Choosing Professional Care
Many women simply call a physician or other
professional and use that person throughout
their pregnancy. If you want a choice in the
type of person who treats you, and in the type
of care and birth experience you'll have, use
the questions in this Appendix. Some questions
are for you to answer, after you meet with a
professional. These questions will help you
understand what qualities you are looking for in
a professional and what type of treatment you
desire. Other questions are for the professional
to answer in your presence, so that you will
know exactly what options you're being offered.
Discuss your choice of professionals and your
treatment options with a counselor or confidant
before making a decision. You have a right to
understand your treatment and to make choices
for yourself and your baby. Utilize that right.
CHOOSING PROFESSIONALS
Choose professionals who will support your
decision to give birth. After speaking to
professionals, analyze what you've heard. Here
are some questions to consider.
Professional's Views on Abortion
* Does this person know that abortion is
hardly ever medically necessary?
* Do you sense respect for your decision to
give birth?
* Does the person have a casual attitude
toward abortion? Or does the individual
recognize that abortion deeply affects many
women?
Professional's Views on Your Right to Seek
and Understand Treatment
* What is the person's reaction if you say
that you might seek a second opinion?
* Is the professional willing to explain side
effects and complications of and reasons for
procedures, drugs, and tests? How about
explaining unfamiliar terms? Or do you hear that
you wouldn't understand or don't need to know?
Do you feel "talked down to"?
* Does this person speak slowly? Clearly?
Intelligently? Truthfully? Do you think some
information is being withheld or misstated?
* If you or your child is facing a medical
difficulty, does your doctor schedule tests to
evaluate the problem, or does the doctor make
diagnoses and sweeping statements without
testing?
* Does your doctor know about recent advances
in medical technology? Is your doctor willing to
find out?
* Will this doctor refer you to another
doctor or to another hospital if necessary?
* If you ask questions, express preferences,
or show feelings, does this person treat you
like an intelligent human being?
* Do you feel comfortable with this person?
Or would you rather switch?
Other Considerations
* How does the professional react when
discussing payment?
* Will insurance pay for your medical
expenses?
* Will the office file any necessary forms
for payment or will you have to do it? Will you
have to pay first and file forms later to be
reimbursed?
* Will a lawyer discuss and evaluate every
option?
* Does a lawyer suggest manipulating the
truth in court? Where might this lead?
* Is a psychologist patient and
compassionate, willing to let you "talk it out,"
or do you feel hurried, pressured, or
misunderstood?
* Does a psychologist seem too quick to
prescribe drugs?
* Is a psychologist or assistant available to
talk in emergencies?
MAKING A CHOICE
Review your answers to the above questions.
Choose a professional who explains procedures,
gives you options and statistics, and respects
your right to give birth. Find one who seems
knowledgeable, flexible, and straightforward.
You need to be able to talk to and trust
professionals so that you will have a good
pregnancy and birth experience.
PLANNING YOUR LABOR AND DELIVERY
You have many choices for labor and delivery.
Today you can have a totally medicated birth
during which you know nothing until you recover
from general anesthesia or you can have a
totally natural birth in which you give birth
squatting or in water and never have an
episiotomy, enema, or medication. Or you can
have anything in between. It's important to know
that, today, you can choose the birth experience
that's best for you.
Speak to other mothers who have recently
given birth. Ask your hospital what birth
options it offers. Read books on childbirth
options. Attend childbirth classes. Get an idea
of the type of birth experience you'd like and
write it down. Then discuss your plan and the
following questions with your doctor or midwife.
Also discuss the recommendations in the
"Pregnant Patient's Bill of Rights" and the
"Pregnant Patient's Responsibilities," as
referred to in Chapter Three. Choose a doctor or
midwife who will give you the plan you want
while also keeping in mind what is safest and
most comfortable for you and your baby.
Questions About Choosing a Birth Experience
* What types of childbirth options do you
offer?
* What is your opinion of my childbirth plan?
* Can you refer me to other women who have
had a birth experience similar to the one I'd
like?
* Where can I learn about natural childbirth?
Can you refer me to natural childbirth classes?
