Questions to Ask Your Doctor or Midwife Before You Complete Your Birth Plan

1. What is your protocol if my water breaks or leaks early in labor or before contractions begin?

• Mom and baby can both be healthy if the mom’s bag of water breaks hours to days before delivery. However, if your bag of water has been broken for an extended period of time (usually 18 or more hours), you are at an increased risk of fever and infection and doctors/midwives usually have protocols to manage the risk. 
• If you are at home in a family environment with germs you are normally around, your risk may be lower. If you are in the hospital, the risk may be greater. 
• Whether or not you are GBS positive may affect your doctor’s/midwife’s answers to this question. Usually there is less concern about infection/fever and more flexibility if you test negative for GBS. You may want to inquire about your GBS status and how that might affect the process.

2. What is your protocol for induction? Are you open to natural forms of induction? If so, which ones?

• A much more detailed conversation about this will happen if there is reason for you to be induced, so don’t worry about having a long “what if” discussion about induction now. 
• The important thing is to get a sense of whether you will be encouraged to get labor going seven days after your due date or 14 days or something else. 
• Rarely will OBs or midwives work with you two weeks past your due date. 
• Induction is usually a much more painful method of birth and most mothers wish to avoid it.

3. What does intermittent monitoring look like in your practice; for example, how many minutes on and off the monitor in an hour? Are you open to using a Doppler instead? Is there a wireless monitor available on the unit?

• If you and baby are healthy and going through a birth process without interventions or medications, monitoring of the baby by attaching small monitors to your belly can be intermittent, meaning on and off for periods of time. 
• You will be required to have consistent monitoring if you have interventions or medications or if you or your baby have risk factors. 
• If you imagine spending most of your labor walking and moving around, having the least amount of monitoring possible or wireless monitoring would assist you in meeting that goal. 
• Some hospitals will allow use of the hand held Doppler instead of electronic fetal monitoring. This is maybe preferable for you, so ask.

4. What is your protocol to help manage tearing?

• Some options you might hear in response are perineal massage, mineral oil, counter-pressure with a warm compress, or a hands off approach. 
• Evidence shows the value of a hands off approach, but it’s a good idea to know what your doctor’s/ midwife’s routine is. 

5. I may want to push while squatting, on all fours, or standing. Are you comfortable supporting me with these options? Which birthing positions have you supported other mothers in?

• Most doctors do not have many clients who push in a variety of positions. 
• It’s good to let them know if this is interesting to you and might happen at your birth. 
• Will the nursing staff be open and willing to support me in other positions as well?

6. I may want to push when my body guides me to do so. Are you comfortable in supporting my decision to push when I feel it’s necessary without counting or breath holding or other guidance?

• The majority of moms opt for an epidural. In most cases, they will need to be coached when and how to push. 
• If you are medication-free, you will feel all the sensations telling you it’s time to push and you won’t need outside interference.
• You are asking this question to notify the doctor that you won’t need outside guidance unless you request it.

7. Can my partner or I catch the baby?

• It’s not necessary to ask this if you or your partner aren’t interested.
• If there are no risk factors, your provider may be open to allowing you or your partner to catch your baby as you deliver.

8. How do you feel about delayed cord clamping? Are you comfortable with allowing the cord to complete pulsing before clamping? Would you be comfortable if I were to wait for a longer period of time?

• Most doctors, who are familiar with the benefits of allowing the cord to pulse, will allow 10 minutes or so to pass before clamping and cutting the cord if you let them know it’s important to you. 
• Some providers follow the ACOG guidelines or WHO recommendations which say delay cord clamping for 1-3 minutes.
• It is important to let your provider know how long you want to delay clamping and cutting the cord for.

9. I would like to save my cord blood and was told that it’s not a problem to extract the blood with the cord still attached; have you been trained on how to do that?

• Some doctors have still not been trained on how to extract cord blood with the cord still attached; see if your provider is willing to research that.

10. Do you normally use Pitocin after the birth as a hemorrhage preventative measure or do you prefer to wait and see if the circumstances warrant it first?

• More and more practices are using Pitocin as a preventative after birth. 
• It’s important to know your doctor’s or midwife’s protocol and flexibility. 
• If his or her answer doesn’t feel comfortable to you, we will discuss this more at our next appointment. 
• Most hospitals have an after delivery Pitocin Protocol, so you would need to specify that you do not want Pitocin administered unless you begin to hemorrhage.