Birth, Baby!

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Welcome, this is Birth, Baby.

Your hosts are Ciarra Morgan and Samantha Kelly.

Ciarra is a Birth Dula, Hypnobirthing Educator, and Pediatric Sleep Consultant.

Samantha is a Birth Dula, Childbirth Educator, and Lactation Counselor.

Join us as we guide you through your options for your pregnancy, birth, and postpartum journey.

Today, we're gonna talk about how to choose your provider, how to make sure that your provider is the right one for you.

So we have a bunch of questions to go over with you to talk about, and by the way, some of these won't matter to you, it's fine.

If something is like, oh, I don't care about that, then don't ask them.

But if these things are important to you, you wanna make sure that you ask them a lot of time, or else you're gonna be really surprised and there's gonna be a lot of conflict, maybe starting at 36 weeks, but maybe you won't even figure that out until you're actually in labor, which is not ideal.

So, Samantha, do you wanna start us off with one of the most important questions to ask?

Yeah, so one of the most important questions, and I think maybe it's good to start with, why do these questions matter?

Why do we even care about these things?

And I think it's important to know, choosing your provider for the birth of your baby is a little bit different, I think, than choosing a provider for other things, because there are so many different ways to practice.

There are so many different preferences that providers have, different ways of training, and just different ways of approaching birth.

And birth is a wildly different thing than most medical experiences that you're gonna have in your life.

So having a provider who is going to support you in what you are looking for is gonna be really important.

And also a provider who's gonna make you feel safe in the things that you are choosing to do is also really important.

So yeah, this is one of the most vulnerable times you're ever going to have in your life.

It's like, if you have allergies and you need to go to an allergy doctor, yeah, that's important, of course, to have a doctor that you like and all of that and that you feel understood.

But at the end of the day, that person's not gonna go, oh, you're having an allergy to Cedar.

We need to do surgery right now.

You know, a birth could end up in surgery if you guys disagree on something.

So it's a little different.

It is, it really is.

So, you know, like as you're thinking through, like, you know, what questions should I ask?

What does all of that look like?

It's also good to have a basic idea of what your birth preferences are.

You know, you don't need to know exactly what kind of birth you want and all of the things at, you know, six weeks pregnant right after you just peed on a stick.

But it's good to have a basic idea of like, hey, I know that, you know, these are the top three things that are important to me walking into this birth experience at this point in time.

So I want to know, you know, where my provider is at with these things.

So I think that's kind of just a good like jumping off place and things will change as you go throughout pregnancy and that's okay too.

So when you are interviewing providers and figuring out, you know, is this person going to be the best person?

Is this practice going to be the best practice for me to be with throughout this journey?

One of the most important questions you can ask is, what is your personal cesarean rate and that of the practice that you work with?

And why does it matter if, you know, the doctor's C-section rate versus the practice's C-section rate?

So are you asking me?

Oh, I thought you were asking me why it matters.

I'll tell you anyway.

Yeah, tell me why.

Because the doctors work on call, right?

It's a rotation.

So midwives a lot of times work on call at a birth center and rotation.

So if you are, you know, let's say your doctor, we're going to call Dr.

A, has a 30% cesarean rate, which isn't ideal, but that's pretty in alignment with the world.

If they have that, but then another provider in the practice has a 70% cesarean rate, you could get that 70% cesarean rate doctor when you're in labor, if you go into labor spontaneously.

And that's if you don't want to be induced.

And by the way, even if you choose date induced on a day where your doctor is going to be there, your induction could last 36 hours.

That doctor may not be on anymore when you actually have your baby.

So that's really, really important.

And these questions are important not only for doctors, but also for midwives.

So if it's a home birth or a birth center, you're going to ask, what is their transfer rate for home birth or birth center to hospital?

And when does that happen?

Is that during pregnancy or is that during labor?

If they're transferring because someone got preeclampsia and they have to now have a hospital birth, that's one thing.

But if they're transferring in labor because of XYZ, you never know what that could be.

And that's something that it's important to know.

