What to ask an obstetrician?
Choosing the right obstetrician (ob gyn) can be a daunting experience for some women. According to a BellyBelly poll, many women (47%) chose their obstetrician based on recommendations from their friends.
An obstetrician who was ideal for your friend’s pregnancy and birth, however, might not be ideal for yours. We don’t always want the same experiences and preferences for childbirth as someone else, nor appreciate the same personality traits in the people who care for us.
In order to achieve the best possible outcome, you should take others’ experience and feedback into account but, ultimately, you need to listen to your gut and feel confident that the health care provider you choose shares your philosophies and vision.
Do your own research
Healthcare providers want the same outcome you do: keeping you and your baby healthy. Getting there can mean different things for each individual.
Interview several obstetricians. If you choose the first care provider you meet or the one recommended by your friend or family doctor, you won’t know who else is available to you.
Don’t underestimate the basics during your first visit to the doctor’s office. Are the office staff friendly? Was the nurse easy to talk to? How would you feel if you had your first prenatal appointment there?
Be sure to follow your instincts; they will never lead you too far astray.
Why you shouldn’t feel stupid asking questions
Don’t feel embarrassed if you have lots of questions to ask a healthcare provider.
It’s a perfect way to find out whether a midwife or doctor is best for you and your baby.
If healthcare providers’ bedside manner is impatient or dismissive of your questions or concerns, then you have your answer. If they don’t have the time or patience to listen to you now, do you think it will be any different during your pregnancy, labor and birth?
At some stage during your prenatal care, you’ll probably need to ask some intimate and personal questions. It won’t be easy if you don’t have that trust and connection with the person you choose. You need to feel comfortable.
If potential health care providers make you feel stupid, uneducated or fearful of pregnancy or the birth process, simply say, ‘Next’, and find yourself a new doctor. Remember, you’re hiring them – not the other way around.
If doctors don’t believe in you or have concerns about your body’s ability to birth, then you should not believe in their ability to help you achieve the best birth possible.
12 questions to ask an obstetrician before choosing one
Whether you’re planning a vaginal or a cesarean birth, we’ve designed these 12 interview questions to help you decide whether the doctor you’re considering is best suited to you and your baby.
Other, more general, questions are listed at the end of this article.
When speaking to potential health care providers, always try to ask open-ended questions, to find out how they really feel. Encourage discussion rather than ‘yes’ or ‘no’ answers, which don’t tell you much at all.
#1. What are your philosophies and beliefs about birth?
This is the most important question to ask health care providers, as it will give you an idea of how they see birth and how much control they believe they should have in the process.
Do they see birth as:
- A medical process that needs to be monitored and managed continuously?
- A process fraught with potential minefields, which requires preventative procedures?
- A natural process, where nature should take its course before they interfere?
#2. How much choice should I have in the decision making process?
You’ll have a much better experience of childbirth if you are given options, and involved in the decision making process throughout your pregnancy. Birthing women who feel they have no control or are not involved in decision making tend to have a less positive experience of childbirth and are more likely to experience depression and anxiety.
It can also affect your experience of motherhood, by influencing how you feel about your body being capable and strong.
It’s important to choose someone you feel will involve and inform you throughout your pregnancy and birth, without rushing you out in five minutes.
#3. What are your thoughts about pain management during labor?
Another great indicator of how healthcare providers view the birth process is to ask their views on pain medications.
- Do they assume you’ll have pain relief, like everyone else, or will they support and encourage more natural methods or different positions, to help?
- Will they fully inform you about any side effects or complications for you and your baby?
- Will they encourage you to accept pain medications, or recommend against them if you are close to birthing your baby?
What they say about analgesia and whether they think you will quickly succumb to it says a lot about what they think of the birthing process and how supportive they will be.
#4. How do you feel about my birth plans? Do you foresee any problems?
Put together a rough list of your birth preferences and take it with you when you interview a potential doctor.
It can always be altered later in the pregnancy, if necessary, but it’s important for your primary health care provider to see what you have in mind for the birth and for you to find out what he or she thinks about it, before it’s too late.
When you’ve finalized your birth plan, ask the obstetrician to sign it in agreement, so when you present it to the hospital or if you face deviations giving birth, you have something signed to show the obstetrician or hospital staff.
Don’t forget to read the BellyBelly article Birth Plan – Why Write One? Free Birth Plan Template.
The free downloadable template can be edited and printed.
#5. What are your thoughts on electronic monitoring and when it should be used?
Intermittent doppler monitoring is standard care during labor. Some hospitals, however, prefer to use more restrictive monitoring, which can affect the way you plan to labor and give birth. Some use continuous electronic fetal monitoring and others have intermittent electronic fetal monitoring.
