wish list on New Year’s Eve 2010 and with some help from a few friends here is what flowed out.

#in2011 breasts will be viewed as nurturing, comforting, and beautiful.

#in2011 the majority of women will be served under the midwife model of care for the majority are low-risk and will remain so.

#in2011 Childbearing women will be greeted with open arms by providers with their questions, needs and knowledge.

#in2011 pioneering social media women will gain even more ground in their work liberating childbearing women.

#in2011 delayed cord clamping and physiologic third stage will become the norm.

#in2011 doulas will be respected as educated, knowledgeable birth professionals by staff and care providers.

#in2011 childbearing women will be given opportunity not limited

#in2011 Those striving to improve the maternity system at the ground floor as educators will be mutually respectful and supportive.

#in2011 Doulas from all backgrounds and organizational affiliation will be open to one another, supportive, sharing.

#in2011 a woman with needs and opinions with not be marked for a cesarean because of it.

#in2011 Homebirth transports will be treated with dignity and respect.

#in2011 Stigma of mental illness and motherhood will be adsressed by every childbirth care provider. RT @WalkerKarra

#in2011 Childbearing women will not have to live in fear of their providers.

#in2011 We CAN change the world together for childbearing women. Put your words intro action.

#in2011 More birthing women will have low-intervention births that lead to healthier outcomes.

#in2011 Childbearing women will be seen, heard, respected and offered a variety of care options.

#in2011 there will be less imbalance of power between maternity patient and provider.

#in2011 childbearing women will rightfully claim their health records as their own -RT @midwifeamy

#in2011 we will wake up to and address the shameful disparities in access to and outcomes of maternity care RT @midwifeamy

#in2011 Less pointing fingers among insurance companies, providers & orgs that continues to feed this ever medicalized maternity system.

#in2011 I would like to see an equal playing field with accessibility to all to maternity research, guidelines, statistics…

#in2011 I would like see accountability for providers and institutions in their maternity care practices.

#in2011 I would like to see hospitals treat only the patients they serve the very best – high-risk or in-need mothers and babies.

#in2011 I would hope more women stop blindly trusting and do their own research for pregnancy, birth and postpartum.

#in2011 I would like to see arrogance leave the treatment room. It is not a personal affront for a patient to have an opinion and needs.

#in2011 I hope women are treated as holistic beings especially in pregnancy.

#in2011 I hope for care providers to be transformed into partners with their patients instead of authorities.

#in2011, I want to see care providers and family members taking postpartum mood disorders seriously. RT@smola04

#in2011 I hope women stop being treated with hostility and looked down upon for wanting something more in pregnancy, birth and postpartum.

#in2011 I would like to see more women receiving comprehensive postpartum care from their OBs and hospital based midwives.

#in2011 I hope that women will openly mentor those coming up after them to better understanding and expectations in birth.

#in2011 I hope social media efforts have even more impact on unveiling the hidden and progressing healthy birth practices.

#in2011 I hope less mamas are unnecessarily cut open in pursuit of delivering a baby.

#in2011 I hope to see midwives working together no matter the track they came up on. Being respectful and open.

#in2011 I hope to see women who have experienced amazing births be loud and proud sharing the good news without fear.

#in2011 I hope that midwives of all types will be fearless in their pursuit of their model of care for women.

#in2011I hope that hospitals and providers realize they need to offer individualized care to women and babies for the health of it.

#in2011 I would like to see women openly breastfeeding their children without shame or discrimination.

#in2011 A drop in the cesarean rate would be progress toward healthier practices.

#in2011 I want to see women in droves having their eyes opened and being fierce about the care they receive. About their maternity options.

#in2011 I would like to see less care providers offering up defensive and fear based medicine to their maternity patients.

#in2011 I hope for more accessibility to home and birth center births for women and babies.

#in2011 I would like care providers to view women as a sum of all parts, not a uterus growing a baby more valuable than she is.

#in2011 I would like to see more women taking charge of their care, taking personal responsibility and being powerful pregnant women.

#in2011 I desire more respect and autonomy for maternity patients.

#in2011 For women who want a VBAC to easily find an accommodating provider.

Is all this attainable in one year? Perhaps not, but pushing toward the positive and never taking the eye of the reason for all of this, the childbearing women and families, I do believe we can change the world and make the maternity care system as a whole a safer, healthier  and more respectful place.

What is on your 2011 wish list? If you would like to have it added here, leave a comment.

