Choosing an obstetrician can feel overwhelming. There are so many to choose from. And how do you choose? Do you go with the recommendation of your GP? Your best friend? A Facebook group? One of the most important things you can do when finding the right obstetrician for you is to get into interview mode and ask questions – lots of questions. This gives you the chance to see if you have the same philosophy on birth, to look for any potential red flags and to find out if your preferences and decisions are likely to be supported and respected. Let’s look at 15 questions to ask your obstetrician to help you determine if they are the best person to be supporting you during your pregnancy, labour and birth.
Questions for your obstetrician
1. What are your beliefs and philosophies around birth?
This can give you an idea whether your obstetrician considers birth to be a ‘risky’ event that requires medical management or a natural, physiological event that occasionally requires medical assistance. Does this match how you view birth? Do you see it as a normal, physiological function of the body or do you see it as a medical event that requires assistance, intervention and medical pain relief.
If your philosophies on birth don’t match, it might be worth shopping around for a different obstetrician.
2. How do you feel about birth prefences/plans in general? How do you feel about my birth prefences/plan?
This is an opportunity to look out for any red flags that your birth preferences won’t be supported during your birth. Whilst you can’t control your birth and map out exactly how it will go, you can have birth preferences (understanding that things can change). A good care provider will respect these preferences and will engage in open, honest conversations with you around them.
If you are being told that you can’t plan a birth and ‘we’ll just see how things go on the day and go with the flow’ it may indicate that the flow that you will end up going with won’t be your own flow, rather that of your obstetrician.
3. Are there any things you won’t ‘allow’ me to do?
To put it bluntly, your care provider is ‘not allowed’ to ‘not allow’ you. Any mention of things that you won’t be allowed to do – such as eat/drink during labour, not be on a monitor, go past 40 weeks, should be a red flag. You have bodily autonomy and have the right to make your own decisions in your labour and birth. The Australian Medical Association’s Position Statement ‘Maternal Decision Making’ says
A pregnant woman has the same rights to privacy, to bodily integrity, and to make her own
informed, autonomous health care decisions as any competent individual, consistent with the
legal framework of that jurisdiction
There may be things that the Obstetrician or hospital can’t support due to the facilities or staffing available (such as a water birth if there is no options), but this is different to not allowing you to do a particular thing.
4. How do you feel about me declining certain procedures?
You have the right to give or refuse consent, even if your care provider doesn’t agree with your decisions. You need to find someone who will respect that, and still continue to provide you with the best care possible, even in the face of disagreement.
Again the AMA’s Maternal Decision Making statement
A pregnant woman’s capacity to make an informed decision should not be confused with
whether or not the doctor (medical practitioner) considers her decision to be reasonable,
sensible or advisable. A doctor may not treat a competent pregnant woman who has refused
consent to treatment. Recourse to the law to impose medical advice or treatment on a
competent pregnant woman is inappropriate.
5. What happens if you aren’t available when I give birth?
You might have found the most incredible obstetrician whose views on birth exactly match your own, but what happens if they aren’t available on the day of your birth. It is important to know who their back up will be (if there is one).
6. What percentage of women have spontaneous vaginal births under your care? Are induced? Have instrumental deliveries?
This can back up (or not) what your obstetrician has said about their philosophies on birth. If a natural, physiological birth is important to you it is important to find an obstetrician who is supportive of this – keeping in mind that obstetricians specialise in high-risk pregnancies and births.
7. Under what circumstances would you recommend an induction?
In Australia approximately 1 in 3 labours are induced, Inductions for complications in pregnancy can be medically necessary, or even life-saving, interventions. On the other hand, inductions can too often be prescribed for variations in pregnancy or for reasons that aren’t medically indicated.There are risks and benefits to being induced and it is important that you understand these. Asking this question, can give you an idea if the obstetrician recommends inductions for complications or variations in pregnancy.
8. What happens if I go past my estimated due date?
Firstly, it’s important to know that based on evidence there is no such thing as a ‘due date’ – as in, one specific date when your baby must arrive by. Approximately 5% of women will give birth on their due date.
Due dates are usually determined based on Naegele’s Rule which says to take the first day of your last monthly period, add 7 days and count forward 9 months. There are a number of assumptions in this
- Everyone has a 28 day cycle
- Everyone ovulates on day 14
- You know when your last monthly period started
- The embryo always takes an the same amount of time to implant
This means that on paper you might be 40 weeks on a certain day, yet the reality is you may only be 39 weeks on that day – those final days and weeks are important in terms of baby’s development. 40 weeks is not an eviction notice!
There are benefits to allowing your labour to start spontaneously – even after 40 weeks.
