Should I have already asked these questions?

[kellyd]

Ok, I just found out that my hospital of choice has a 98% epidural rate. I am most definately opposed to receiving an epidural. I have had a lot of back problems in my life, and the idea of sticking a needle into what is one of my most sensitive areas, is not a comfortable one. If once in labor I need one then ok... but if not, then I'd prefer to avoid it. Also, I have recently realized I have no idea what my doctors policies on childbirth are! The dr. I originally went to at this practice has changed practices, her methods went along w/ my wishes. Now I'm pregnant, and I do like my current OB... but if he doesn't see eye to eye w/ me I need to change. I have an appt on Tuesday, and I am trying to assemble a list of questions, but am afraid he will think it's too early to answer them. Also, I'm afraid I'm not going to like his answers, which will necessitate a search for a new doctor, and probably switching my choice of hospital.

I'm feeling very stressed about this, and I never get stressed about things like this! ARGH... I think the hormones are finally getting to me!

oh and I'm 15 weeks along.

ETA: From what I've been told one of the reasons their epidural rate is so high is that once your water breaks you are confined to bed. If you refuse, some of the nurses have actually called security!!!!

[boolady]

You have time to figure these things out. Make sure you ask the questions you want answered. I (personally) was not overtly worried about epidural rate, and was not pressured in any way to have one; to the contrary, I think, as someone who decided I wanted one, that I could have had it sooner. I guess I was lucky in that regard, especially since I went in thinking that I definitely did not want an epidural.

That said, you are not too far along IMO to change doctors and/or hospitals if you feel that it would be best for you. Ultimately, you have to be comfortable with your doctor and facility. Good luck.

[o_mom]

I wouldn't be too concerned about the epidural rate on its own. I have delivered 2 out of 3 with no medication at a hospital with a 95% epidural rate. It is just what 95% of people delivering in a hospital want.

Now, as far as the other policies, you will have to find out about that. I think the best way would be to call some doulas that have attended at that hospital and ask them some very direct questions about the policies. Also talk with the nurses there - I'm not sure what the title of the person would be. You can also request copies of their consent forms and policies that are given to patients.

As far as the OB, you will have to be very careful in how you word questions, don't be afraid to follow up and really judge if he is being honest. Some OBs will say things like "I only cut an episiotomy if it is necessary", but turns out they think it is necessary 80-90% of the time. You need to go deeper with questions like "When was the last time you had to cut and episiotomy?", "What was the reason for that?" , "What do you do to help prevent tearing?", etc.

Hiring a doula can help in these situations and doing some sort of natural childbirth preparation - Bradley, Birthing from Within, HypnoBabies etc. You can also ask on Mothering.com in the Finding your Tribe area for other people's experiences there and recommendations for natural birth friendly providers. It is also good to know your rights and practice polite ways of asserting yourself (and have your partner also practice because you may be a bit distracted).

Don't be afraid to change if it means you will get the care you want. Don't be afraid of hurting your OB's feelings. You are still early and have plenty of time to work everything out.

[missym]

ETA: From what I've been told one of the reasons their epidural rate is so high is that once your water breaks you are confined to bed. If you refuse, some of the nurses have actually called security!!!!

If that's true, that's all I'd need to hear to convince me that I'd deliver in my car rather than that hospital. What about the rights of the patient? :irked:

[kellyd]

If that's true, that's all I'd need to hear to convince me that I'd deliver in my car rather than that hospital. What about the rights of the patient? :irked:

I'm not sure how to confirm it other than to say that I was told that by 2 different doulas who have attended births at that hospital. Now as far as I know the dr. can override that particular policy, but that hasn't been confirmed yet.

What's so crazy about it is that it's the number 1 hospital for births in this city, only 25% of their births last year were c-sections, which while above the national average wasn't as high as i expected it to be with their policy on being in bed after the water breaking and epidural rates.

