please review my list of questions

[Momma Aimee]

I am not PG nor are we TTC -- YET -- but I found a CNM I want to meet with. she encourages family to come to the pratice before TTC for education, health and support. I am to meet with her soon.

Here is the looong list of questions I have so far. Have I missed anything?

1. How long have you been in practice? How many babies have you delivered?

2. What have the worst emergencies you have dealt with? How did they turn out?

3. How many babies due at a certain time do you take? If I am your client before TTC, will I be sure to get you to delivery my baby? What if you have a number of clients due at the same time?

4. What healthy woman care do you offer? Paps? Etc? Only for clients TTC or for any woman?

5. Can I continue my OBGYN care with you after the birth of a child (we plan to have more than one). Can you help me with BC after our children are born?

6. Do you refer to your consulting OBGYNs for non-baby related OBGYN care?

7. If your clients are only TTC; at what point can I become a client?

8. What pre-conception counseling and testing is available? Can it be billed to insurance as a regular check-up; if not what does it cost? What medical test do you do before conception? ---I have read that many tests done when you are first pregnant – if done before conception allow you to better get a grip medically before conception?

9. Are there any pre-conception needs for my husband? Diet? And so on? What role does his health play in baby’s health at conception?

10. What pre-conception diet changes do you suggest? Should one start something like the Bradley diet before conception – while TTC to ensure proper nutrition from the moment of conception on?

11. What childbirth prep books and classes do you offer or suggest? Any books you suggest besides the ones listed on your site? What about classes? Bradley? Others?

12. Can you refer you to a Bradley instructor? How early do you suggest we start that? I want the 10 or 112 week class.

13. Do you have a recommended reading list for TTC and for pregnancy? What about infant care and so on? Again, any suggestions beyond the site list?

14. I have a list of books I have picked out on-line; can you review that list and tell me of the better ones, or the ones not worth reading?

15. What exercise do you suggest? TTC? Pregnant?

16. Do you bill insurance like any other health care provider? Do you accept BCBS – federal employee plan?

17. What about lab work and tests? Blood work? Glucose? Strep B? What is routine? Is anything included? Or is all billed extra? How expensive is that usually? What do these tests determine / why are they used?

18. What about prenatal testing? Do you recommend any? What determines that? What information do you have available about tests for us to read and consider if we want them? Can it be billed to insurance? How expensive is it if not?
.
19. Can we tour the hospital before conception, early in pregnancy? Do you labor, deliver and stay all in one room? Do you room in for the baby and the father? Is that possible if we are willing to pay extra for a private room? Are queen sized beds available for us to family sleep?

20. Is your practice supportive of co-sleeping and a family bed?

21. is there a separate unit for natural births, or is it just one basic ob unit

22. Can I eat during labor? Drink? Walk around?

23. Is photography and / or video tape allowed? Can you help me find a photographer if we choose that? Can I have a friend or family member do it?

24. Who can I have in the labor room with me? Who can I have in the delivery room with me?

25. How many nurses are on duty? Will we have the same nurse for her/his whole shift? Or will there be lots of people in and out/ We’d prefer our care team not be constantly changing.

26. how long are you in hospital after the birth? What effects this? What effect when you can take the baby home?

27. Is the doula services a separate fee (I assume it would have to be as she is not a medical necessity)? How is that charged? can you bring in an outside doula or do you have to use theirs? How busy is the doula; how much attention before, during and after the birth is available?

28. What is husbands role? Mine is currently hesitant. He wants to be there; but not watch, not cut the cord and so on. I need for him to feel comfortable. Encouraged to be active but not made to feel bad if he won’t.

29. Are hot tubs available for labor? What about frequent hot showers to ease pain?

30. What are the birthing options? Birth chair? What physical support do you suggest for birthing in an upright position?

31. do you do routine "checks' for dilation?

32. What do you do for slow labor? What do you define as slow?

33. How far past the official due date will you allow me to go? What happens if I pass that point?

34. What experience is there in the group for depression? Both during pregnancy and post-partum? I am currently medicated. I am working with a therapist who is confident in my ability to go off medication to get pregnant, carry the baby and hopefully to BF. I might have to go back on medication after the birth. Would I still be a candidate for your practice? Is this something you have dealt with before? I have read a great deal about BF and my medications; there are medication that barely pass though to the milk. Would your practice be supportive of my Bfing if I go back on my medication.

35. The CNM would deliver my baby at the hospital. That is what I want. Is the doctor on call just in case? I know they consult. What is their role? Or if something happen during delivery do you get “luck of the draw” doctor from emergency?

36. If I have to transfer to OBGYN care at some point during the delivery…how much control do I retain? Will the CNM and/or doula stay with me? Would the care become routine OBGYN or would I still be able to stay as natural as possible?

37. If – at some point during the pregnancy I become “high risk” can I transfer to one of those doctors? Would I still be able to contract for Doula care? How natural a child birth would be possible at that point?

