Choosing the hospital: Questions to ask the head labor & delivery nurse

1. Does hospital have one room available for labor delivery and recovery? How many? What happens if someone is occupying it?
2. Is it always staffed?
3. What's the nurse/patient ratio? (ACOG guidelines are 1 to 2 in labor and 1 to 1 in pushing).
4. What's the hospital's c-sec rate?
5. How familiar and comfortable are you with patients bringing their own Labor Support Professional?
6. If cesarean, can husband and labor support or relative be present?
7. What is the epidural rate? How many women have drug free birth and can squat, walk, kneel? sit on toilet? In bathtub? In shower? Why and when is this not allowed?
8. How familiar and comfortable are your nurses with a patient coming in active labor?
9. Do you have lactation consultants? Breastfeeding classes/instructors in maternity ward?
10. Percentage of mothers who are breastfeeding upon dismissal?
11. Can baby stay with me at all times? Is it okay to sleep with the baby in same bed? Can my partner spend the night too?
12. Can my older children be present at the birth? When can they visit me?
13. The Electronic Fetal Monitor policy: what is minimum amount I must be monitored? In what circumstances is constant monitoring required? Is remote monitoring required or is intermittent acceptable? If MD or CNM approves, can doppler be used instead of EFM? What about for VBACs?
14. What are your protocols for fetal distress?
15. How often do you use internal monitor? What circumstances require it?
16. Does this hospital do fetal scalp ph sampling to confirm fetal distress?
17. What is your policy on the IV? Can a Heparin Lock be substituted for the IV? What about if I am a VBAC? Can ice chips and/or water or juice be taken? Can I eat in early labor?
18. Can we take our placenta home? (To bury in our yard and plant a tree for the baby).
19. Ask her what your doctor's standard policies are regarding all of the above...

Choosing a doctor: Questions to ask the obstetrician

1. Do you have a nurse-midwife in your practice? When is she on call? Can she deliver the baby in the hospital if you're not there?
2. What is the length of your appointments? How long must I wait to see you?
3. How many patients do you deliver per month? (fewer than 10--will give you time & attention; over 30 this may mean 5 or 6 per day; long office waits/short dr. visits at prenatals).
4. if you're not on call, or busy with another birth, then who will deliver my baby? What percentage of your patients do you actually deliver?
5. How much time do you spend with me in labor and delivery? During Pushing?
6. What percentage of your patients have hired a Professional Labor Companion? What do you think of them? Who have you worked with? Who do you like/dislike, and why? Who would you recommend?
7. How do you feel about having my professional labor companion, if qualified to do so, check my cervix (with sterile gloves, so long as not ruptured membranes) and ausciliate fetal hearttones with doppler or fetoscope, and stay with me at home, coming into hospital only when I'm in active labor (5-8 cms.)? What about if I am a VBAC?
8. What is your Cesearean rate? What situations do you most commonly section for?
9. What do you consider a high risk pregnancy?
10. What is your protocol if pregnancy goes past the due date? At what point do you insist upon induction?
11. What percentage of your patients have:
    
    • epidurals?
    • pitocin?
    • I.V.'s?
    • confinement to bed?
    • internal monitors?
    • continuous fetal monitoring?
    • intermittent monitoring?
    • remote monitoring?
    • episiotomies in first time mothers? second time mothers?
12. How do you feel about a patient not having these? What about all of the above if patient is a VBAC?
13. How long do you allow for latent phase? Active phase? Pushing? Placenta?
14. Do you use a vacuum extractor?
15. How do you handle ruptured membranes in early labor?
16. Do you use fetal scalp PH sampling to confirm fetal distress? Why? Why not?
17. Do you think childbirth preparation classes are valuable? Who do you recommend? Why?

Questions to ask when interviewing the birth center

1. Do you have CNM's, LMs, NP's or OB's? Will I actually meet the OB? Will s/he be present at the birth or prenatals?
2. What's your hospital transfer rate?
3. In what situations will you transport mom or baby to hospital?
4. What's your Cesearean rate?
5. What hospital and doctor do you use?
6. Waht are the most common reasons for transport to hospital?
7. Are drugs available here? What type? In what circumstances do you use them?
8. Are childbirth classes, prenatals, postpartum visit included in price? What method of childbirth preparation are taught?
9. How long are prenatals? Who does them? ( to see how busy they are)
10. Who will be with me during labor and delivery?
11. What prenatal tests do you require?
12. Do you use, Electronic Fetal Monitor, ultrasound doppler or fetoscope? Why?
13. What emergency equipment do you have on hand?
14. What situations will I be too high risk for birth center?
15. . Do you have birthing tubs? Do you do deliveries in water?
16. What is your philosophy about childbirth?
17. At what point in labor will I be allowed to come to the birth center?
18. Who may I have with me at the birth?
19. At what point after the birth will I go home?
20. Does insurance or medi-care pay for your services?

Questions to ask when interviewing the homebirth midwife

1. How long have you been practicing and how many births have you been the primary midwife responsible? What is your philosophy about childbirth? Why did you become a midwife?
2. How did you receive your training?
3. Are you certified or licensed? By what organization? Why or why not?
4. Do you practice with a partner or assistants/apprentices? When will I meet them? What happens if I don't want one of them, or prefer one of them at my birth?
5. What happens if two people are in labor at once?
6. Who is your back up doctor?
7. What hospital is s/he at?
8. Do I need to see him/her prenatally?
9. What situations do you consult him/her for?
10. What situations do you transport for?
11. What complications have you handled? How did you handle them?
12. What emergency equipment and medicinals do you bring? When will you use the following: pitocin or methergine, newborn ressuscitation equipment, oxygen, suturing materials, IVs?.
13. When will you come during labor? What happens if my labor goes on for days? What happens if it's so fast you miss the birth? Have you ever missed a birth? Why?
14. What are your fees? What do they include? When is payment expected? Does insurance or medi-care cover your services?
15. How do I get my lab work done? What routine prenatal tests do you require?
16. What situations should they occur, would I be too high risk for homebirth?
17. What prenatal tests do you require? Where can I get them done?
18. Where do you conduct prenatal examinations?
19. How many women do you see at prenatals daily?
20. How long do you give each woman? What is discussed? What is done?
21. Do you do a postpartum home visit? When?
22. How do I contact you ?
23. What pharmaceutical drugs, homeopathics and/or herbs do you use prenatally and at births?
24. Do you use a doppler or a fetoscope? Why?
25. How many babies do you deliver per month?
26. What is your Cesearean rate? What are the most common reasons?