Reader Additions:

Kay Miller:

I hope that we (doulas/educators) can stop alienating the providers, instead partnering with them to provide the best care possible for the mamas and babies that we work with.
I hope that doulas/educators and providers can have mutual respect for one another, and realize the value of the care and support that each provides.
I hope that while we work to change the negatives of health care for pregnancy, birth, and postpartum, that we can remember to openly recognize and affirm the positives.
I hope that families will make decisions based on education and research, not on fear.
I hope that both “sides” stop using fear tactics to persuade families to make certain choices. A decision to home birth due to fear of hospital birth is still a decision based on fear.

Some thoughts on birth and being a consumer.

Sunday, January 3rd, 2010

While “teaching” childbirth class the topic of being a consumer is addressed often in a variety of ways.  I have a firm belief that a woman has the ability to understand, be well educated, and make her own decisions. It is in no way in my job description to tell someone else how she must birth or how to do it in the right way.  She is the one who needs to take the information, explore it and apply it to her self and situation.  Being a consumer in her childbearing year is a key component.

I have a great and deep sense of obligation to give truthful, helpful, real life applicable information to the families I am blessed to work with.  Because of this my mantra is,  “You go home or stay home with your baby and are the one who must live with the decisions and outcomes from them. Not the doctor, midwife, nurse, doula, educator – no one else.  We all go home to our own lives. So if you have to live with all that happens then do your best to choose wisely to what you can live with.”  No mother escapes the outcomes and the legacy it leaves behind forever no matter who makes the decisions for her. Even if it seems easier at the time to allow others to call the shots, I can hope the epiphany of this will help the pregnant woman to push for what she really needs and wants instead of being a passenger in her own process.

Birth options are integrated into prenatals and/or class structure as we discuss birth philosophy, birth planning, re-interviewing care provider, realistic expectations for chosen birth location, and interventions and medications.  Most often I find that women have no idea that there are so many options available for the asking or available in a reasonably close proximity to our local area.  This tells me that care providers expect the burden of knowing the options is to be on the pregnant woman to find out about, explore, and ask for.  She may find that in this process she and her care provider/birth location are either well on or not on the same page with her needs and desires.  This is where she can decide if needed to seek another provider and/or birth location.  There almost always is a way, it may mean more work, effort, and at times out of pocket expense. Some women choose to relocate, ask for help with out of pocket expenses in lieu of baby shower gift, petition insurance to cover the “right” provider…

Really as a consumer the burden is on her to find the right fit and go for it.  It is not for her to fit into whatever is the local expectation for her as a birthing woman.  This comes down to something akin to buying a car because the dealer tells you this is the car you must buy because everyone else has bought it and even though it clearly does not suit your needs, you still buy it.  I have never heard of that happening, yet I hear of women day in and day out having this sort of exchange from prenatal care through the birthing day with their care provider and/or birth location staff.

When it comes down to it, I really want women to have what is individually needed and desired. Who is paying the bills? Who is keeping the hospitals, birth centers, ob/gyns and homebirth midwives in business? Those caring for birthing women ought sit up and take notice. You all wouldn’t exist without birthing women paying for your services.

Every provider or birth location has a practice style, protocol base,  etc.  So why not honestly explain expectations, protocols, practice style in detail at the first visit or during the tour so the mother who is hiring you or birthing at your location can decide whether or not right off the bat if this is a solid fit? No one provider or location is going to fit with every mother nor is every mother going to fit with every provider or location.  Whatever a provider or birth location is good at, expects,  and is striving to be, put it out there so the mother coming in knows what she is buying in to.

My dream is that every birthing woman will know all the options and subsequently exercise her want to the care she desires even if it means walking with her cash or insurance card, since ultimately she lives with all that transpires positive, negative, or in between.

Shocking quotes regarding maternal choice to VBAC birth

Friday, October 16th, 2009

Joy Szabo has been in the news lately for desiring a second VBAC for her fourth baby (vaginal birth, emergency cesarean, and vaginal birth).  She has been denied locally in her area of Page, AZ to have a vaginal birth. Due to this situation, the International Cesarean Awareness Network has been assisting her in fighting the VBAC ban along with seeking out additional options.

After reading the latest article regarding Ms. Szabo, I am completely dumbfounded by the remarks made by other readers of her story.  I am stunned by how it seems the general populous regards a woman’s autonomy and medical rights.  I am also including positive comments as counterpoint. Where do you fall?  What do you believe? Many of these comments point me in the direction of what is so wrong with the system.  That of physician and hospital trumping patient.

You decide is the comment pro or con?

