APPENDIX E

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.