Questions to ask your OB/Gyn early on


Two of the most important decisions you can make about your care to decrease your risk of cesarean are choosing your place of birth, and choosing your care provider. I will discuss about the pros and cons of different birthing settings in another blog post, but this one is all about providers.

Note: This post is particularly tailored to finding an Ob-Gyn for a birth in a hospital setting. There are some different considerations altogether if you are looking for a midwife or for a home birth.

Generally, if you're looking to find a provider that will not pose additional risk of an unnecessary cesarean to you, you will want to find someone who has a laid-back, or calming presence. Birth is such an unpredictable, and uncontrollable event, even for a doctor, so it helps to have someone who knows how to stay calm in a storm, as even the slightest indication of fear from your provider may affect you during your birth, and increase your risk for unnecessary interventions.

There is an article on the Evidence-Based Birth website that demonstrates the effect that the fear of a practitioner can have on their practice, and therefore their outcomes:

“Overall, a total of nine different studies from 1992 to 2015 have all shown that it is the suspicion of a big baby—not big babies themselves—that leads to higher induction rates, higher Cesarean rates, and higher diagnoses of stalled labor (Levine et al. 1992; Weeks et al. 1995; Parry et al. 2000; Weiner et al. 2002; Sadeh-Mestechkin et al. 2008; Blackwell et al. 2009; Melamed et al. 2010; Little et al. 2012; Peleg et al. 2015).”

That being said, I believe the best way to ensure that your doctor is following evidence-based, yet individualized care and practice, is to

  1. know the evidence yourself

  2. ask open-ended questions, and

  3. Watch out for generalized ‘rules’ and policies without consideration for your personal situation and preferences.

The American College of Obstetricians and Gynecologists gave a committee opinion that ethical care in ObGyn practice should include a culture of informed consent, principle-based ethics (including respect for autonomy), feminist theory, and case-based ethics, or individualized care.

So, to help you achieve some of these goals, I would recommend following the ACOG practice bulletins to know the evidence, ask some of the questions below, and push back against any ‘rules’ that don't consider your personal medical situations and preferences.

Here are some questions you can ask your doctor or midwife on an initial interview to get a feel for the way your doctor practices medicine:

  • Under what circumstances would you suggest an induction? What methods of induction might you use?

  • How do you define a full-term or post-term pregnancy, and how do you manage that? What are the risks that come with it?

  • Under what circumstances would you suggest a cesarean? What kinds of accommodations can be made to make a cesarean as gentle as possible?

  • How do you define "high risk," and how are those patients treated differently?

  • What kinds of medical situations might necessitate an episiotomy?

  • Among your last 10, 20 patients, or overall, how many were inductions/cesareans/episiotomy, etc.? What were the most common reasons your patients had to have those things?

  • What kinds of situations would you suggest use of pitocin for augmentation (speeding up) of labor?

  • What kinds of things might restrict my movement in labor, and which of them are medically necessary? What is the evidence for and against their routine use?

  • How recently and how often have you attended specialty training on handling shoulder dystocia?

  • Will there be any time limits on the length of my labor?

  • How do you define a full-term or post-term pregnancy, and how is that managed?

  • What can I do during pregnancy to maximize my chances of successful breastfeeding/bottle feeding?

  • What does immediate after-birth care look like? When, and which tests and/or procedures are done for my newborn? How is the third stage of labor usually managed?

  • What happens if you make a recommendation, and I'm unsure that I agree with it? How would you talk through those decisions with me?

  • Do the other doctors in the practice operate similarly? Can I meet them?

  • Which routine tests are done during pregnancy and when?

  • How can I get my questions answered after hours?

  • (If you feel this applies to you:) Do you consider yourself to be a feminist? How does that affect the way you practice?

  • Do you know any doulas you would recommend? ;)

The idea is to get your doctor talking, and telling you about what they are familiar with. Try not to hint too much at your opinions on birth topics too early, if you have them. If your questions imply the answer you expect, your doctor might be tempted to manipulate the answer to fit what they think you want to hear. They might even be well-meaning, by trying to soothe your fears, but it can interfere with getting the clearest picture possible of what their routine care looks like. That is important, because their routine care is what they are best at performing, and asking them to step outside what they are familiar with could potentially mean causing them to do things wrong, or at least, not as well as they are capable of.

Then, it's just a matter of comparing what you've heard to what you already know and want, and to consider how similar your doctor's view of an ideal birth is compared to your own. This is a great time for you to figure out which parts of your plan might be negotiable, and which parts of your plan are truly important. Take the time to backup the information you were given, and fact-check your doctor. Ask them for primary sources and research that backs up what they are recommending.

However, don't assume that one doctor's practice is your only option, or that it represents what routine care looks like for all doctors in your area! If yours and your doctor's ideas about birth are too dissimilar, it may be a good idea to keep looking. Remember, these conversations can take place over a period of time if they can't fit into one short consultation, so start the conversation early. And you can always get a second opinion from another practitioner if any of the answers don't seem right to you; it's never too late to change providers (even when you're in labor) because you have a right to a provider who is willing to help you actualize your ideal, safe, and beautiful birth!