Continuous CTG monitoring means you are stuck in one position, usually on the bed, and can be detrimental to the progress of labor. A Cochrane review states that where continuous CTG was used, there was:
‘… no significant differences in cerebral palsy, infant mortality or other standard measures of neonatal well-being. However, continuous cardiotocography (CTG) was associated with an increase in cesarean sections and instrumental vaginal births. The real challenge is how best to convey this uncertainty to women to enable them to make an informed choice without compromising the normality of labour.
‘Data for subgroups of low-risk, high-risk, pre-term pregnancies and high quality trials were consistent with overall results. Access to fetal blood sampling did not appear to influence the difference in neonatal seizures nor any other pre-specified outcome’.
Researching all the options you have your birth plan is the key. It shows you understand what you have planned. You’re less likely to stick to a plan if you haven’t researched the reasons why you made your choices.
#6. What is your induction rate and when do you think induction should be considered?
Obstetricians have varying preferences for induction. Some will put it on the table only a few days after your estimated due date. Some prefer to induce 7-10 days after your estimated due date (post-dates); others will wait until two weeks post-dates. Some will allow more if baby and mother are well; you might need to agree to be monitored for short periods of time. If there is no evident medical reason, you can say no.
The problem with inductions that are not medically necessary is they trigger the cascade of interventions. It might sound harmless to start labor earlier with a little bit of artificial labor hormone but it doesn’t work the same as natural oxytocin; it doesn’t even cross the blood brain barrier. You might change your mind when you realize it significantly increases your chances of an epidural (requiring a catheter and IV fluids), and you might also require forceps, vacuum or even a cesarean.
Find out the induction rate of the hospital and the doctor. Unfortunately some don’t like to tell you, which would suggest they aren’t proud of it.
Knowing the induction policy before you choose a health care provider can help avoid interventions you aren’t hoping for. Make sure you’re informed about the risks of inducing labor without medical necessity. We know the benefits, but many women are not told about the risks. It’s one of the quickest ways to derail your birth plan, because it means you will become a high risk pregnancy.
#7. What is your cesarean rate and in what situations would you recommend one?
This is a question you need to ask both your healthcare provider and the hospital.
As with inductions of labor, they might not be forthcoming with statistics, but an answer to this question can be very helpful, possibly saving you from major surgery and a 6-week recovery from a cesarean.
The World Health Organization states 10-15% of cesareans are medically necessary, and rates higher than that number don’t save more lives.
Many hospitals in Australia and the United States, however, now have cesarean rates of up to 70%.
If healthcare providers aren’t telling you their c-section rate or can’t give you an estimate, then it’s possibly a rate they don’t want you to know. Transparency is super important.
Be sure to read this article: Doctor Nails Reasons Behind 500% C-Section Increase Since The 70s.
#8. What mother centered options do you offer for c-sections?
What happens in theatre will be up to the anaesthetist or the obstetrician.
If you’re having an elective cesarean, it might be beneficial to speak to the anaesthetist prior to your surgery date.
In order to perform a cesarean as quickly as possible, things are often done to save time. Once your baby has been born, the normal process is to give you a quick look of the baby, after someone else has checked the baby and wrapped her up, and then to give baby to your partner for a cuddle.
Weighing and other procedures will usually be done after you’ve been sent to recovery, alone.
If you find the right obstetrician and there’s no life threatening situation, however, you can have a more special bonding experience.
Some obstetricians allow some or all of the following during and after a cesarean, provided mother and baby are not in danger:
- Maternal assisted c-section, where you can lift your baby out and onto your chest
- No screen to obstruct the view or a screen that’s lowered for the birth. Read about the C-Section Drape
- Delayed cord clamping, so babies can have all of their valuable cord blood
- Lotus birth, with no cutting of the cord at all
- Immediate skin to skin contact after the birth
- Breastfeeding in recovery; this usually depends on whether staff are available to be with you.
Some of these might not appeal to you but it’s useful to know how providers feel about mother-centred choices and that you have options (which might change later). Services usually follow consumer demand, so if more women ask for these things, they might become the norm rather than the exception.
#9. What is your episiotomy rate and in which situations would you perform one?
These days, it’s uncommon to find an obstetrician who routinely performs episiotomies for all births. If you find one, run!
Many episiotomies are still performed during childbirth, however.
Ask health care providers in what percentage of births they perform episiotomies and how they feel about them. When would they do one? Do they prefer you to tear naturally or have an episiotomy, and why?
To learn more, read our article 7 Tips To Avoid Having An Episiotomy.
#10. Do you support vaginal breech birth? If so, what conditions do you have?
Most women won’t have to worry about this during pregnancy, but it’s a very important question.
Some babies will be in the breech position during pregnancy and, although most babies will turn when given the chance, some stay bottom down.
If your baby is breech, most obstetricians will recommend a c-section before your due date, usually around 38 weeks of pregnancy. However, there are some breech savvy obstetricians who are skilled in vaginal breeches. Some work in breech birth clinics, too – you just have to do your homework to find them.