Ugh... I hate being so wishy washy on this. I need to have a discussion with my dr. on Tuesday, and if it's not satisfactory, I'm going back to my old dr. and probably switching hospitals. Since my hospital choice was what made me want to switch in the first place!

[ThreeofUs]

You have time. I changed OB's when I was 8 months along!

Ask your list of questions, but more try to engage your OB in conversation, about your birth preferences and her philosophy.

[jhrabosk]

I don't think you necessarily should have already asked these questions...many of the things you're talking about are subjects that a lot of women don't even KNOW to think about until they're pregnant! I certainly didn't.

But, definitely ask your questions now and get answers that make you comfortable. It's still very early and you have lots of time to find the right person. I was wishy-washy and waited too long. My daughter's birth was a wonderful experience, but I didn't follow my instincts beforehand.

Good luck!

[writermama]

I did with DD#1 later than that ... 26 weeks, I think. Changed from an OB and hospital to a midwife and birth center. It was the best decision I could have made. Hypnobirthing and a doula for DD#2 was even better and I would have done for #1 if I had known then what I know now.

So no, it's not too late. And much better to pursue these questions now than find out when you arrive at the hospital to deliver.

[american_mama]

With DD1, I switched from ob to a midwife at 7 months, but that was due to a move. I did have some trouble finding a practice that didn't raise eyebrows/get unhappy at me switching at that point, even though I had all my records and an uncomplicated pregnancy. Many women do switch, even at late dates, so don't get freaked out. But you might try calling two or three practices that you've heard good things about (especially if they are small practices that may take a limited caseload) and seeing if switching at any point presents a problem.

I have not read it, but you might look at the book "Creating Your Birth Plan" by Marsden Wagner. http://www.amazon.com/Creating-Your-Birth-Plan-Definitive/dp/0399532579 I heard him talk on the general subject of childbirth, not this book per se, but given the title, it might be of help to you in firmly discussing what you want with your ob and feeling confident that he or she will do his best to help you achieve it.

If you don't want to switch back to your old ob, can you call her, explain your concerns, and ask for recommendations? I personally would not trust the situation at that hospital as you described it. If you end up going there, my only suggestion would be to have your doctor put a signed copy of your birth plan in your chart and/or take a signed copy with you during labor. Hopefully, that frees the nurses and the ob on call to follow what has already been discussed by you and your ob. Once at the hospital, I would have you or your husband (whoever is able to be more firm at that point) say that your goal is a natural childbirth without epidural, and to ask for a nurse who enjoys working with that kind of patient. If your nurse turns out to be a majro mismatch, ask your husband in advance if he will be the bad guy and request another one.

[BeachBum]

My town has 2 OB's and one hospital.
I knew that my Doctor's personal philosophy about birth didn't line up with mine. So I just went with the approach of this is what I want, are you ok with it? While my doctor didn't see things my way, he did work hard to let me have the birth experience that I wanted (no meds, no interventions).
If you do feel like the hospital regulations are so different from what you want, why is that your hospital of choice? Maybe following your old OB who's philosophy you agree with is a better idea. Perhaps she is at at hospital that is more compatible with your fews?

[vludmilla]

I agree with the previous posters that the epidural rate is probably so high because that is what patients want. I delivered naturally with no painkillers of any kind at a hospital and with a doctor where 98% of women choose epidural. FWIW, I didn't get out of bed after my water broke and I still went 13 hours until delivery without any pain medicine. It is possible to do if you have a supportive husband or other partner, some coping (breathing) techniques and a fairly good pain tolerance threshold. I think you just need to know what your doctor will support, not what the nurses will.
Good luck!

[SnuggleBuggles]

I haven't read the other replies so sorry if I repeat!

I would find a new hospital ASAP if your Dr. supports their whole "if your water breaks you are stuck in bed" policy. The only time that would make sense is if baby is super high because they afraid of cord prolapse. But, the risk of that is very, very rare. And you would hope that they would not break your water on purpose if baby is high. If it breaks naturally they should just check to see if when the waters were released if baby came down- odds are they will.

