Caregiver Compatability Questionnaire

[granola_mom]

I'm starting to realize the importance of being compatible with your caregiver, and making sure you are both on the same page. So I decided to type out a questionnaire for my clients to ask their caregivers and have decided to do my first prenatal visit ASAP so we can make sure they have the right caregiver for them, then do additional prenatals later in the pregnancy. Though I'd share this handout with all of you and would love some feedback and let me know of anything I could add. Thanks!!!

Are You Compatible With Your Caregiver?

This is a list of questions to ask a prospective caregiver, preferably during the first prenatal interview. If it is later into your pregnancy, you may want to get these questions answered to determine whether your views of how your labour and birth will go are in line. If you find that you have very different ideas, it is best to look for a different caregiver that is more in line with your ideas. You will both be happier for it in the end. The type of birth you end up having has a lot to do with your caregiver.
Prenatal Care

• Which Childbirth classes do you recommend? (ie hospital or private)
• What is your advice regarding pregnancy health: exercise, nutrition, weight gain, etc.
• What are your hospital affiliations?
• Which prenatal tests are routine? How involved can I be in deciding which to accept?
• What is your call schedule? (group or solo practice; birth philosophy of other doctors)
• What is your vacation schedule? (If s/he is away during your due date)

Labour and Delivery
Management of Labour

• How do you manage the pain of childbirth? (ie encouragement, medication, etc)
• What is your view on natural childbirth? Will you support me in achieving this goal, and if so, how?
• Will you allow me to walk during labour?
• Will you allow me to improvise various labour, birthing and delivery positions?
• How do you feel about having labour support persons present during the birth? (doula, babies father, older children, etc.)
• How do you feel about birth plans?
• Will you allow me to use water during labour? (Ie bath, shower.)
• Do you allow water births?
• How far into labour can I stay at home?
• Can I eat and/or drink as I please during active labour?
• What will be the locale of my labour and delivery?
• Will I be allowed to personalize the atmosphere (with music, lighting, items from home)?
• How would you feel if I decided against a test or procedure you recommend to me?
• Will you go over the risks, benefits and alternatives of each procedure, test and intervention?

Interventions- Use and Prevention

• Do you use electronic fetal monitoring routinely? (continuous, intermittent, telemetry, none.)
• Under what circumstances would you suggest using the internal monitor?
• Is it possible to do intermittent checks with a Doppler as an alternative to EFM?
• How often do you check blood pressure?
• Do you routinely administer intravenous fluids/heploc? Under what circumstances do you use the I.V.?
• Will you help me prevent a perineal tear, and if so, how?
• How often do you perform episiotomy and under what circumstances? (around ten percent is a low rate, while fifty percent is a very high rate)
• How often and under what circumstances do you use forceps or vacuum extractor?
• What is your rate of spontaneous vaginal delivery?
• What is your criteria for cesarean birth?
• What is your vaginal birth after cesarean rate, and do you encourage it over repeat cesarean? (the rate should be at least 70%)
• What is your cesarean birth rate? (A low rate will be around ten percent. A percentage of more than fifteen is high.)
• For what reasons do you artificially rupture the membranes? Will you perform AROM before labour begins, in early labour and/or only later in the first stage or second stage?
• How do you manage a slow to progress labour?
• What is your definition of failure to progress?
• What strategies or procedures do you employ for a slow labour?
• What interventions do you use to speed labour and at what point would they be used?
• Do you regularly use oxytocin to augment labour?
• What is your policy and recommendations on epidural anesthesia?
• What is your induction policy? (how far past due date s/he recommends it, alternatives)
• When and under what circumstances do you do catheterization?
• How do you manage the pushing stage? (coached pushing, following natural urge, positions for pushing and birth)
• How often do you perform vaginal exams during labour?
• How much time will you allow for the second stage before assisting delivery?

Postpartum Care

• Do you routinely suction the newborn?
• Will you allow me to hold my baby immediately after birth?
• Can I breastfeeding immediately?
• Will you allow postponing of weighing and administering eye drops until we have some time together?
• The weighing of the baby, administration of eye drops, the pediatric exam, baby’s first bath
• What kind of baby feeding support is available? (breastfeeding support, avoiding supplement bottles and pacifiers)
• What is your policy on circumcision?
• Can you tell me about postpartum medication and treatments for me and my baby?
• What will the length of my hospital stay be, barring complications?

[ctowndoula]

Have you read "10 Questions to Ask A Care Provider"? Some similar stuff.
www.motherfriendly.org

[DoulaCBE]

I think it's a great questionnaire, but I think it's really long and not likely to actually be covered in what we see as a standard prenatal visit with an OB around here.

[UtahDoula]

How do you see your clients using this? Because I can' t imagine a sitdown between patient and doctor or midwife where all these questions are asked and answered.

[granola_mom]

How I plan on suggesting my clients use it is to determine what is most important to them. The list is to give them ideas. I don't expect them to sit down with their caregiver and go down the list, asking every question. Perhaps circling the ones that are important to them... sometimes seeing everything and all the possible questions written down helps. Sometimes they don't know what to ask or havent thought about what is important to them.

[UtahDoula]

Then I would recommend rewriting the introductory paragraph, where you suggest these questions should be asked at the first prenatal. Because that really does make it sound like every question should be asked at ONE visit.

[AussieDoula]

Quote:

Originally Posted by UtahDoula How do you see your clients using this? Because I can' t imagine a sitdown between patient and doctor or midwife where all these questions are asked and answered.

Why not? I personally used a list as long as this one during my own pregnancy.