38. What is an emergency? When would I go from CNM care to doctor’s care?

39. Do you use any monitors? What determines if they are necessary?

40. what is c section rate, what can be done ensure I avoid one? Will the CNM stay with me, and/or the doula if I have to have one?

41. Do you have kids? How did you birth them? What did you learn for that experience?

42. What breastfeeding support is available? At the hospital and afterwards? Can I call in with questions, or come in, after the first few weeks if I still am struggling or just have questions? Do you support extended BF – say up to two years of age? What are your feeling on weaning?

[TurboClaudia]

Aimee:

Wow! That IS a loooooooong list of questions. I think you covered most everything.

Are both you and your partner going to meet with this CNM? Two sets of ears would probably be helpful since you have many questions.

You may consider grouping your questions together around the same topic (i.e. well-woman care and pre-conception/post-birth, pregnancy care, laboring, postpartum/breastfeeding support) so you are clear on what answers you get. You may also consider asking some more open-ended questions like what is your general philosophy about birthing and what is your typical protocol for care during pregnancy. The things the care provider focuses on when answering these questions will give you a hint of what her philosophy is.

warmly,
claudia

[Momma Aimee]

Here is the CURRENT list. I have goruped by heading. I knw it is loooong. But a lot of the questions all relate and follow each other.

Questions for Nurse – Midwife

General:

1. How long have you been in practice? How many babies have you delivered?

2. What have the worst emergencies you have dealt with? How did they turn out?

3. How many babies due at a certain time do you take? If I am your client before TTC, will I be sure to get you to delivery my baby? What if you have a number of clients due at the same time?

4. What healthy woman care do you offer? Paps? Etc? Only for clients TTC or for any woman?

5. Do you bill insurance like any other health care provider? Do you accept BCBS – federal employee plan? If not is there someone that can help me with insurance and required paperwork?

6. What about lab work and tests? Blood work? Glucose? Strep B? What is routine? During PG and TTC? Is anything included? Or is all billed extra? How expensive is that usually? What do these tests determine / why are they used? I am interested in a thyroid test (mom is on medication) as well as blood sugar. I’d like an STD screen before TTC – am I symptom free but I read that doesn’t always matter. Could those be done? Or would I need to ask a GP to do them and send you the results?

7. Can I continue my OBGYN care with you after the birth of a child (we plan to have more than one). Can you help me with BC after our children are born?

8. Do you refer to your consulting OBGYNs for non-baby related OBGYN care? Or do I have to find my own?

9. What exercise do you suggest? TTC? Pregnant? What is the most important fitness? Flexibility? Strength in abs and back? Endurance? Cardo?

10. What are your views on herbs and supplements? While TTC, while PG and while Bfing? Are there any that are useful to TTC, or to start labor that is late or slow? Are there any that help with milk production. I do not like to experiment and I am fairly conservative; but I am open to the fact that some maybe helpful at limited times.

11. Is your practice supportive of co-sleeping and a family bed?

12. Do you have kids? How did you birth them? What did you learn for that experience?

13. I know you have other CNMs available if you can’t make a delivery. Do we meet them as a routine; or only if we need them?

Trying to Conceive

1. If your clients are only TTC; at what point can I become a client?

2. What pre-conception counseling and testing is available? Can it be billed to insurance as a regular check-up; if not what does it cost? What medical test do you do before conception? ---I have read that many tests done when you are first pregnant – if done before conception allow you to better get a grip medically before conception?

3. Are there any pre-conception needs for my husband? Diet? And so on? What role does his health play in baby’s health at conception?

4. What pre-conception diet changes do you suggest? Should one start something like the Bradley diet before conception – while TTC to ensure proper nutrition from the moment of conception on?

5. How would a 8-hour a day cashier job effect TTC?

6. I have been off the Pill since Aug of 2003. What effect could that have on TTC; now or in a year? Do you know anything about anti-depressant medications and any effect they might have on TTC after going off them?

7. Do you have a recommended reading list for TTC and for pregnancy? What about infant care and so on? Again, any suggestions beyond the site list?

8. I am taking RanibowLight Pre-nautilus now. I will bring in the ingredient list or send it to you. Are there others that you recommend?

Pregnant Care

1. What childbirth prep books and classes do you offer or suggest? Any books you suggest besides the ones listed on your site? What about classes? Bradley? Others?

2. Can you refer you to a Bradley instructor? How early do you suggest we start that? I want the 10 or 12 week class.

3. What about prenatal testing? Do you recommend any? What determines that? What information do you have available about tests for us to read and consider if we want them? Can it be billed to insurance? How expensive is it if not?

4. How do you involve the father in the pregnancy care? Is he welcome at all visits?

5. If – at some point during the pregnancy I become “high risk” can I transfer to one of those doctors? Would I still be able to contract for Doula care? How natural a child birth would be possible at that point?