I will say a lot of home birth transfers and birth center transfers are for pain management, so that's not really the fault of the midwife or the birth center.

But that is something you should consider.

Yeah, it's still important to know regardless.

And so another question that you can be asking is, what is your episiotomy rate in that of the practice that you work with?

And this is a really important one because it's really going to give you a pretty clear idea of the culture of that practice and of that provider's care.

Because ideal episiotomy rates are, I think it's less than 5% is what we're looking at according to the World Health Organization.

And some providers have a much higher rate.

It used to be that we had like a 99% episiotomy rate in the United States and it's dropped dramatically.

But there are still providers who do a lot of episiotomy.

So asking that question is going to give you a pretty good idea of what's going on there.

And I think this is an important time to remind people that not only are their answers important, their demeanor when answering your questions is important.

So are they bothered that you're asking these questions?

Do they seem annoyed?

Do they seem defensive?

Do they seem like they're trying to cover something up?

Kind of like, are they nervous?

Do they seem nervous?

Those are really important because they might not be honest.

You know, you can ask me what my how many births I've been to.

I could say 300 and you can't prove me wrong.

I've not been 300.

I've been to over 100.

But also in none of those have I ever seen an episiotomy.

So that's amazing.

That's great.

That's how it should be.

We've had a couple of times where we've said it might need to happen because it was becoming emergent.

But usually, when that's said out loud, a mom pushes real hard and manages to get that.

By the way, if you're listening to this and you are like, what the heck is an episiotomy?

That is where they cut you.

Instead of having you tear on your own as much as you would need to to allow your baby to come out, they cut and they almost always cut more than you would have torn neutrally.

So it is not what's recommended.

You usually heal better from tearing on your own than you would from an episiote.

Then it's just easier to tear.

Yeah, it's easier to tear more along an episiotomy cut.

So you might just continue tearing with a cut than you would if you had a natural tear.

But there are times when episiotomies are recommended, are beneficial.

And they should only be done in those emergencies.

Right.

We just want to know that your episiotomy is being done in a situation where it's warranted.

So ask those questions.

That's a great place to start.

And if they don't know what the like how often it's being done, maybe they don't know the exact percentage fine.

But and they might say, like, I have no idea what that exact number is.

That's OK.

Could you tell me, like, what situations you would give an episiotomy in?

You know, you can ask more questions.

And if they don't know that of the partners that they're working with in the practice, that's also concerning because they should be interested in knowing what's going on in the practice that they're sharing call with.

Yeah, and you can always ask them, like, hey, if you don't know this off the top of your head right now, you know, that of your providers and stuff, can you maybe send me a follow up email?

And that can also help you kind of get an idea of how important your feelings are in these situations.

And then you have it in writing.

So another question along these lines would be what percentage of your patients get induced?

So we hear a lot of people say that around the 36-week mark, their doctor is having some reason that they want to induce them at 39 weeks, 40 weeks, or we don't want you to go past 41 weeks when people, you know, it's a 37 to 42-week range.

So in the absence of a medical situation, it's really important to find out why they're inducing, what they're going to induce for, and the percentage of the patients that get induced, because your labor tends to be a lot harder if you don't go into labor spontaneously and you choose to get induced instead.

Yeah, absolutely.

Absolutely.

I think that's also a good place.

I know that we kind of had it in a different order, Sam, but, you know, we're talking about sharing call with other doctors or midwives.

So I think it's important also to ask, how does the call schedule work for your office?

So a lot of OB practices here in Austin, a lot of them go on an on-call rotation, where even if they're at office hours, there's one doctor that's on call.

There are some of them, a couple of them, that if it's during their work hours and they're in an office, they're going to run over to the hospital and deliver your baby.

But that's not always the case.

So that's important to ask.

And do they share call with other practices?

So, you know, practice may have four doctors, let's say.

But are they also sharing call with other doctors that are at that hospital?

Because you might have purposely not chosen another practice because you know something about another doctor or those doctors have super high cesarean rates.

And all of a sudden, you're in with like a super low intervention doctor.

But oh, guess what?

In walks Dr.