The World Health Organisation defines a prolonged pregnancy as beyond 42 weeks. 40 weeks is not an eviction notice!
9. What procedures do you recommend ‘just in case’ in labour?
This can be another indicator for red flags. If your care provider says that they support physiological birth but then recommend procedures like having a cannula placed, getting an epidural or recommending no food or drink during labour in case of an emergency caesarean, these may be good indicators that your care provider is more likely to want to medically manage your labour and birth.
10.What are your recommendations for monitoring during labour?
Some care providers will recommend continuous monitoring (CTG) for all women (including low-risk women) even when there is no evidence for improved outcomes for mother or baby. Continuous CTG can limit your movement and mobility which can impact your labour.
This Cochrane Review states that CTG saw
‘..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 caesarean 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.”
An alternative is hands on listening (instead of electronic fetal monitoring) which
- Has been linked to few caesareans and instrumental births
- Leads to frequent contact between the birthing person and her care providers, which provides the benefit of continuous support
- Provides more chances for the care provider to observe the birthing person, not just the results on a screen
- Supports movement and the ability to change positions more freely
- Can be used in the shower/bath
11. What are your recommendations for pain relief during labour?
Does your obstetrician recommend natural pain relief methods as well as pharmaceutical options? Do they recommend that ‘all women’ benefit from an epidural? Is there conversation around ‘why would you put yourself through the pain of labour when epidurals are available’?
This conversation can give you another indication of how the care provider views the pain and intensity of labour and again, whether birth is a physiological function of the body that benefits from support or is a medical even that requires medicated pain relief?
12. What happens if my baby is breech? Do you support vaginal breech births? If so, under what conditions?
A breech baby is another variation in pregnancy, not a complication automatically requiring a caesarean birth. Yet, finding an obstetrician to support a vaginal breech birth is becoming more difficult. This is not to say that breech birth is dangerous – the skill and knowledge of vaginal breech birth is being lost, as a result of carers not being trained in breech birth and/or choosing to attend breech births, opting for caesareans instead
13. Under what circumstances would you recommend a caesarean and what is your caesarean rate?
This is an important question to ask your obstetrician. Similar to inductions, caesarean births can be medically indicated and sometimes life-saving. 1 in 3 women in Australia had a caesarean birth in 2018. The World Health Organisation recommends that the caesarean rate should be between 10 – 15%. This will help you determine whether a caesarean birth is recommended for complications in pregnancy or variations in pregnancy (ie not medically indicated).
It is also worth asking your obstetrician why they have the caesarean rate they do.
14. Do you offer family friendly caesareans? If so, what does that look like?
If a caesarean is necessary, you can still have birth preferences around what your caesarean looks like. Somethings to consider may be;
- The environment (having your own music, no unnecessary chatter)
- Your support people
- Maternally assisted birth – where the birthing person helps baby out
- Allowing baby time and space to make their own way out
- Delayed cord clamping
- Skin to skin
- Immediate breastfeeding
15. How do you manage the third stage of labour?
The third stage of labour is the birthing of your placenta. Birthing your placenta can be either an expectant management (where you wait for your placenta to come naturally) or actively managed (a combination of an injection of syntocinon, cord clamping, and controlled cord traction). It is most common to have an actively managed birth of your placenta, however it doesn’t mean that it must be done this way. Having this conversation can give you an idea of how the care provider views birth – as a medical event that must be managed or a normal physiological function.
16. How do you feel about doulas attending births?
This is the bonus question to ask your obstetrician. There is a great deal of evidence of the benefit of having a doula at your birth.
Is your obstetrician open to having a doula or birth coach with you or do they see doulas as just another person to ‘get in the way’. Doulas often provide education and information to parents to help them feel confident to make their own decisions. This can be challenging to some care providers – it is important to know where your care provider sits on this.
Kate Vivian is a self-professed pregnancy and birth geek who is finally learning to embrace the chaos of having 3 kids. It was the birth and ‘bringing baby home’ experience of her first baby, and the overwhelming guilt that went with it, that led her to start Bright Mums – and create a world where Mums matter.
A Certified Hypnobirthing Australia Practitioner, childbirth educator and postpartum doula, Kate works with Mums-to-be not only supporting them through pregnancy, and birth but also teaching them to honour themselves at a time when the world is telling them their baby is the most important thing.
With almost 2 decades in adult education, Kate has the ability to create a safe space, a non-judgey space. A place where Mums can relax and feel supported regardless of what their journey looks like.
A keen traveller in a former (pre-kids) life, Kate dreams of the day her kids are big enough to take skiing and they can completely show her up while she is busy falling down mountains.
Find out more about Kate and how she can help you feel confident and empowered to give birth on your own terms.