1. Can my partner be with me at all times, including in the cesarean operating room? This is first an issue of hospital policy, and then secondly, it's up to individual doctors.
  2. How many other people can I have with me at all times? The role of the helping woman, the doula, is becoming more popular in American hospital births. Some laboring women prefer that they have two women there with them.
  3. What percentage of your patients do you deliver yourself? You naturally assume she'll be there, but many a laboring woman has a rude awakening when an unknown doctor shows up at a time there are enough strangers (nurses and other hospital employees) to cope with as it is. Now your doctor may say (and many have), "Of course, I'll deliver your baby, except if I'm not on call or if I'm out of town." At first hearing, it sounds as though she'll be there. Check further. Ask, "About what percentage of your patients do you personally help deliver -- 75 percent, 50 percent, 30 percent?" She'll have some idea.

    We know from what mothers tell us, which is reinforced in recent studies, how important it is for most of them to have their own doctor there, especially if they have gone to a lot of trouble to choose her. But as most of you will not have a guarantee that Dr. Right will be on call, ask to meet all the other doctors who cover for her, and review your birth preferences with them.Continued from

  4. What is your cesarean rate? ACOG suggests that a reasonable rate is something less than 16 percent, while other observers believe a reasonable rate is even less than that. Ask what are the usual reasons why she performs cesareans? (Is her list compatible with valid reasons?)
  5. What is your definition of high-risk? The following conditions, according to ACOG in 1991, are considered high risk: maternal diabetes, high-blood pressure, heart or kidney disease, sexually transmitted diseases, such as AIDS and herpes, other viruses, including rubella and viral hepatitis, previous or current birth defects, multiple pregnancies, vaginal bleeding during pregnancy, breech position, postdate pregnancy (beyond 42 weeks), alcohol and drug use, smoking, environmental hazards, such as working around certain chemicals, radiation, prematurity, maternal age under 16 or over 35, convulsive disorders, chronic urinary tract infections, and severe anemia.

    Your physician's list might have more or fewer conditions. Just as with the terms bonding and rooming in, the term high risk does not have a uniform accepted definition. If you're labeled high risk, don't assume that you will automatically have problems with your pregnancy. If the consequences of your doctor's high-risk label for you are upsetting, because it requires you to do things you don't want to do (such as frequent use of ultrasound or stress and nonstress tests), get a second opinion.

  6. What is your usual recommendation if pregnancy goes beyond 42 weeks? Some doctors automatically schedule a cesarean, others induce labor, while there are those who wait and see. No research supports intervention for this.
  7. What percentage of your patients have epidurals? Other drugs? Pitocin? Routine IV's? Confinement to bed? (See Chapter 7 other common birth interventions, which you can add to this list.) You are likely to get what your doctor usually prescribes. Remember we discussed the hospital's written rules (#10 in Ten Questions for Hospitals)? The unwritten rule is the doctor's protocol, her usual, routine recommendations for all patients. That's why hospital nurses could answer your questions about specific doctors.
  8. What is your recommendation for the use of the EFM? While the hospital itself is likely to have a policy for use when you first get there, continued use is up to your doctor. She may say that she wants you to use the EFM during all of the labor because either there aren't enough nurses, or none of them will use the fetoscope to monitor your labor. If you like everything else about her, and she's willing to waive the EFM if you have your own nurse, then hire a monitrice. You don't have to take potluck with the staffing.
  9. What is your recommendation for the use of ultrasound? According to the FDA, 80 percent of women use ultrasound at least once during pregnancy. It's most commonly used in the following three instruments: a. Doptone or Doppler, the hand-held fetal stethoscope with transducer that's placed against your abdomen, and is used to listen to your baby's heart beat each month. b. scan, video screen with attached transducer that can determine your baby's gender and due date. c. external EFM, one or two belts with transducer (to monitor baby's heart beat) placed around your abdomen, or newer telemetry models which allow you to carry the transducer in your pocket.

    There are no apparent immediate side effects, and not enough time has passed to know if there are long-term side effects. The FDA and the American Medical Association, however, recommend that ultrasound be used with caution.When you're offered ultrasound, ask yourself if its use this time will make a difference, and ask your doctor if there's an alternative. Will she use a fetoscope, for instance, to listen to the heart beat during your prenatal visits? If you're positive of your menstrual dates (which is just as accurate as the scan), are not interested in knowing your baby's gender in advance, and do not have any unusual occurrences, such as, larger than expected uterus, why not forgo the unknown risk and cost of the scan?