In my opinion, your Dr. or midwife can make or break your experience, especially if you want something that isn't the norm. For example, I didn't want an I.V. or a hep lock even though they are standard. My CNM just cleared it with the nurses and we were good to go with no arguments or anything. So, if you ask your Dr. your q's and don't like the answer then I would shop around.

A question I like to ask is when do they induce labor, how do they induce labor (Cytotec as an answer would be a deal breaker) and why do they induce labor. I think you learn a lot about their approach to childbirth and the likelihood of whether you are likely to have a birth with fewer interventions. If they say the induce at 401d because you are "postdate" that would be reason for me to move on. Also, if they induce based on an u/s size estimate I would move on. Basically it boils down to whether they view birth as a problem waiting to happen or they have faith in it. If they have faith in it then you will face fewer unnecessary interventions and fewer unnecessary interventions mean less need for pain meds, probably.

The hospital ds1 was born at had a 90+% epidural rate. But, like I said, my CNM was on board with my birth plan. I also hired a doula. And the nurse assigned to me was a big believer in unmedicated birth. There is usually one L&D nurse on shift that is going to be more supportive of that and I have heard they really like the occasional unmedicated birth. If you and your nurse don't mesh then you can always ask for a new one.

Have you considered a free standing birth center? I know it's kind of an idea that a 1st time mom would possibly be nervous about but they can often be great. :) If there is one near you I would recommend going to their orientation and seeing what you think. You can always do a hospital transfer for problems (there are very few immediate emergencies in birth and if you are low risk that helps too) or for pain meds. Also, if a birth center is outside your comfort zone check the other hospitals in your area. There's no need to settle, imo, if you have choices. It's your birth, advocate for it.

This link has a lot of great questions to ask hospitals, Dr.s....
http://www.mother-care.ca/questions.htm

BTW, it's not too late. :) I kept switching till I found a good fit. I finally found one around 17 weeks.

Beth

[MamaMolly]

Two things: It isn't too late to change by a long shot, and when making plans just make sure who will be delivering your baby.

Make sure that your doctor is the one who will be the one delivering your baby. We moved in my 7th month and had didn't discover until we were taking the hospital tour the week before DD was born (4 weeks early) that the chances of my doctor being there for the birth was slim to none.
There were 4 doctors in the practice, 2 nurse practitioners and one doula. They were all contracted with 9 other doctors in other practices. So the long and short of it is that IF I went into labor between 8-5 on Monday through Thursday my doctor MIGHT make it there for the delivery, 8-3 on Fridays, and on the weekends and after hours it was a crapshoot of getting whoever was on call.

Needless to say when I went into labor a month early at 2:30 a.m. on a Sunday I got a very nice, capable doctor I'd never met before.

So even the best plans can go bad. One of the most important questions I'd ask your doctor is who will be attending your birth.

Take care and best of luck!

[klwa]

I agree with the PP that it's not too late to first be thinking of these things nor to make changes if need be. Talk with your OB first. However, I will tell you that the answers you get may be political speak. I asked the OB who ended up delivering DS what the practice's episiotomy rate was and all she'd ever say was that they only did it if necessary. I could never get a straight answer out of her. (She was my least favorite of the OB's at the practice.) After delivering DS, without a single tear, I commented to the nurse how happy I was. She looked at me like I had a second head and told me that OB almost NEVER had any tearing, and never cut unless there were major problems. It could be that the "hospital policy" is actually that of just a few nurses or OB's who deliver there. The other practice who delivered at the hospital DS was born at had much less, uhm, progressive views on labor. The nurses weren't happy about a lot of the things they did (the childbirth instructor even mentioned it), but because the doctors were in charge, they had to do it. I'm assuming your previous GYN was also attached to that hospital & since she had similar views as you it may be that the whole practice leans in that direction.

Oh, and I did fight the doctor on a few things in the delivery room. Wouldn't let her start me on pitocin just because my water had broken, etc.