“…..it seems like many people do not grasp malpractice and insurance companies. This is not about the hospital, but about medical professionals and hospitals not wanting litigation. Can you blame them? After spending tens of thousands of dollars on an education before making a dime, I would do what I needed to to avoid a lawsuit, too! … we go to doctors because they DO know what is best for our health! Like another poster said, in health care, the customer is NOT always right.”

“My son was born by c-section, then my daughter vaginally, with no adverse affects. While I agree it’s the doctor’s decision to take the risk or not, it seems over-the-top conservative. Does the doctor’s insurance premium go up if this procedure is performed? Then charge more and give the patient the option.”

“C-sections are done in the US more routinely than in any other developed country but our infant mortality rate is not lower but higher. Doctors do not want to deliver on weekends, at night, if the mother is one week over her electronically determined due date. Yes complications can happen, more so if you are made to stay in a bed hooked up to monitors, a monitor screwed in to the baby’s head, your water broke prematurely, inducement before the baby or mother are physically ready to give birth. All of this leads to more injuries and deaths than needed. Doctors look upon birth as an illness, not the process that it is – an inexact human birth. I am not suggesting giving birth in a field alone, but a c-section has a greater risk than the V-Bac especially if she has had one already. C-sections for true emergencies yes, otherwise no.”

“Did anyone else notice that when they list the risks of a C-section, they failed to mention that the mother is 4-7 times more likely to DIE than with a vaginal birth.?!?!?! They also fail to mention all the potential complications to her health, the roughly 30% rate of problems following the surgery (some severe enough to require rehospitalization) and the challenges associated with caring for children while recovering from major abdominal surgery.  Good for this mom and I hope more mothers will take courage from her”

“This story is exaggeration. If the woman wants a vbac, she just has to show up at that hospital in labor and refuse a section. They can’t force her to have a c-section no matter what they would prefer she do. You can’t force a woman to have a c-section under any circumstances, so as long as the docs and nurses say she and the baby are tolerating labor, she has no reason to fear being forced into an operation.”

“I worked in the hospital for 5 years and then in a birth center for the last 4 years. I had to get out of the hospital because I started feeling guilty about my complicity in that system in which so much goes on behind closed doors of which the patient is never informed. I’ve had docs tell me in the lunch room that they are doing a c-section because they have an important golf game, fishing trip, or hot date. Then they go into the room, lie to the woman and say, ” oh your baby is too big, your progress is too slow, it’s never going to happen.” the woman believes them and thanks them so much for saving their babies lives. Over and over and over again. In Miami we have over 50% c-section rate, and it’s way more convenient for the docs. If VBACS are not allowed at more and more hospitals, the rest of the country will soon be like it is here…..”

“I find this decision by the hospital(s) to not do a VBAC as a little crazy. My older brother was born (in 1955) by C-section; both me (in 1958) and my younger brother (in 1962) were born vaginally. NO COMPLICATIONS. It could be done 50 years ago, but not now??”

“The risk of MAJOR complication from a second cesarean is TEN TIMES that of the risk of uterine rupture in a VBAC mother. Someone please explain to me how an “elective” repeat cesarean is safer than a VBAC? Especially since more than 75% of uterine ruptures occur PRIOR to the onset of labor. How is a scheduled cesarean at 39 weeks (which is the ACOG recommendation) going to save the mother who ruptures at the dinner table at 34 weeks? Using their logic, we should all go live at the hospital the moment we become pregnant after a previous cesarean, just in case our uterus blows up and we need an OB and an anesthesiologist “immediately available”.”

So what do you think?  It worries me that is seems the mother’s rights do not count for much. That in some of the comments the idea of  forcing a cesarean is no big deal if it makes the doctor’s position safer.

I think that most people are woefully under educated on childbirth and what safety really means.  A conservative physician errs on the side of evidence not defensive practice.  Do your own research. Be your own advocate.

Preparing For Birth – The Passage from She Births

Sunday, October 11th, 2009

The below writing in my opinion is one of the most eloquent and beautiful takes on labor and birth I have read.   I am using it by permission of the author, Marcie Macari from her book She Births.   I encourage you to go to her site and see her offerings.  Inspiring and fantastic. Thank you Marcie for allowing me to bless others.

I have and will continue to use this piece as a visualization with clients and class participants.  Enjoy!

“The Passage” from She Births by Marcie Macari

The earth shook. The women gathered.

The chanting of The Women Of a Thousand Generations began,  their hands intertwined.

I breathe low, moaning deep through my body to touch the depth of sound they generate.