What books on natural childbirth do you
recommend?
* Where can I learn about home birth? What
are the advantages and disadvantages of home
birth? What is your experience with home birth?
Considering my proximity to a hospital in case
of an emergency, would you consider home birth a
good option for me?
* What can you tell me about a medicated
birth? What medications are used? Why? Which can
I request? If I want to refuse medications, can
I do so?
* Do you anticipate a Cesarian section for
me? Do you recommend a local or general
anesthetic? Why?
* Will a partner, relative, or friend be with
me in labor and delivery?
Questions About Labor and Delivery
* How long can I safely stay at home during
early labor? When should I go to the hospital?
How frequent and how long should my contractions
be before I call you? What other signs of labor
should I look for?
* What can I bring to the hospital to occupy
my mind during early labor? How about card
games, books, knitting, or mending? Can I watch
television? Is one available?
* What can I eat or drink during labor? Can I
suck on fruit juice ice cubes or lick lollipops
to give me both liquid and energy? Do I have to
bring these from home? Will the hospital supply
them?
* How much monitoring during labor can I
expect? What examinations will I receive? What
devices will be used? Can I refuse these? What
if I do?
* Must I spend my entire labor lying on a
delivery table, strapped to monitors? What if I
refuse to do this? Can I walk during labor or do
whatever else seems more comfortable?
* Will you, as doctor or midwife, induce
labor? Why? What tests will you do to make sure
that induction is medically necessary? Can I
refuse induction? What might happen if I do? Is
induced labor more difficult for me to manage,
more painful? Might it be ineffective and result
in a Cesarian section? Can I safely wait for
labor to begin or progress naturally?
* Can I try a specific birth technique or
position? How about giving birth while in a
squatting position? Sitting in a birthing chair?
Lying in a delivery room? Resting in a birthing
room? Supported in a water bath? Do I have to
have an episiotomy? A pubic shave? An enema?
Questions About Procedures After Your Baby Is
Born
* What will happen to my baby upon birth?
* Which of these can I request or refuse for
my baby? A dim, quiet birthing room? A warm bath
after birth? Breastfeeding immediately after
birth? Rooming-in totally from birth on?
Circumcision? Bottle-feeding? Breastfeeding?
What are the advantages and disadvantages of
each choice?
* Who can visit me in the hospital? My
spouse?
Children? Relatives? Can they see the baby?
* When can I go home from the hospital? Hours
after birth? A day later? In a few days?
* Will insurance pay for a person to help me
in my home for a few days after I give birth?
A Good Plan
Together with your doctor or midwife, confirm
your plan for labor and delivery. Then write it
down. A few weeks before your due date, give a
copy of your plan to your doctor or midwife and
to the hospital, if you will be giving birth
there. Doing so will increase your chances of
having the birth experience you prefer.
Have copies of the plan with you when you
actually go into labor. Hand the copies out
again to your caregivers and hospital. This will
remind everyone of what you've already planned,
and your caregivers will more likely respect
your choices when you are actually giving birth.
MEDICAL DIFFICULTIES
When you or your baby facees medical
difficulties, you have a right to complete
information. Take this book along with you when
you visit your doctor. Discuss with your
physician the "Pregnant Patient's Bill of
Rights" and the "Pregnant Patient's
Responsibilities," referred to in Chapter Three.
Does your physician agree with these documents?
Also ask your doctor any of the following
questions that fit your circumstances. You may
adapt some questions or think of others. Jot
these down and ask. Write down the answers to
these questions as you discuss them with your
doctor, or tape-record the conversation so that
you have an accurate account.
General Questions to Ask About Medical
Difficulties
* Exactly how is this pregnancy going to
affect me or my baby? What specific problems do
you foresee?
* What is the probability, in percentages, of
one of us developing one of these problems? May
I see the source of your information?
* What tests can determine if these problems
are actually present? Do you recommend these
tests?
* How much do these tests cost? Will my
insurance pay for them?
* If I have these tests, what is the margin
of safety, given in percentages, for me and my
baby? What risks, if any, do my baby and I face
from these tests? What is the percentage of
risk? The severity of risk?
