When deciding on an Obstetrician for your pregnancy and birth care it is important you go with one who aligns with your own beliefs about birth and one who will support you on your journey. Remember this is your body, your baby and your journey. You may like to think about having a short list of Obstetricians (2-3) to meet with and ask some questions before deciding if you want to continue your pregnancy and birth care through them.
When asking questions, particularly ones around interventions, do your own research first on the birthing statistics in Australia, your state and even the hospital you’re looking to birth in. Having this knowledge base can help you really consider the answers you receive.
Below are just some of the questions you may like to think about asking, you can add your own to this or take some away.
1. What are your philosophies and beliefs about birth. Do you trust the natural physiological process of birth?
You can gain a lot of information about an Obstetricians practice and beliefs around birth when asking this question. If there is the trust in birth, they are more likely to support you. If there is pushback here this is a red flag. Everyone needs to be on the same page from the beginning. Obstetricians who support vaginal births will be keen to discuss ways in which you can prepare for your birth with particular techniques and education.
2. Who is your back up Obstetrician if you cannot attend my birth. Do you have planned time off around my birth?
It is really important to know who the backup obstetrician is and whether or not they have the same birthing philosophies as your chosen Doctor. This can eliminate stress around the time of your birth and can provide comfort if in the event your Doctor is unable to attend your birth. It is also good to know when their planned time off is during your pregnancy. It can be really disappointing, along with increasing stress if you find out at 38 weeks that your Doctor has a planned week off when you are 40 weeks.
3. What do you think about Doulas?
As the birthing woman you are entitled to have your supports with you on the day you give birth. Unfortunately, in recent times there has been a push back on Doulas where some hospitals and even Obstetricians in Australia will not allow or support a Doula. If you are planning on having a Doula it is really important to gauge what your Doctor thinks of them and if they are happy to have them along for the journey. If there is hesitation here from the Doctor and you are planning or would very much like a Doula, then you might wish to choose another Doctor.
4. Are you skilled in and would you support a vaginal breech birth?
Breech births are becoming very rare in hospital settings as there are not many Obstetricians who will support a breech vaginal birth. There are many reasons for this, some have not been involved in enough, some don’t feel comfortable or prefer to do caesareans to reduce risk of potential complications. If this is something you feel confident in doing, you need to have a confident care provider who is highly skilled and supportive. Ask how many breech births they have been involved in and in what circumstances would they not support/advise one. There are only a few Obstetricians in Melbourne who support breech vaginal births.
5. Do you support and encourage VBAC’s?
If you are planning your subsequent birth where your previous birth was a caesarean, and you would like to explore and attempt a VBAC it is essential you have a Doctor who will guide you and support you. Asking this early will help to prevent any confusion and potential conflict later on in the pregnancy if they turn around and no longer support your birth wishes. Many women who wish to have a VBAC will be successful, one of the contributing factors of this is having supportive caregivers. Ask them how they will support you to achieve this. When would they intervene, how long are they comfortable for you to labour for, how long in the pregnancy are they comfortable for you to go over ‘dates?’.
6. How far over 40 weeks will you support a woman before recommending induction of labour?
If you are wanting to achieve a spontaneous, physiological birth you need someone who will be comfortable in letting you go to your comfortable timeframe. Some care providers will begin offering inductions from 38 weeks and others will offer from 40 weeks, even if there is no medical indication. You need to know what your comfort level is and know you will be supported outside of medical reasons where intervention may be required.
7. What is your episiotomy rate and in what circumstances would you consider doing one?
It is important to note that there is no research to support routine episiotomies and in fact research supports natural tearing over episiotomies for better recovery. In some cases, they can be justified however, but before your birth you need to understand what these reasons are and in what circumstances the Doctor would recommend doing one.
