12 Questions to ask your Maternity Care Provider

You may have heard that choosing your care provider can be the most important decision you make in your birth journey, but how do you make that choice? There are so many varying factors that can influence whether a care provider is right for you; every woman and baby is different, and each family will have different philosophies and expectations of their pregnancy, birth and postpartum. 

I have made a list of 12 questions that you can take into an appointment with your care provider to see whether they are the right fit for you and your journey. Ask these questions, and any others that you would like to know about, early on in your pregnancy, so that if you decide you and your provider aren’t aligned, you have as much time as possible to look around for different options.

What are the ways you help facilitate the hormonal physiology of birth?

Your hormones are perfectly designed to work within your body in order to effectively labour and birth your baby. To allow those hormones to do their job, you as the birthing woman should feel private, safe and unobserved (read Dr Sarah Buckley for more). If you are planning on having a physiological or a low-intervention birth, your care provider should have an understanding of this and be able to provide you with information on what they do to support your labour hormones and birth physiology. If a physiological or normal birth is important to you, or even something you want to consider, and a care provider does not have an understanding of this or can’t provide you an adequate answer, it is a big red flag!

What are your policies and recommendations based on my specific circumstances?

This is something you can ask when you are interviewing care providers, as well as incrementally in your pregnancy if circumstances change or complications arise. If you have had previous pregnancies, it is worth asking what the policies are regarding any circumstances that arose last time, e.g. gestational diabetes diagnosis, ‘big’ baby, prior caesarean, etc. If you have had no prior pregnancies, you still may have a health history and many providers have policies regarding first-time-mothers that are worth being aware of. 

What happens if I go past my estimated due date?

Many care providers will routinely recommend interventions to induce labour at or around a certain date in your pregnancy, even if you have no complications and are deemed ‘low-risk’. If it is important to you that your labour begin spontaneously, and you will only consider an induction if it is genuinely medically necessary, this is a pivotal question to determine if you are aligned with a care provider. Important to note is that some providers may say they only recommend induction after 41 weeks, for example, but will offer or recommend stretch and sweeps even before your estimated due date, which is still a form of induction. Ask them if they recommend routine stretch and sweeps (or vaginal exams) at any point in your pregnancy. Information is power, and you can include your informed decisions regarding post-dates on your birth map or plan to discuss with your care providers in advance. 

What is your policy on and availability of waterbirth?

Many women know the benefits of water immersion in labour and as the place they want to birth their baby. Women that are planning a physiological labour and birth may choose a waterbirth for a number of reasons: it is a natural pain-management tool; it allows for freedom of movement; and it gives the birthing woman an established safe space to cocoon her from her surroundings. 

If you want to be immersed in water during your labour, you will need to find out if your chosen place of birth has this available to you. In a hospital setting, this will mean asking if they have baths available in the birthing suites, and if so, if they are available in all of them or only a few. If the latter, discuss with your birth support about asking for a birth suite with a bath when they call the hospital to inform them you are coming in when you are in labour. At a homebirth, this will simply involve you deciding if your home bath is suitable, or if you’d like an inflatable birth pool set up. 

Most hospitals and birth centres will have policies regarding waterbirth, if it is something they have available. Ask your care provider if they have waterbirth or water immersion policies, and very importantly, any policies that relate to your particular circumstances (e.g. VBAC, higher BMI, baby measuring big, etc.).

Important to note is that some care providers will have policies that differentiate between water immersion in labour and waterbirth: water immersion may be defined as being in the bath during labour, but not when your baby is being born. A policy may state that it is recommended you get out of the bath when the care providers decide you are in the second stage of labour and it is ‘time to push’. It is useful to be aware of this when you are mapping out your birth so that you are prepared for these recommendations if you decide to stay in the water to birth your baby. I always highly recommend giving your birth map or plan to your care provider in an antenatal appointment so that they are aware of your decisions ahead of time, and you are ideally not having to negotiate them in labour.

If you are interested in finding out more about the myriad benefits of waterbirth, check out this article from Evidence Based Birth: https://evidencebasedbirth.com/waterbirth/. 

What is your current caesarean rate, instrumental birth rate and episiotomy rate?

These statistics will give you a fairly clear idea of your care provider’s philosophies. The World Health Organisation states that a caesarean rate over 10% does not improve outcomes for mothers and babies (read more on this here). If your care provider has a caesarean rate closer to 30, 40 or 50%, and you are hoping to avoid a surgical birth, it is worth asking them why that is.

Caesarean sections, instrumental birth (using vacuum or forceps) and episiotomies can be life-saving procedures, however statistics show that most of the time they are used these interventions are not improving health and safety outcomes. If you are envisioning a birth that does not involve any of these procedures unless genuinely medically necessary, a care provider with a higher intervention rate is likely not in your best interests.

You can read up on detailed statistics from all NSW public and private hospitals in the NSW Mothers and Babies Report at https://www.health.nsw.gov.au/hsnsw/Pages/mothers-and-babies-2021.aspx.

If you are considering a private midwife or obstetrician, they should have their own patient statistics readily available to discuss with you.

Can I make informed decisions for my pregnancy and birth that go against your policies and recommendations?

Use the phrase ‘informed decisions’ here, instead of something like ‘can I decline recommendations?’ to really get a good idea of whether a care provider is right for you. Your care provider should respect that if you are given enough information, you are intelligent and reasonable enough to make the decisions that are right for you and your baby.

