Obstetrician
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An Obstetrician is a specialist in high risk pregnancies, high risk births and gynecological surgery. Should you select an OB as your primary caregiver, the likelihood of experiencing interventions is increased as they are trained in surgery and tend to view birth from a pathological viewpoint. Although, you would see the same obstetrician during your pregnancy, depending on the time you go into labour, the obstetrician you have been seeing may not be "on call" and you would get one of the other obstetricians or residents available. The use of obstetricians for a normal low risk woman is unnecessary because of the increased chance of intervention as well as limiting the obstetrician's availability for high risk women genuinely in need of their service.

Philosophical Questions

You should feel free to ask any potential caregiver any questions you may think are relevant to your care, such as:

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What is your training and how many births have you attended?

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How do I contact you between visits if I have any concerns?

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How do I contact you when I am in labour?

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How much time do you normally spend with a labouring woman?

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If a woman is in labour and you are not there, who provides her care?

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Do you have a working relationship with another doctor/midwife if needed? Who and where? What happens in the event that you are unavailable?

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Do you do prenatal checkups? How often? Do you do postpartum checkups?

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Do you offer prenatal classes? Where are they held?

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How will you assist me in preparing for labour?

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What percentage of women receive episiotomies in your practice? How do you prevent the need for episiotomies?

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What percentage of women receive cesarean sections in your practice?

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How long does it take, on average, to prepare for a cesarean section?

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What do you do in emergency situations?

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Do you encourage family-centered maternity care? How do you see this working in practical terms?

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Do you immediately clamp the umbilical cord or do you allow it to stop pulsating before clamping and cutting?

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What medications are available?

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How do your services differ from that of other birth attendants?

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Do you offer water births?

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What is your policy on informed decision making by the parents?

ASAC, 1997

Practical Questions

When would you like me to come to the hospital?

bulletWater breaks
bulletContractions ______ minutes apart, _______ long
bulletIdeal admission at _______ cms

What if my water breaks before labour starts?

bulletCall you and stay home
bulletCome in to office or hospital for monitoring, then home
bulletImmediate admission to hospital

How long after my water breaks will we wait before starting syntocinon?

If my cervix is long and thick, can we use prostaglandin gel even with ruptured membranes? Yes or No

What are your standard admission orders?

bulletIV
bulletContinuous EFM
bulletIntermittent EFM
bulletEating OK
bulletDrink clear fluids
bulletNPO except ice chips
bulletWalking OK
bulletWalking OK with ruptured membranes
bulletShower/bath OK
bulletShower/bath OK with ruptured membranes
bulletAROM at _______ cms
bulletInternal monitor at _______ cms

Do you believe in active management? (defined as progress < 1 cm per hour will be treated by AROM and/or syntocinon)

When can I have an epidural? No earlier than _____ cm, no later than ____ cm

If I use epidural anesthesia, is it allowed to wear off for pushing? Yes or No

If I choose to use narcotic pain relief, what would you prescribe?

Would you prefer that I am in a certain position for the actual birth?

Why do you do episiotomies?

Do you routinely use syntocinon after birth to reduce bleeding?

How long after my due date will we wait to induce labour?

If my labour is induced, what are your policies on

bulletEFM
bulletwalking
bulletshower/bath
bulletbed confinement
bulleteating/drinking

Who is your back-up? Under what circumstances would I see him/her?

If my pediatrician does not have privileges at the hospital where I deliver, who would you recommend for the initial exam?

Kelli Way, ICCE 1996
 
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