If you have decided to hire an obstetrician to support your pregnancy and birth, I strongly suggest speaking to a few doctors and interviewing them to determine their suitability in providing you with the kind of care and experience that you envisage for your pregnancy and birth.
In order to do this, you first need to think about what kind of experience you want. I have a list of questions below that I recommend asking an obstetrician to help understand their practice which might help you in thinking about the kind of care you want as well.
Have a read of this list, and my notes alongside, and if you think you could do with some more help in decided what kind of care you are looking for, feel free to get in touch! I’d be happy to help direct you to some more information or resources to help you in your journey.
I'm planning [insert ideal birth here]. How would you plan on supporting me in that?
What is your caesarean rate? Under what circumstances would you recommend a caesarean?
If I required a caesarean, can you provide the option for maternal assisted caesarean and/or gentle caesarean?
What is your induction rate? Under what circumstances would you recommend an induction?
What is your episiotomy rate? Under what circumstances would you recommend an episiotomy?
Under what circumstances would you recommend an assisted delivery i.e. forceps or ventouse?
All of the above questions help you to know and understand how frequently a care provider is performing interventions and the reasons for them. If you're wanting to avoid these kinds of interventions, that is useful information to have when deciding if a care provider is right for you.
What tests and scans do recommend during pregnancy, and what if I decline them?
There are a myriad of tests and scans that are usually recommended to women throughout pregnancy, and as with everything in pregnancy, there are risks and benefits to each and knowing their results (i.e. growth scans, gestational diabetes testing, group b strep testing). Many women would rather not have certain tests which might land them in a certain risk category and may lead to interventions, but it is common for obstetricians (whose jobs are to treat pathological conditions in pregnancy) to want to know, and therefore it is good to know in advance if an OB is going to have a problem with you declining certain tests along your pregnancy if you wish to do so.
Do you have holidays booked or planned around my due date?
This is a generally important thing to know, as usually you would want the care provider that you hire to be the one available to you when you go into labour.
Do you share on-call duties with any other OBs or would it only be you responding to me in labour?
Again, an important question to ask to manage your own expectations about who will actually be attending your birth, particularly if it is important to you that the OB you hire is the person physically attending.
Do you have expectations for how my labour should progress that I need to be aware of?
There are often policies or guidelines that OBs follow which dictate how labour should progress which can often lead them to suggesting interventions if a woman’s labour slows or stalls. It is important to have this discussion early on, as every woman and every labour is different, and if you are eager to have an intervention free birth, this question might give some insight into how readily the OB will work with you to avoid interventions.
Do you have a postdates policy and what do you consider ‘postdates’?
There is a range of difference in opinion with care providers as to what constitutes ‘postdates’ or being ‘overdue’. It is generally agreed to be after 42 weeks, however, many OBs will consider 40 weeks as a ‘cut off point’ where they will automatically be offering (or sometimes even requesting) an induction or sometimes even a caesarean. It is important to know what they consider as ‘overdue’ and what they expect to do at that point. They may offer stretch and sweeps and additional monitoring, or they may book you in for an induction. Knowing how far you are comfortable to gestate and what interventions you do and don’t want is important, as well as making sure that the OB will support that.
Do you offer antenatal classes or recommend any?
This can be helpful to get a gauge on what kind of birth the OB supports. Some OBs will suggest a calm birth or hypnobirthing class, which is brilliant and focuses on physiological birth and alternative pain relief, as well as a run down of what happens when things don’t go to plan. Others might not have any suggestions, or they may recommend the local hospital’s class. Hospital classes are known to represent the policies of the hospital, so can suggest a narrow-minded view of birth.
Do you support water birth?
An important question to ask if you are keen on a water birth, and not just a water labour.
How many people are allowed in the delivery room with me?
Will the OB allow you to have all your support people, including your doula, or mother, or sister? If not, why not?
How do you feel about me hiring a doula?
This is a useful question regardless of whether you intend to hire a doula or not. A care provider who is not happy or comfortable with a woman hiring a doula raises a red flag, because... well, why not? What reason would they have for not wanting doulas around?
What pain relief options are available, or do you recommend?
This is a good question to ask if you believe you will be wanting to take pain relief, or if you are wanting to avoid it. What is the OBs attitude toward pain relief in labour, and how does it align with yours? Are all the options that you want available to you in labour actually available?
What are your fees and my out-of-pocket costs?
This is also an important question, as simply having private health insurance does not prevent you from having out of pocket costs during pregnancy and birth. It is important you know how much you will need to budget for across the pregnancy.
For women planning a VBAC, it's also a good idea to ask the following:
Do you have any criteria I need to meet in order to have a VBAC?
How do you plan on supporting me in achieving a VBAC?
How many women planning VBACs do you support each year?
What is your VBAC rate?
What is your repeat caesarean rate?
VBAC rate along can be a deceptive number, because if they have a 'rule' about needing to go into spontaneous labour by 40 weeks, otherwise have an elective repeat caesarean, then a VBAC rate of 80% of women who labour might only represent 5 women who went into labour by 40 weeks, but not count 15 other women who were hoping for a VBAC but ended up booking elective caesareans because they hit their 40 week mark (who then technically have been counted as "repeat caesareans" rather than VBACs).
What did you think about this interview list? Are there more questions you feel are important to ask that I should add? Leave a comment with your best interview questions!
If you want to know more about some of these questions, why you would ask them or how to know what answer you’re looking for, please feel free to get in touch so I can help you find the resources you need.
My name is Katelyn Commerford and I am a doula and next birth after caesarean guide located in Western Sydney. If you want to know more about what I do and how I can help you, please visit my website where you can get your free cheat sheet of my favourite VBAC resources, or find me on instagram @thenbacguide where I answer commonly asked questions about planning the next birth after caesarean and share loads pregnancy, birth, postpartum and parenting content.
Katelyn Commerford - Doula and NBAC Guide
Phone: 0431 369 352