I feel that communication is vital to having a positive birth experience. If your prenatals happen to take longer than the 5 minutes care providers assume you'll be happy with, then so be it. Maybe if more women felt confident enough to ask all of their questions and push for the detailed answers they deserve, perhaps we will see an end to doctor visits being sheduled in 10-15 minute time slots (only a third of which you actually get to see the specialist) and more appointments lasting the 30 minutes that patients usually need talking to their doctors (not the intake nurse) in this country. We pay for these services; it is frustrating that so many women start off their patient/doctor relationship by playing the hostess and are fearful of "inconveniencing" their care providers. Change for the better isn't created by continuing to do the accepted minimum standard.

Quote:

Originally Posted by UtahDoula Then I would recommend rewriting the introductory paragraph, where you suggest these questions should be asked at the first prenatal. Because that really does make it sound like every question should be asked at ONE visit.

The opening paragraph suggests asking these questions at their first prenatal interview - presumably before they have hired a care provider. In my opinion, this is the best time to make sure their philosophies are in line with your own.

Chloe, I think your list covers many things women forget or are too timid to ask. Just having a list to focus on can totally change their confidence level, and can help facilitate open communication about everyone's expectations. I am a little concerned about some of the wording you chose ("Will you allow me to") but other than that, everything looks great!

You may even want to consider adding a few questions about what would occur if there were complications with mama or baby. Often the best preparation is knowing in advance what will happen.

[UtahDoula]

Why not? Because I can't imagine most providers around here spending that much time. Most doctors and hospital MW around here don't even DO interviews - you just set up for a first prenatal. At the birth center, all interview stuff happens at a once a month open house - again, I don't see a Q&A of this depth happening there. Maybe with the home birth midwives. Maybe.
But it isn't very realistic for women to go through all those questions in one interview.

[DoulaCBE]

Quote:

Originally Posted by AussieDoula Why not? I personally used a list as long as this one during my own pregnancy. I feel that communication is vital to having a positive birth experience. If your prenatals happen to take longer than the 5 minutes care providers assume you'll be happy with, then so be it. Maybe if more women felt confident enough to ask all of their questions and push for the detailed answers they deserve, perhaps we will see an end to doctor visits being sheduled in 10-15 minute time slots (only a third of which you actually get to see the specialist) and more appointments lasting the 30 minutes that patients usually need talking to their doctors (not the intake nurse) in this country. We pay for these services; it is frustrating that so many women start off their patient/doctor relationship by playing the hostess and are fearful of "inconveniencing" their care providers. Change for the better isn't created by continuing to do the accepted minimum standard.

The duration of appointments are also largely governed by insurance company pay outs. In order to make a living and cover their overhead they need to see X amount of patients in one day.

Again, I think it's a great handout, but most doulas aren't seeing clients before they're pregnant or in the first trimester.

Something targeted at how to find out if your care giver is supportive in the 2nd and 3rd trimester and how to change providers if yours no longer meets your needs would also be a great thing.

I just told a woman today to follow her gut. She hadn't had anything directly from her provider, yet, but all the birth stories she's hearing of women with this practice are all things she doesn't want. I gave her the name of two alternatives and once again encouraged her to follow her gut. We'll see what she does.

[MyDoulaStacia]

Quote:

Originally Posted by ctowndoula Have you read "10 Questions to Ask A Care Provider"? Some similar stuff. www.motherfriendly.org

That's what I hand out to my my clients.

[MothertheMother]

I like your line of thinking, Aussie. Just because it is the way it is doesn't mean it is the way it should be. I believe women do need to start asking more questions and getting more answers before they end up in stirrups!

I also agree that the language could be worked out a bit better. I like the idea of asking open ended questions more than yes/no questions so you don't end up with a provider that tells you what you want to hear. ie Can I breastfeed immediately? What doctor is going to sit there and say "No, we won't let you do that" A question that might open up more communication could be "Besides medical emergencies, what circumstances would keep me from breastfeeding right away?"
I do like that the list is long and detailed and you clients are getting the message that there are lots of things they should know from their doctor before they head to L&D. The biggest problem IMO is that women just don't know what questions to ask!
Great thinking!

[missilla]

i like the questionair thanks for posting it i use something similar

[granola_mom]

I personally like that it is long, and even if it takes several appts to get everything answered, I definitely believe that each woman should be aware of what is going on beforehand and either be able to find a better caregiver or discuss it with her doctor or midwife before she is having contractions.

Sometimes first time moms don't know all the different decisions and options and cant think of questions to ask. I know I didn't! I was lucky that I had an amazing midwife who was very intuitive of my desires, but I know next time I will be asking a lot of questions long before labour to make sure we're on the same page... not necessarily all of these things if I trust her... but for example in my first pregnancy I never thought to ask how many vaginal exams are done and I would definitely ask that next time!

I will work on the wording. And I agree that just because nowadays prenatals don't allow time for any questions, that that should mean women should accept that. Perhaps if we started wanting to be more involved in our health care, things would change. For the first half of my pregnancy I was with a doctor and our prenatals lasted ten minutes with little talking, mostly instructing and delegating on his part, and when I wanted to discuss birth plans he told me "you do that at 37 weeks with your OB!" Right after that I left and found a midwife, and our prenatals often lasted an hour and I got all my questions answered and felt empowered. Why can't people with a doctor have that?

[suz]

Very good point... I appreciate you posting the questionnaire, i am new at this, can i use it? I haven't given birth yet (or for that matter supported a mom through one as a doula) but i think i would want to know the answers to all of those questions and if the doc doesn't want to take the time to answer them then that would be a red flag to me anyway. IMHO they are there to serve the momma, not the other way around... Good communication with patients is a key to good patient care. Anyone every had a doc walk out of the room while they were in the middle of a sentence? I have... I know they need to see X number of patients a day to make a living, but i don't know any OBs or any docs for that matter that are just scraping by.
Sorry, i will get off of my now...

[granola_mom]

Sure, of course anyone is free to use it. Thanks for all your input.