It’s also good to know that on the Royal College of Obstetricians and Gynaecologists website, there’s a statement about vaginal breech birth that supports this method of birth. It has certain conditions but it’s a great start. It would be wonderful if more obstetricians could ‘skill-up’ in breech birth and if it were taught in medical schools.
If healthcare providers support breech birth, find out what conditions they have. Some will support you on the condition of performing an episiotomy, or using continuous monitoring or an epidural. You can negotiate, in some cases; just make sure you have their commitment. Some variations of the breech position are more favorable for a vaginal birth – for example, frank breech – so your baby’s position could be the single deciding factor in being able to birth vaginally, or not.
A health care provider who is supportive of breech birth is more likely to have a flexible and supportive philosophy of birth, so even if your baby isn’t breech, you’re probably on to a winner.
#11. How do you manage the third stage of labor?
The third stage is the birth of the placenta.
It might seem irrelevant but there are some very important events that can affect your baby.
First, in order to hurry things along after your baby is born, some obstetricians (or hospital midwives, if the doctor can’t make it) will clamp and cut the cord right away. They might then give you an injection of synthetic hormone, to expel the placenta.
The injection is given to prevent a possible haemorrhage, which is an increased risk if you have a high intervention birth or induction. You can ask to be given this only if you show signs of excessive blood loss or if you have had an induction; for normal, healthy births, haemorrhage rates are low.
For a normal labor, there is no reason to hasten delivery of the placenta. Most of the time it will come out on its own – either when you stand up, or when you breastfeed your baby, which stimulates natural oxytocin.
Some healthcare professionals have been known to knead the woman’s belly or pull on the cord (which risks breaking the cord and needing manual placenta removal), simply because they haven’t given it enough time. It is an unpleasant thing for a new mother to go through.
When the cord is left unclamped until it has stopped pulsating (i.e. all the blood has gone from the placenta to the baby), the baby is less likely to experience anaemia and other conditions, or require blood transfusions. The baby will benefit from months of iron stores due to this valuable supply of blood, which contains precious cord blood and stem cells.
Learn more about delayed cord clamping by reading our article Delayed Cord Clamping – Why You Should Demand It.
#12. What do you think about doulas?
Whether you want a doula or not, it’s a great question to gauge how much the health care provider will support you to have a normal birth.
Years of studies from around the world have repeatedly shown that the support of a doula helps reduce the incidence of intervention (c-section, forceps, vacuum, pain relief and more) and helps to shorten labor, while having no adverse effects.
You can read the findings of the latest, independent study review (published in 2017) about the benefits of doulas.
Some healthcare providers have had bad experiences with doulas and some have been known to refuse them. As in any profession, some aren’t very professional. By doing your research, you can avoid most problems. If the obstetrician doesn’t allow doulas, or see their value, ask why. You should know there are many fabulous doulas helping women to have supported, empowered births.
Related reading: What Is A Doula | 11 Important Facts About Doulas.
The practical questions
Here are some other practical questions to ask a potential obstetrician:
#1 Which hospitals do you attend?
Obstetricians only work in certain hospitals. You’ll need to have your baby at one of the hospitals they work in or, if you have your heart set on a particular hospital, you’ll need to find out which obstetricians work there and go from there.
#2. Who is your back-up and will I get to meet him/her?
Your obstetrician might be unable to attend your birth, due to holidays or training events or being unable to be on call. Naturally, you’d want a replacement who shares the same philosophies, and have the opportunity to meet him or her.
#3. When are you planning holidays in the next 12 months?
You can find out when the obstetrician might be unavailable.
#4: How do you feel about water birth?
Many obstetricians and hospitals won’t support water birth – usually because they have no training in it.
There are water birth clinics, however, and some hospitals have water birth facilities.
If you think you might like to consider a water birth, choose a healthcare provider who will be supportive of this option.
If healthcare providers are open to options like water birth, it tells you more about their philosophies about birth – i.e. normal, natural, safe. You should know that babies don’t breathe under the water; they are still attached to the oxygen-supplying umbilical cord. A reflex will make them breathe when they are brought out into the air.
Questions if seeking a vaginal birth after c-section
If you have previously had a c-section or have a scar on your uterus (e.g. from fibroid removal or any uterine surgery that leaves a scar) and would like a vaginal birth, here are some extra questions to ask:
- How do you feel about me going beyond my estimated due date, and how long before you would recommend a c-section?
- When I go into labor, what monitoring will you recommend?
- What do you think about time limits for laboring?
- Will I be required to have an epidural or an IV line?
- Will you be supportive of my desire to breastfeed my baby right away, whether I have a vaginal birth or c-section?
- Will you be supportive if I want a natural third stage?
BellyBelly has a list of recommended birth books, which is a fantastic starting point.
Invest in independent childbirth education. It will open up your options and give you more tools for birth. If you don’t know your options… you don’t have any.