Choosing a Birthplace: 10 Questions Expectant Parents Should Ask
The
document below, “Ten Questions to Ask,” is c. 2000 by the Coalition for
Improving Maternity Services (CIMS). To find out more about CIMS, see www.motherfriendly.org.
Inside of the document, you will notice several links to more information. Some
of these links will take you to summary pages that I have developed which
provide an overview of the topic, then link you to specific articles. Many of
the links take you directly to articles written by other professionals and
interested laypersons. Please be aware that the information on these sites is
not intended as a substitute for medical advice from licensed healthcare
professionals who are familiar with your specific health issues.
These are primarily questions to ask when choosing a caregiver or a
birthplace. For questions to ask your care provider when a test or procedure is
recommended, read Penny Simkin’s Key Questions About Your
Care.
When you are deciding where to have
your baby, you'll probably be choosing from
different places such as:
• birth center,
• hospital, or
• home birth service.
Here's what you should expect, and
ask for, in your birth experience. Be sure to find out how the people you talk
with handle these ten issues about caring for you and your baby. You may want
to ask the questions below to help you learn more.
Mother-friendly birth centers,
hospitals, and home birth services will let a birthing mother decide whom she
wants to have with her during the birth. This includes fathers, partners, children, other
family members, or friends.
They will also let a birthing mother
have with her a person who has special training in helping women cope with
labor and birth. This person is called a doula or labor support person. She
never leaves the birthing mother alone. She encourages her, comforts her, and
helps her understand what's happening to her.
They will have midwives
as part of their staff so that a birthing mother can have a midwife with her if
she wants to. (choosing a
caregiver)
If they give mother-friendly care, they
will tell you how they handle every part of the birthing process. For example,
how often do they give the mother a drug
to speed up the birth? Or do they let labor and birth usually happen
on its own timing?
They will also tell you how often they
do certain procedures. For example, they will have a record of the percentage
of C-sections (Cesarean births) they do every year. If the number is too high, you'll want to consider
having your baby in another place or with another doctor or midwife.
Here are some numbers we recommend you
ask about.
A C-section is a major operation in
which a doctor cuts through the mother's stomach into her womb and removes the baby
through the opening. Mothers who have had a C-section can often have future babies normally. Look for a
birth place in which 6 out of 10 women (60%) or more of the mothers who have
had C-sections go on to have their other babies through the birth canal.
Mother-friendly birth centers,
hospitals, and home birth services are sensitive to the mother's culture. They
know that mothers and families have differing beliefs, values, and customs.
For example, you may have a custom
that only women may be with you during labor and birth. Or perhaps your beliefs
include a religious ritual to be done after birth. There are many other
examples that may be very important to you. If the place and the people are
mother-friendly, they will support you in doing what you want to do. Before
labor starts tell your doctor or midwife special things you want.
In mother-friendly settings, you can
walk around and move about as you choose during labor. You can choose the positions that are most
comfortable and work best for you during labor and birth. (There may be a
medical reason for you to be in a certain position.) Mother-friendly settings
almost never put a woman flat on her back with her legs up in stirrups for the
birth.
Ask, "Can my doctor or midwife
come with me if I have to be moved to another place during labor? Can you help
me find people or agencies in my community who can help me before and after the
baby is born?"
Mother-friendly places and people will
have a specific plan for keeping in touch with the other people who are caring
for you. They will talk to others who give you birth care. They will help you
find people or agencies in your
community to help you. For example, they may put you in touch with someone
who can help you with breastfeeding.
Experts say some methods of care
during labor and birth are better and healthier for mothers and babies. Medical
research shows us which methods of care are better and healthier.
Mother-friendly settings only use methods that have been proven to be best by scientific evidence.
Sometimes birth centers, hospitals,
and home birth services use methods that are not proven to be best for the
mother or the baby. For example, research has shown it's usually not helpful to
break
the bag of waters.
Here is a list of things we recommend
you ask about. They do not help and may hurt healthy mothers and babies. They
are not proven to be best for the mother or baby and are not mother-friendly.
A birth center, hospital, or home
birth service that does these things for most of the mothers is not
mother-friendly. Remember, these should not be used without a special medical
reason.
The people who care for you should
know how to help you cope with labor. They should know about ways of dealing
with your pain that don't use drugs. They should suggest such things as
changing your position, relaxing in a warm bath, having a massage, and using
music. These are called comfort
measures.
Comfort measures help you handle your
labor more easily and help you feel more in control. The people who care for
you will not try to persuade you to use a drug for pain unless you need it to
take care of a special medical problem. All drugs affect the baby.
Mother-friendly places and people will
encourage mothers and families to touch, hold, breastfeed,
and care for their babies as much as they can. They will encourage this
even if your baby is born early or has a medical problem at birth. (However,
there may be a special medical reason you shouldn't hold and care for your
baby.)
Medical research does not show a need
to circumcise baby boys. It is painful and risky. Mother-friendly birth places
discourage circumcision unless it is for religious reasons.
The World Health Organization made
this list of ways birth services support breastfeeding.
More
resources:
More
information about the questions
to ask caregivers, birth places, doulas, etc. can be found on the website for
the Maternity Center Association. Also, see their article on the Rights of Childbearing Women.
You may
find that there are no birth options available to you which meet all of the
CIMS recommendations. Here is some data to help you know what to expect in the
“real world” of US maternity care….
Ideals versus
Realities, a look at how US statistics compare to the CIMS guidelines.
Ideals
versus Seattle Realities: How Do Seattle Area
Hospitals Measure Up to CIMS guidelines?
How would you know you’d chosen the right birthplace
for you?
This article addresses the choice of birthplace from a very
logical, left-brain view. But truly, one of the best ways to know if a birth
place is right for you is to listen to your gut! We birth most easily in the
place that feels safest to us, where we feel nurtured, cared for, and
protected. Tour your possible birth places, and ask yourself: “Would I feel
safe here?”
Imagine a
place where everyone around you…
Believes in
the importance of the natural process
Honors the
work you do…. Acts as if birth is
sacred…
Speaks with
affirming words and acts calmly…
Respects
your need to be spontaneous – to eat, drink, make sounds, move around, cry,
shout, laugh…
Keeps you
and the baby together at all times.
Helps the
father be supportive and fulfill his potential.
Birth in a sanctuary.
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