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How to Have a Better Birth: Questions to Ask Care Providers
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1. Will you allow me to have my choice of companions during birth?
A mother-friendly hospital, birth center or home birth service provides unrestricted access to continuous emotional and physical support from family members, friends and/or a labor support professional (e.g., a doula).
2. Will you allow me to move freely during labor and birth?
A birthing woman should have the freedom to walk, move about and assume the positions of her choice during labor and birth, and should not be required to labor and birth in separate rooms. In particular, the position with the woman flat on her back with her legs elevated ("lithotomy position") should be discouraged.
3. How do you work in collaboration and consultation with other health care providers and social services?
Every care provider should have written, clearly defined policies and procedures for collaboration and consultation with other maternity professionals and services (for example, in the event of a transfer from home or birth center to a hospital) and should provide access to appropriate social services.
4. Will you allow me to eat and drink during labor? Do you regularly use IVs and electronic fetal monitoring, shave women or give enemas?
Eating and drinking should not be restricted and intravenous medications (IVs) should be administered only when needed. Continuous electronic fetal monitoring should not be used routinely on low-risk women, as data show it increases cesarean births (c-sections) without improving outcomes in low-risk situations.
5. How often do you artificially break the water bag (a technique physicians believe speeds up labor)? How often do you use drugs to artificially induce labor or to increase the strength or frequency of contractions with drugs?
A mother-friendly care provider's answer should be 10 percent or less. There are no data to support the routine artificial rupture of membranes, and induction and augmentation should be used only as needed.
6. How often do you perform episiotomies (a surgical cut to enlarge the vaginal opening)? What is your c-section rate? Do you encourage VBACs (vaginal birth after cesarean)?
A woman-friendly clinic performs fewer episiotomies and fewer cesarean sections, and encourages mothers whose previous birth(s) were by cesarean to deliver vaginally, where possible. Percentages should be less than 5 to 20 percent for episiotomies, less than 10 percent for c-sections, and 60 percent or greater for VBAC delivery. These percentages are approximate, and will vary by facility, but they are a good indicator of the philosophy of a birth place. Less cutting is better and yields quicker, less painful recoveries with fewer complications, allowing a new mom to get on with the business of enjoying and caring for her baby.
7. Do you encourage "rooming in" (allowing the mother and newborn to remain together 24 hours a day)? If there are no medical complications, how long is a baby usually separated from its mother and how soon after birth?
A mother and newborn should be able to remain together 24 hours a day after birth unless separation is required for specific medical reasons. Mothers and families, even those with sick or premature babies, should be encouraged to hold, touch, breastfeed and care for their babies to the extent compatible with their conditions.
8. What support will I receive for breastfeeding?
Mother-friendly care providers encourage breastfeeding within one hour of birth, and they should provide mothers with the appropriate tools and resources to breastfeed successfully.
9. What types of pain relief do you provide during labor and
birth?
Your care provider should know about and offer non-drug
methods of pain relief (massage, hot bath/shower, etc.), and should
not promote the use of drugs (e.g., epidurals) except as specifically
required to correct a complication.
10. Where can I get more information about your procedures
and about other options for birth?
Request accurate, descriptive,
and statistical information about the full range of a woman's choices for
birth.
Adapted from the Ten Steps of Mother-Friendly Care, produced by the Coaliton to Improve Maternity Services (CIMS).
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