Z that is not even close to what you thought you were going to get in labor.

And all of a sudden, your risk of cesarean goes up quite high.

Yeah.

Yeah.

I mean, that's that's that's a huge one.

And, you know, with that, like, do you share call just within your practice?

Or are there other practices that are involved?

There are some.

I think there's one major hospital system in Austin where they share call between the entire, like every every practice that works at that hospital.

So that can be super crazy.

We've had that happen a few times where we walk in knowing that we're with this really great practice and then, you know, Dr.

So-and-so from this other practice walks in and we're like, oh, my goodness, what is going on here?

So asking that.

I've actually received a text message from Sam before going, Dr.

So-and-so just walked in.

Am I wrong?

Are they with this practice now?

And we go into our dual association group and we're all texting like, what's going on?

What's going on?

Yeah, it's it's weird.

It doesn't happen, like, obviously, because we're it weird us out when it does happen.

It doesn't happen super often, but it is becoming more more common.

So asking that question is going to be really important, you know, really important, too.

And then, you know, talking about some of the questions that are going to be more important towards like when you're actually going into labor is going to be really important, too.

So like, how far are you willing to let a low risk pregnancy go past their due date?

Are you comfortable with someone going to the 42 weeks that is recommended by a cog?

Or are you, you know, a little more risk adverse and you'd prefer to induce at 41 weeks?

Or, you know, I'm 36 years old, so I'm, you know, borderline, borderline old.

People on YouTube that are watching YouTube just saw my eyes roll real good.

I'm borderline old, so I have to have my baby by my due date or whatever that looks like.

Asking those questions is going to be important.

And, you know, also that I think that is really where knowing your personal preferences are going to come in, you know, really, really handy here.

Are you OK with being induced at 40 weeks?

I would still ask the question, regardless of what your preferences are, because you never know, you know, what might happen later on in pregnancy.

But knowing those things ahead of time so you can make those decisions as you're getting that information is going to be really huge.

There's a practice here in Austin that likes to induce at 39 weeks pretty much across the board.

So if you were comfortable with going to 40, then and you didn't ask that question there, and then all of a sudden they're trying to induce you at 39 weeks, that would be like, what the heck is going on?

Right.

And this is provider preference, not evidence based medicine.

So that is concerning.

You do need to ask those questions.

And I totally agree, Samantha.

If you are like, I don't want to be pregnant past 41 weeks, then great.

But ask that question still so that you make sure that they're cool with you going to 41 weeks in the absence of a medical situation.

It's also going to be frustrating for people who want to go to 42 weeks when so many providers are wanting to induce at 41 because the average first time mom doesn't go into labor spontaneously until 41 and 2 or 41 and 3, depending on what study you're looking at or whatever.

So very important to talk about these things because it is so and early, early on, if you can, because it is so common for at 36 weeks.

All of a sudden, they're going, you know, I just think that your baby is getting kind of big and I'm just worried that they're going to get too big to fit through the pelvis.

These are red flags, y'all, unless it's like, hey, your baby is currently off the growth chart.

Like your baby is measuring at 11 pounds at six weeks or something at 36 weeks, something wild.

Right.

But if they're saying we're worried that maybe or it might all of these things are convenience, those are not real worrisome things.

Right.

Right.

Exactly.

Another really good question is, are you comfortable catching my baby in whatever position I choose to push in?

Again, it doesn't really matter if you're planning on an epidural or if you're planning on going on Medicaid.

You need to know the answer to this question because even if you have an epidural, you can still push on hands and knees and on your side and squatting and whatever you want.

Just because you have an epidural doesn't mean you have to be on your back.

But you need to know, is your provider comfortable catching your baby in that position?

And I want to put emphasis on that catching because a lot of times we have providers that are like, sure, you can push in whatever position you want.

But whenever I walk into the room, you got to be on your back so I can catch baby because that's the only way I can catch.

That's not helpful.

Let me explain real quick why.

So I don't want to just like throw providers under the bus that they're like, they only want to catch in one position and whatever.

Most of them only want to catch in the position or receive your baby in a position when you are on your back pushing.

