Making Choices

Identifying the right birth location & provider for me

Many people find themselves choosing a pregnancy/birth doctor or midwife for a lot of reasons:

  • Close to work location, so easy to get to appointments
  • Found them on my insurance website
  • They were my gynecologist before I got pregnant
  • My family/friend/co-worker used them
  • They came up at the top of a Google search.

Once the doctor or midwife is selected, the birth location is all but decided.  Or it works the other way around, you choose a facility near you and find a provider who works there.  These may not be the wrong reasons to make a choice, but there are more things to be considered.

It is important to be thoughtful about these decisions because research shows that they really matter!  Being extremely thoughtful about who will provide your perinatal care and where you will meet your baby for the first time deserve careful consideration.  The information and resources on this page can help you to identify what might be the right choices for you and your family.  You can take this short quiz to see where you line up?  It is interesting to have the other parent do it separately, to see if you both have the same thoughts.  Below the quiz are questions to ask a provider.  You will also find a downloadable version to take to appointments!

If you would like to chat about anything related to your pregnancy, birth or postpartum, I would be happy to offer you a 15 minute info session to help you get clarity or head in the right direction for you.  You can schedule that here

This online quiz is adapted from a tool developed by Janelle Durham and Parent Trust for WA Children.

Questions to ask your potential or current provider

Here is a very comprehensive list of questions that originate from best practice and evidence based information on labor and birth.  You can use it to help you make decisions about who might be the right doctor or midwife for you.  At the bottom of this list you will find a downloadable version for you to take with you to any provider interviews/meet and greets or prenatals that you do.  The download includes space for you to take notes.

This was adapted from a consumer brochure from Choices in Childbirth.

1. Will you be at my birth? At what point in the labor will you join me? Who cares for me before that? Under what circumstances do I get admitted to the hospital? For out of hospital midwives, what circumstances might cause me to transfer from your care during pregnancy? During labor? Postpartum?

Asian mother holding her naked newborn to her chest with her partner embracing them immediately after birth2. Is there a limit to the number of people who can accompany me during my birth? during postpartum? How do you feel about a birth doula joining my birth team?

3. Will you encourage me to eat and drink in labor?

4. If I were interested in having an unmedicated birth, how would you support me in this goal?

5. What comfort and coping measures do you recommend? What do you encourage your patients to do that helps them during their labor and birth? Can I labor in water?

6. What would your recommendations be if my water breaks before contractions have begun and I am GBS negative? What if I was GBS positive? How long after my water breaks would you recommend induction if my labor doesn’t start on its own? Can I still use a tub/shower after my water breaks?

7. What are your protocols regarding my due date, i.e. inducing labor at 39 weeks, 40 weeks? 41 weeks? 42 weeks? If I am approaching my due date and tests show that my baby and I are doing well, can I wait until labor starts on its own? What if I was past my due date and we are both doing well?

8. Do you believe in active management of the first stage of labor? For example, would progress of less than one cm per hour call for artificial rupture of membranes (AROM) or Pitocin augmentation? If everything is fine with me and my baby, will I be able to labor at my own pace and for as long as I need?

9. If you feel that labor has to be stimulated, what methods do you recommend? Does this change at 41 weeks or 42 weeks?

10. What is your protocol regarding the following procedures and how often do you perform them?

  • Induction
  • Heparin/Saline Lock IVs
  • Continuous versus intermittent fetal monitoring Internal fetal monitoring
  • Epidural
  • Artificial rupturing of the membranes (AROM)Assisted vaginal delivery (forceps/ vacuum)
  • Episiotomy

11. If I want pain medication during my labor, what are my options if was birthing with you? Narcotics? Nitrous Oxide? Epidural? Combined Spinal Epidural? Local anesthetic for repairs if necessary?

12. What is your cesarean rate? What factors do you believe contribute to that rate? What is your VBAC success rate and how many do you attempt each year? What are your standard protocols for VBAC parents? Will you support me in a VBAC after two cesareans?

13. Will I be able to choose the position in which I will push and give birth such as side-lying, all fours, or squatting? Do you have birth stools and squatting bars available? Can I give birth in the water?

14. Do you believe in active management of the third stage, delivery of the placenta? If everything is fine with me and my baby, would I be able to birth my placenta at my own pace?

15. Can my baby remain with me at all times from the moment of birth? Do you support skin-to-skin contact between my baby and I immediately after birth?

16. Will you support me if I want to wait until my baby's umbilical cord has completely stopped pulsing before it is clamped and cut?

17. How will you and your colleagues support me as I initiate breast/chestfeeding? Can we delay newborn procedures until feeding has been initiated and I am ready for the procedures to happen?

18. For hospital midwives and family practice doctors: Under what circumstances would I transfer out of your care to an obstetrician?

19. For community (out of hospital) midwives: How long will you stay with me after my baby is born?

20. For community midwives: What is your rate of transfer to the hospital? Who are your back up midwives? Will I be able to meet or interview them? Which hospitals do you transfer to? Who are your consultant obstetricians?

Downloadable Questions to Ask Your Provider