* How accurate are these tests, in
percentages? What is the possibility of error?
* Can these tests be done in this area? If
not, where?
* May I see your medical literature on this
type of testing?
* Would you recommend this testing if I plan
to continue my pregnancy, no matter what the
test reveals?
* What causes these problems? Did my partner
or I do anything to cause these problems? Can we
do anything to keep them from getting worse or
from happening again?
* Is there any treatment for these problems?
What? How costly is it? Will insurance cover it?
* How is treatment done? When must treatment
begin? Is there any reason why treatment must be
done at the time you suggest? Is it possible to
wait? How long?
* What is the probability of success in
treating these problems, given in percentages?
Are there alternate treatments? What are their
success rates?
* May I see your literature on the treatment
of this problem?
* Can you refer me to other women who have
faced these problems? Are there any local or
national support groups for women facing these
problems? How can I contact these groups?
Questions to Ask if You Face Your Own
Possible Death
* Are you saying that I will definitely die
if I have this baby? If so, why? If not, then
what medical problems do you think I will have?
* Are you saying that you expect definite,
life-threatening medical problems with this
pregnancy or are you saying that there might be
medical problems?
* What is your estimate of risk?
* What percentage of women with my condition
have experienced these problems?
* What is the range of severity of these
problems?
* Can I deliver my baby early, then receive
more aggressive treatment?
* Are you concerned that I will be unable to
properly care for my baby because of my
condition? Is this why you are suggesting
abortion?
* May I see literature on pregnancy among
women with my condition?
Questions to Ask if You Have a Baby With
Special Needs or Health Problems
* If prenatal tests indicate that my unborn
child has special needs or health problems, can
you tell how severe these problems will be?
Could you refer me to a parent or institution
that cares for children with these needs? Could
I visit these children?
* Does my child need surgery or medication?
What type? How much? What does this cost? Will
insurance pay for the treatments? * Do you know
of anyone who has made an adoption plan for a
child such as mine?
* If you cannot refer me to anyone, do you
have any suggestions of whom to call for
referral?
* If my child experiences a medical crisis
either before or after birth, will you
aggressively treat the problem?
* Will you deny treatment to my child that
other children would receive? Why or why not?
* Can you give me specific examples of how
you have treated children with this problem
either before or after birth?
* If both my baby and I have medical
difficulties, will you treat my unborn child the
same way you would have if I were healthy?
* Will you fully discuss with me all
treatment or nontreatment options for my child?
* If my child has a fatal abnormality or a
terminal illness, will you respect my wishes to
give my child the best possible chance of
living? Will you allow death to occur naturally
when medical science can do no more to help my
baby?
Questions to Ask if Your Baby Dies
* What makes you certain that my baby has
died?
* What prenatal tests can I have to confirm
that my baby has died?
* Should I have a pregnancy test that
measures the level of pregnancy hormones? Is my
hormonal level at or far below normal limits?
What does this mean?
* What could have caused my baby to die? A
genetic condition? Environmental hazard?
Something I did or did not do? Is there any way
to prevent this from happening in another
pregnancy?
* Is this cramping normal?
* How long will the bleeding last? Why is the
blood so bright? Should these blood clots
concern me?
* Why do I still have a positive pregnancy
test if I have all this bleeding?
* Should I rest?
* Will I hemorrhage?
* Can I get an infection?
* What should I do with the pregnancy tissue?
* Do I need any surgical procedures? Why?
Please describe these procedures in detail. Do
you suggest that I be awake or asleep for these?
What are the advantages and disadvantages of
either option?
* Would you suggest an autopsy for my baby?
How might I arrange for one?
* May I have my baby's body for burial?
* When can I resume sexual relations?
* When can I get pregnant again?
* Will this pregnancy loss happen again? What
can I do to avoid another pregnancy loss?
Evaluating What You Hear
Review your doctor's answers before making
any decisions. Also consult literature on the
topic and strongly consider obtaining a second
and third opinion before choosing treatment.
With a confidant or counselor, separate feelings
from facts before deciding what to do.