Delivery

1. Can we tour the hospital before conception, early in pregnancy? Do you labor, deliver and stay all in one room? Do you room in for the baby and the father? Is that possible if we are willing to pay extra for a private room? Are queen-sized beds available for us to family sleep?

2. Can the baby be placed on me instantly? Can the cord be allowed to pulse before cutting? Can the cord be cut and the baby cleaned while on me? Can we give the baby time to breastfeed right upon birth before disturbing it to clean/weigh and so on?

3. How far past the official due date will you allow me to go? What happens if I pass that point?

4. How big a baby will you deliver? How do you determine the baby size?

5. Is there a separate unit at the hospital for natural births, or is it just one basic ob unit?

6. Is the hospital supportive of co-sleeping, rooming-in and BF?

7. Will a birth plan be respected? To what extent?

8. Can I eat during labor? Drink? Walk around? Massage? Bring music? Talk on the phone (my two bestfriends are in MI and VA)?

9. I am a little afraid of the pain. I want a natural birth; I want it to be drug free. I understand that until that cord is cut everything I get, the baby gets and I will not risk that. How can we approach this. What “help” is there for me? Scott is unsure I can do it, my mom really thinks I need an eperdural. One of my two bestfriends had her’s totally medication free and is supportive.

10. Is photography and / or videotape allowed? Can you help me find a photographer if we choose that? Can I have a friend or family member do it? Will they ever be asked to leave or stop taping?

11. How many nurses are on duty? Will we have the same nurse for her/his whole shift? Or will there be lots of people in and out? We’d prefer our care team not be constantly changing. Who will be in and out besides the nurse and you and the doula (if we choose to go that route)?

12. Who can I have in the labor room with me? Who can I have in the delivery room with me?

13. How long are you in hospital after the birth? What effects this? What effect when you can take the baby home?

14. What is the hospital security for the babies like?

15. What is husband’s role? Mine is currently hesitant. He wants to be there; but not watch, not cut the cord and so on. I need for him to feel comfortable. Encouraged to be active but not made to feel bad if he won’t. Are hot tubs available for labor? What about frequent hot showers to ease pain?

16. What are the birthing options? Birth chair? What physical support do you suggest for birthing in an upright position?

17. do you do routine "checks' for dilation?

18. What do you do for slow labor? What do you define as slow?

19. What do you do if I tear? Can you stitch me or does an MD have to?

20. The CNM would deliver my baby at the hospital. That is what I want. Is the doctor on call just in case? I know they consult. What is their role? Or if something happen during delivery do you get “luck of the draw” doctor from emergency?

21. If I have to transfer to OBGYN care at some point during the delivery…how much control do I retain? Will the CNM and/or doula stay with me? Would the care become routine OBGYN or would I still be able to stay as natural as possible?

22. Do you use any monitors? What determines if they are necessary?

23. What is an emergency? When would I go from CNM care to doctor’s care?

24. what is c section rate, what can be done ensure I avoid one? Will the CNM stay with me, and/or the doula if I have to have one?

Other / After care

1. I have a list of books I have picked out on-line; can you review that list and tell me of the better ones, or the ones not worth reading? How can I pick out “middle of the road” solid books that are not just all preaching and hype?

2. Do you have one or two book suggestions for Scott? He is busy and isn’t a big reader like me. But one or two; great and useable books would be great. I thought of The Birth Partner, Second Edition by Penny Simkin (this is the Bradley partner’s book – correct?) and there is supposed to be a fathering book by Dr Sears. What are your thoughts on these; are there other’s you’d suggest?

3. Are the doula services a separate fee (I assume it would have to be as she is not a medical necessity)? How is that charged? Can you bring in an outside doula or do you have to use theirs? How busy is the doula; how much attention before, during and after the birth is available? Are home visits (before and after) possible?

4. What experience is there in the group for depression? Both during pregnancy and post-partum? I am currently medicated. I am working with a therapist who is confident in my ability to go off medication to get pregnant, carry the baby and hopefully to BF. That is part of my “getting ready” plan. I intend to be totally drug free before TTC. I might have to go back on medication after the birth. Would I still be a candidate for your practice? Is this something you have dealt with before? I have read a great deal about BF and my medications; there are medication that barely pass though to the milk. Would your practice be supportive of my Bfing if I go back on my medication.

5. What breastfeeding support is available? At the hospital and afterwards? Can I call in with questions, or come in, after the first few weeks if I still am struggling or just have questions? Do you support extended BF – say up to two years of age? What are your feelings on weaning?

6. What about vaccinations? We are undecided. I am concerned and Scott is of a more Western Medication background. Can you discuss them with us? Can you suggest solid books (not just scary tactics?)?
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I will add : what is your general philosophy about birthing and what is your typical protocol for care during pregnancy. from your post. Thanks!!

A