And the way that I explain it to people taking my childbirth classes is it's kind of like asking you if you're right handed to write with your left hand.

It's kind of like upside down and backward.

So if you're on hands and knees and they're doing a cervical exam or something, they're checking and they're like, oh, like they're trying to reorient themselves.

And then when you're pushing, you don't need any help.

To receive your baby, you can receive your own baby.

So every hospital here in the Austin area, they're going to say you have to be on the bed.

So fine.

But you can push on the bed on your hands and knees or squatting with a bar.

They're going to say it's harder for me to help protect your perineum.

However, that doesn't really matter because if you're on hands and knees or you're in a squatting position, your body is going to be helping protect your perineum by using gravity and your own force on those things.

So don't worry.

Or to manage a potential complication like a shoulder dystocia or something like that.

And then actually it's more safe to not be on your back.

Exactly.

You know, pushing on your back increases your risk of shoulder dystocia.

So it's looking at the risks and the benefits and making an informed decision.

Like if we could just sum up our entire podcast in one thing, that's what it is.

We want you to look at the risks and benefits and make your own informed decision with your provider, with your partner, with your doula, with whoever is on your team.

We want you all to kind of work together to figure out what's going to be best for you.

So asking these questions so that you know the answers ahead of time, so you know kind of what you're up against and what you're looking at in those situations.

I can't overstate it.

I'm going to say it 10,000 times.

And that is one of the things that makes these questions so important is you wouldn't know until you're pushing and your doctor asks you to get on your back if they weren't comfortable with that.

So then that's an, oh my gosh, puts you in a fight or flight.

You feel like you're all of a sudden having to explain yourself and go all cerebral in this moment that you're supposed to be more animalistic.

And that's another one would be intermittent fetal monitoring.

People want intermittent fetal monitoring most of the time.

It's like a 20 minutes on, 40 minutes off some places.

We actually have a hospital in Austin where if there's literally zero going on and you have no very, very low risk, you can do one minute on, 30 minutes off.

But nobody tells you that because they would rather you just be on them all the time.

You have to find a nurse that knows that rule and then like, oh, yeah, we can do that.

You have no risk.

It's fine.

So intermittent, for what a lot of places consider it to be, is 20 minutes on the fetal heart rate monitor and then 40 minutes off.

And so for every 20 minutes on, you earn 40 minutes off.

And this is if you see pictures of somebody giving birth, this is those straps that are around their belly.

One is monitoring the baby's heart rate.

The other one is monitoring your waves.

They can't tell how strong they are, but it definitely can tell when it starts, peaks and stops.

And so we can see what the baby's heart rate is doing in relation to your waves, which is an important thing for them to know, especially if there's some sort of complication that they're worried about.

But in an out of hospital birth, this isn't even a thing.

They do it with a Doppler.

They just like check real quick and it's maybe a minute, maybe not even.

It's like every 40-ish minutes and a little bit more frequent when you're pushing.

So you wouldn't know this until you got to the hospital and checked in and they strapped to your blood pressure.

You know, if you hadn't taken classes or whatever, you wouldn't even know that that was an option.

So ask them if they're comfortable with intermittent monitoring or if they are wanting full-time monitoring all the time with the caveat that if you have any induction medications or pain medications, they're going to have to have you on monitors.

Yeah.

Yeah.

Or some other, there's some other like, you know, higher high risk things that might make continuous fetal monitoring something that would want to be considered.

So definitely that's a big one.

Another one that's really important to talk about is how do you feel about doulas?

Do you feel that you work well together?

And why does this question matter?

Because in the long run, you know, as doulas, we work for you, we don't work for your doctor.

So who cares, you know, kind of where your doctor is at.

The reason why is because one, it's going to give you a pretty good idea of how they are approaching birth and how they are approaching your care.

But also, you know, we do, you know, kind of work together with providers a little bit, you know, again, we're working for you, we don't work for them, but we want to know that we can all work together and be a cohesive team.

You know, when Ciarra and I walk into a birthing room, we're not there to fight with your provider, we're not there to take over for them or speak for them or tell you what to do.