8. When would you consider a baby to be too big for a spontaneous labour or vaginal delivery?
The big baby debate is a heated discussion amongst many practitioners. Research does not support induction of labour for suspected big baby >4kg. Some care providers will routinely do ultrasounds and fundal height measurements throughout the pregnancy care, particularly in the third trimester and again research does not support the accuracy of these. Women birth big babies all the time and with little or no intervention required. Not every baby needs to fit into the ‘average size’ bracket, bigger babies may be common in your family tree with genetics. Having a big baby does not mean you need to have an induction or scheduled caesarean.
9. What is your caesarean rate?
This is a simple question but one you can create an in-depth discussion around. Asking what their reasons are for recommending a caesarean birth and at what gestation do they perform them. Would they support you labouring first then having one to help close the hormonal gaps that can occur with caesarean births. Do they offer gentle or family centred caesareans where delayed cord clamping is occurring, skin to skin initiation straight away, gentle emergence of baby or mother lifting her baby from her belly in a maternal assisted caesarean.
10. What is your idea of a normal timeframe on labour as well as the second stage of labour?
If you are wanting a physiological birth, you will need time and patience from your care provider. Knowing if they have limits to this is important in a deciding to go with them for your pregnancy care. What are they comfortable with? If you go over this, will they want to intervene with augmentation of your labour or recommend caesarean or if you and your baby are perfectly well will they be comfortable to let you go and allow things to naturally progress. Also, what timeframe do they have for second stage labour before recommending an assisted birth (forceps/ventouse).
11. What is your induction rate? And how often would you need to augment a labour?
Research does suggest that private care has higher rates of induction, and some care providers prefer to induce a woman than to wait for spontaneous labour. There are high induction rates in Australia with 48% of first time mums having one and 35% of all birthing women overall (Australian Mothers and babies Report 2020, released in 2022). Remember this is their business and they will run it according to how it works best for them. Ask about the type of situations where one would be recommended, as well as when they would augment (speed up) a labour (this part can be incorporated with the above question).
12. Will you support me birthing in any position I choose? Side lying, standing, all fours etc.
Birthing upright is more beneficial for the mother in many ways. Some Obstetricians will have a preference as to where their patients give birth, that being the bed or close to the bed. However, your comfort is so important, and your body will naturally adopt the correct position to be in to facilitate a smoother decent and birth of your baby. If they prefer you on the bed or in stirrups this is a red flag.
13. For what reasons would you perform a vaginal examination?
This is important to know, both during pregnancy and labour. There are many ways a labour can be assessed for progress and knowing how they assess this is important to consider. Outside of an induction of labour how often would they perform vaginal examinations? Are they happy to not do examinations if everything is progressing well. If you have experienced trauma in the past or just do not feel comfortable with these, it is important to state this and make it well known. Some care providers will begin offering vaginal examinations from 37 weeks to assess the cervix for labour preparation, this may be another red flag for you, particularly if you are wanting to achieve a spontaneous labour.
14. Do you support birth plans/preferences?
This is really good to know, a great care provider will support your preference and do what they can to honour them during your labour and birth. Having written preferences is a great tool for advocacy and gives care providers a good understanding on how they can best support you to achieve the birth you desire. If care providers are against birth preferences this is a red flag as it can indicate the level of control, they desire for your birth. Remember it’s not about them!
While this may seem daunting to sit and ask your Doctor these questions, it is important to get a clear understanding of how they practice. This is such a special time in your life, and you will carry many memories from this. You want this experience to be a positive one.
If you feel uneasy during your first appointment, chances are that feeling will not disappear. You need to feel comfortable during your appointments and also comfortable with the person who will be at your birth. If you find after your appointment and asking these questions that the Obstetrician is not best for you, continue to search for the right one, you do not have to go with the very first one you meet.
My name is Vanessa Barnard, I am the founder of Illoura Birth. I am a Childbirth and Newborn Educator, Doula and Paediatric Nurse. My mission is to support families on the journey to meeting their baby with holistic and evidence-based information. My focus is to empower, and boost confidence within you to make an informed decision.
I can be contacted by email at illourabirth@gmail.com or visit my website and learn more about my birth and newborn educational services, postpartum support packages and more blog articles.
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