I’m a big fan of talking to your care provider about things that have a huge impact on the outcome of birth for both mom and baby, but I know some of those big questions can seem awkward. After talking with some of my Confident Birth and Beyond (Lamaze) classes lately, I’ve come up with some questions that should be pretty easy to just slide into your prenatal appointments.
1) When’s the last time you did an episiotomy?- Episiotomies are only really necessary in very rare, very specific circumstances (victims of female circumcision can need episiotomies, for example). If you trace the history of episiotomies, it’s pretty clear that it’s rarely needed. A good answer to this question goes something along the lines of, “Well, I haven’t done one in 8 years” or “I’ve done maybe 4 in my whole career at the very most.”
2) Are you OK with me using upright pushing positions?
3) Are you going to make me lie down for the actual birth? Question #2 and question #3 kind of go hand in hand, but you’d be surprised how often a doctor or midwife tells a mom she can PUSH in any position, but will then, at the last minute, tell a mom that she HAS TO lie down for the “delivery”. Lamaze Healthy Birth Practice #5– Avoid Giving Birth on Your Back is best for moms and best for babies, period.
4) So, what do you think about the ACOG/ SMFM Consensus Statement on the Safe Prevention of the Primary Cesarean Delivery? When it came out in March of 2014, the Consensus Statement was a really big deal. How big? It redefined the onset of active labor from 4 cms cervical dilation to 6cms of dilation. That’s just one of the numerous guidelines published to help improve our rising maternal mortality rate in the US. Your care provider should be up to date and following these practice guidelines, because there is a need for improvement from the normal way of doing things.
5) Do you do a lot of VBACs? The issue of VBACs versus Elective Repeat Cesareans is so much bigger than just the oft-cited “rupture”. The rising cesarean rate in the US is largely a result of reduced access to VBACs, and our rising maternal mortality rate has been tied to repeat cesareans. Most women who gave birth by cesarean are candidates for VBACs; it’s a matter of finding a care provider who will “allow” them. And if your doctor “allows” them (see how I put that in quotation marks? heh), does he or she actually DO any?
6) How quickly after birth do you clamp the umbilical cord? The case of delayed versus immediate cord clamping is pretty much decided– it needs to be delayed. A recent study on cord milking following cesareans (since you can’t really wait for the cord to stop pulsing on it’s own during a surgery) had some pretty important results, including a reduction in cerebral palsy. Yeah, you know that thing fetal monitoring was supposed to prevent but doesn’t? At this stage, it’s pretty hard to defend immediate cord clamping, even when babies are born prematurely or need resuscitation. Clamping and cutting needs to wait.
- What questions did I miss?
- Did you ask your provider about any of these things?
- What kind of answer did you get?