We're just there to be your support and to make sure you have all of the information.

But if we're walking into a room and a provider walks into a room and we're there, and they are immediately on guard and kind of ready to go at it with us, that's going to change the vibe of your birth, that's going to change how your hormones are working, that's going to change so many different things about your birth.

So you really want to have those conversations with your provider ahead of time.

There are some, we have a provider at Austin who tells clients that they have to approve doulas.

They have to approve the doula that they're working with or that they think that doulas just sit around and say good job, Bob, instead of doing anything.

And that's not what we do.

But that tells you what they think about us.

That tells you what they think about what your goals are for Birth.

If your goal is to have a doula there, then you deserve to have that and you deserve your team to support that for you.

All right.

And I think this is our last question, but is do you support me having an unmedicated low intervention birth, no matter what modality I'm using, whether that's hypno birthing or whatever, are they familiar with the techniques that you're going to use?

Are they going to be supportive of that or are they going to feel like there's absolutely no way?

Like most people don't make it unmedicated or whatever.

You need to ask those questions because if there's someone that has no experience with physiological birth, it's going to really trip them out when you're doing that.

So ask those questions.

And even if they've never done it before, are they open to doing it just because they haven't been exposed to it doesn't mean that they can't still be a good provider in that situation.

Yeah, absolutely, absolutely.

So I think this is just a little intro into what it can look like when you're choosing a provider.

I think some things to be remembering is that a lot of choosing a provider is about your gut instinct and what you are experiencing when you're there.

Do you feel safe with this provider?

Even if they're answering all of your questions, right?

Is there still a nagging voice in the back of your head that this isn't right for you?

If so, listen to that.

Or maybe they're not hitting all of your questions, but you just know that this is where you're going to feel safe and taken care of.

Great.

I think listening to that gut instinct, listening to what your heart is telling you is really, really important and cannot be overlooked in these situations because your gut is what's going to help you get through this labor.

I will say if it's your gut telling you to stay with a provider that's answering all of the questions wrong, but you just feel good about it, is that coming from a place of trauma or is it coming?

You know what I mean?

You really have to kind of assess where that's coming from because my fear there is if you stay with that provider who's not answering the questions right, but makes you feel good, are you going to end up with birth trauma at the end of this because you still didn't get what you wanted?

It's possible that there's a provider out there that you can feel like that with, but also is willing to do the things that you're asking for.

And again, this isn't just about OBs.

This is for midwives.

I know that there are some home birth midwives even here that are not the best fit for a lot of people.

One, it could be their bedside manner is just not what that person meshes well with or they are a little bit more medicalized and this person's wanting a very hands-off birth or you really like the check-ins and the testing and things like that.

You want to have a home birth, but you do like to have the data and that's okay.

There are some midwives that are like, no, we don't need to do that test.

That would make you feel dismissed.

And so you need to ask these questions because no matter what side you're coming from, there's going to be really important information there that you're going to gather that's going to tell you whether or not this is the person you're supposed to be with.

Yeah, yeah, absolutely.

Yeah, I full agree on that.

And I think even just beyond your OB and midwives, this applies to chiropractors, this applies to pelvic floor therapists, this applies to all of these different things.

If you go back and you listen to our episode with Amy in our Defeat Diastasis program, she talks a lot about that feeling of safety and how it really aided with her healing.

It's going to be the same in this situation.

Make sure that that feeling of safety is there.

So I think that wraps up our little bonus, maybe not so little bonus episode here.

Hopefully you guys have been asking for video for the YouTube channel instead of just like that little squiggly line thing.

So here we go.

This one's going to be videoed.

All the people watching on YouTube are going to get to see me snapping and clapping and whistling at my dogs because they were barking.

So you know, you'll see more real life when you're looking at the YouTube channel and not all of them are because they're not coming out in the exact order that we record them in.

But we're getting there, guys.

Hang with us.

Yes.

So thanks for joining us, and we'll see you next time on Birth, Baby.

Thank you for joining us on Birth, Baby!

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