And for a moment I am with them.

“We’re here-with you, you are one of us-you can do it!”

One of them

I breathe.

The coals glow-mocking my strength

Embers flick their tongues tormenting my courage.

I step onto the coals-

The Women Of a Thousand Generations push closer to the embers- their faces glowing from the coals.

I keep my eyes on them, focusing on THEIR ability to push through the pain, to keep walking in spite of their fear- remembering that they made it to the other side.

I find MY courage and step again.

I feel the embers, and wince.

The Women start beating a drum.

I find their rhythm in my abdomen, and slowly move forward:

One step- look at the face.

Second step- focus on the eyes.

Third step…

I see the African dancers, rehearsing their steps as I walk my last few.

I see the circle being set-the fire at the center,  the food and festivities.

This will be the stage for my welcoming into this elite group- this Women Of a Thousand Generations.

My heart swells.

I am close to the end now, and my body starts to shake-

Spirit stronger than flesh.

I want to give up-to step on the cool grass

And off these coals.

I look for the faces, and my eyes meet theirs.

One of them smiles.

She who is With Woman, reaches out her hand

Her face is the clearest, eyes at my level.

“Listen to your body and do what it tells you” She says-no trace of concern.

The chanting changes: “Listen to your bo-dy”

In rhythm, hands are again joined, like an infinite chain.

I realize just how many have gone this way before me.

The one who smiled places her hand on the shoulder

of the One who is With Woman- with me, and I breathe,

stretching out my hand to grasp the outstretched.

I am about to cross over-

Silence comes over the Universe.

I near the end-

my body aches,

my mind is empty of everything but that last step.

Last step.

Hands grasped.

Cool grass. On my toes, cooling my feet-

my arms reach out to claim my prize-

“Reach down and take your baby.”

I hold him to me tightly, and proudly take my place in the chain.

I am now a Woman Of a Thousand Generations.

The celebration begins.

Excerpt from She Births: A Modern Woman’s Guidebook For an Ancient Rite of Passage, by Marcie Macari.

“There is more to Birth than the physical process of having a baby. Birth is a Spiritual Rite of Passage for women, offering an opportunity for profound transformation. She Births challenges each woman to consider how their Birth Choices profoundly affect not only their lives individually, but the world as a whole.”

Preparing For Birth – Affirmations

Friday, October 9th, 2009

Guarding what you put into your eyes, ears, and mind is such an important part of pregnancy and birth.  As women we learn socially, from one another.  When we allow the pervasive negativity (TV, horror stories, fearful education, good patient education, unsupportive comments, etc.) to take root we lose so much inborn knowledge and wisdom of all the women who came before.  I encourage you to read the below affirmations, use them, tweak them, and then write your very own. Place affirmations everywhere that you are. Encourage others around you to also speak them to you. whenever you think of labor and birth, recite your affirmations.  Build in the positive at any opportunity. If someone gets a negative experience out to you, stop and ask what she would have or could have done differently if she was able.

  • I will take labor one contraction at a time. I can do ANYTHING for a minute or two.
  • I am able to make the best possible choices for a healthy, joyful birth.
  • I TRUST my body to labor smoothly and efficiently.
  • My design is PERFECT to birth my baby.
  • I trust my baby and body to choose when labor will begin.
  • I will receive the start of labor and I will labor well.
  • I accept the unknown of labor and birth.
  • My baby already knows how to labor and come into my arms.
  • I am well equipped to mother my baby.
  • I can make choices and decisions based out of love/evidence not fear.
  • I embrace the concept of healthy pain.
  • I am welcoming my contractions.
  • I have enough love to go around.
  • There is always enough love for me.
  • I am strong, confident, assured, and assertive and still feminine.
  • I am helping my baby feel safe so that she can be born.
  • I am a strong and capable woman.
  • I am creating a totally positive and new birth experience.
  • My pelvis is releasing and opening (as have those of countless women before me).
  • I am accepting my labor and believe that it is the right labor for me, and for my baby.
  • I now feel the love that others have for me during the birth.
  • I will treat my mate lovingly during the birth.
  • I will have exactly who I need supporting me for my birth.
  • I am birthing where I will be the safest, most peaceful, and most encouraged.
  • I have a beautiful body. My body is my friend.

If you would like to add to my list, please email me at desirre@prepforbirth.com.

Preparing For Birth – Question of the day #1

Wednesday, August 19th, 2009

What are the top three things you wish you would have known prior to pregnancy, labor or birth?



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