5 questions to ask your OB/GYN before you go into labor

I recently received my prenatal yoga teacher's certification from the Prenatal Yoga Center in NYC. It's a fantastic yoga studio and support center for both pre-natal and post-natal moms with sites in Manhattan and Brooklyn. The studio and teacher certification program are both run by Deb Flashenberg a certified doula (DONA). As part of our training, she provided us with these 5 questions for our students to share with their doctor.
1. What is your c-section and episiotomy rate? How far past my "due date" can I go? If you watched "The Business of Being Born" then you know that two unnamed hospitals on Long Island have an astounding 40% cesarean rate. Sadly, the majority of cesareans happen around 4 pm and 10 pm. Is it just concidence that this happens to be right before dinner and bedtime? Episiomoties, originally performed for the purpose of preventing tears have actually been proven to not improve the situation and take much longer to heal than tears. The average gestational period for a healthy, fully-developed, human fetus is between 37 and 42 weeks. Be sure that your doctor respects your baby's and your body's timeline.
2. If all is well with mom and baby, do you allow intermittent monitoring? Technology is a wonderful thing...most of the time. But when it comes to constant EFM or electronic fetal monitoring some argue that this advance has actually set us back. Firstly, it requires the mom-to-be to stay bed-ridden or close to it (not ideal for natural labor). Secondly, it places a lot of the medical staff and labor partner's attention on a beeping monitor as opposed to the mom. And most importantly, it's misread too often, leading to unnecessary c-sections. If there are no known concerns for mom and baby, intermiitent (every 20 min) monitoring is ideal.
3. May I labor in any position I find comfortable and effective? If you think about animals in the wild giving birth, you won't find a single one laboring on her back. Movement and position changing will help with pain management.
4. May I push my baby out in any position I find comfortable and effective? If you're going for a natural labor experience, then lying on your back is the worst position for both pain management and moving the baby through the birth canal, especially since you are now working against gravity. Doctors are typically trained to catch babies in one position. Out of their comfort zone, many will only allow their patients to push and deliver on their back. Other positions more conducive to birthing include side lying, squatting, on all fours, or on a birthing stool.
5. What is your philosophy on birth? If I choose not to take pain medication, are you fully supportive of natural birth? Or do you prefer your patients to have a medicated birth? If I have had a previous cesarean, do you support VBACs? While some doctors perceive pregnancy, labor, and birthing as a natural part of life and something every female body is innately equipped to do, other doctors consider pregnancy a medical condition requiring a multitude of medical interventions. Additionally, if you had a previous cesarean, and wish to have a vaginal birth the next time around, some doctors will whole heartedly support this wish while others won't.
For more information about the issues discussed in this article check out Penny Simkin's Birth Partner, Ina May Gaskin's Ina May's Guide to Childbirth and Henci Goer's The Thinking Woman's Guide to a Better Birth.