A tip is to use an example to see how the care provider responds, especially if you already have a particular decision you know you are likely to make for your birth. For example, if you are having a VBAC, and know you do not want continuous CTG monitoring, tell them you will be making the informed decision to only have intermittent monitoring, and see what their reaction is.

If the idea of you going against their policies seems to make a care provider uncomfortable, if they are dismissive and say something like “we’ll discuss these things later in your pregnancy”, or if you get an instinct that they might make it difficult for you to make and stand by your own decisions, it is definitely worth reconsidering if they are the right provider for you.

In a hospital setting, the reality is that many policies are designed to be highly risk-averse and assist with making sure there are enough beds for incoming patients. A private clinician, whether a midwife or obstetrician, may have policies that they follow in their practice that make them feel safe and comfortable, but that aren’t always applicable to each woman’s circumstances. You have the right to make informed decisions about your body and baby without pushback or coercion from your care provider. 

Will I have any time limits placed on me in labour?

There are a number of common policies and guidelines that put time limits on well women with healthy pregnancies for the stages of labour. This is not evidence-based, and is more in the interest of care provider convenience and their concept of risk-management. An example of this is the Friedman curve, a commonly followed guideline that a woman should be dilating 1cm per hour, an idea that has been debunked by researchers a number of times since it was introduced in the 1950s. If you and your baby are well and there are no genuine medical reasons to hurry labour and birth along, your care provider should not be placing any time limits on your birth. If they say that they do indeed have these policies in place, follow up by asking why this is and if they can show you the evidence to support them.

What if my baby is breech?

This may seem like an unnecessary question, especially if you have had a previous pregnancy where baby was presenting cephalic or head-down at term, however 3-4% of term babies are breech, so it is worth bringing up. A very small number of care providers support vaginal breech birth, and most will start to recommend an elective caesarean if your baby is still presenting breech at 37 weeks. Ask first, what the the care provider would recommend in this circumstance, and secondly, if they are skilled at and comfortable supporting vaginal breech birth. If they do not support VBB at their hospital and recommend a caesarean section as your only option, they are keeping information from you. A care provider unskilled in vaginal breech birth should discuss all your options with you, which include referring you on to someone else who is, in the event of a breech baby at term.

What would you consider optimal cord management?

Many in the birth world are opting to use this term instead of ‘delayed cord clamping’ to describe waiting for the ideal time to clamp and cut the umbilical cord that is in the best interest of baby’s health. This is because it is believed the norm should be giving the baby’s blood time to move from the placenta (where much of it is housed immediately after birth) through the cord to the baby. Many care providers have different definitions of ‘delayed cord clamping’ (some may consider it one minute after birth, while others may wait for the cord to stop pulsating and turn white). If you have made the decision to keep your baby and placenta connected for any length of time after birth, ask your provider about their definition of ‘optimal cord management’, and whether they will support your decision, to get an understanding of their policies and philosophies.

What are your views on physiological placental birth?

A physiological placental birth or ‘third stage’ is where you are given time and space to birth your placenta with no intervention. Many consider that the environment that is optimal to birth your baby is just as essential for you to birth your placenta - perhaps even more so, because your placenta is not an active participant in its birth.

Many care providers have policies on routine procedures for ‘active management’ of placental birth, like injection of syntocinon and other medications, fundal massage and cord traction. The reason for this is that the likelihood of a postpartum haemorrhage is higher if you have had interventions in your birth. If you have decided to have a physiological labour and birth, an aligned care provider would be open to discussing your options for a physiological placental birth with you.

What does postpartum care look like with you?

Postpartum is a very often-overlooked topic when it comes to considering your care provider, and indeed in general. When envisioning your ideal pregnancy and birth, it is in yours and your baby’s best interests to also consider how you want your postpartum care to look, and what factors are important to you. 

Are you seeking to be in your own home with your family as soon as possible after birth, with a clinician attending to you there for your postpartum care? Or would you like to be in hospital for as long as possible, with your care provider providing you clinical care in your own private room? If you want to breastfeed your baby, ask your care provider what kind of lactation support they provide and what is available for you (e.g. Lactation Consultant/IBCLC, hospital-grade breast pump, etc.).

How do you feel about me having a doula?

Whether or not you have made the decision to have a doula at your birth, this is a powerful question to ask when interviewing a care provider. If you are considering having doula support, one can assume you are envisioning an empowered, supported birth on your own terms. Ideally, this will be positive to hear for an aligned care provider who also wants you to have exactly that. 

A doula is an advocate and support person for the birthing woman and her partner, and has no ties or obligations to care provider policy. If the idea of that makes a provider uncomfortable or they seem to have any negative views of doulas in general, this is a red flag. If they are providing respectful, woman-centred, evidence-based care, a doula who is there to support and encourage the birthing woman should be a welcome addition to the birth space.

There are so many more questions you can ask a care provider to ascertain if they are the right one to care for you in your pregnancy, birth and postpartum. Hopefully, the list I have provided gives you a solid starting point and springboard from which to begin deeply considering the type of birth you want, and how you want your care provider to fit into your birth vision. A quality care provider, regardless of if they end up being aligned with your philosophies, will be comfortable answering any and all questions you have for them. Don’t be afraid to speak up and ask for what you want! You are the most important person in your birth, and you deserve to be informed, empowered and in charge at all times.