afvinklist It is wise to discuss a number of issues well in advance:

Who is going to support you during labor? Your midwife? The nurse?

How often does she listen to the fetal heartbeat during labor? Are they making a CTG as a routine when you come in? (this means that you have to lie down on a bed for at least 20 min)  Does your midwife/ob use a partogram?

How will labor be diagnosed? Do they believe in latent phase? Do all the midwives and ob’s agree on this or are you left to the personal convictions of the person on call? Do they perform an amniotomy as a routine with the first vaginal exam? Or only when insufficient progress is diagnosed? Does the hospital offer augmentation during the night if needed? What are the options for pain relief?

How often does your midwife or ob cut an epis and for what reason? Do they have experience with the birth stool, birthing on hands and knees or in the bath? What is the cesarean rate in their hospital. In a hospital with over 50% of all baby’s being born via cesarean section you hardly stand a chance of having a normal birth. Be aware that there is a wide variety between hospitals regarding this, and that there is no evidence whatsoever that more cesarean sections improve the outcomes for mother and or baby.

There is lots of evidence that delayed cord clamping is good for the baby, but still this is not done everywhere as a routine.  If the cord is not clamped until pulsations have ceased, the baby gets warm blood full of oxygen pumped into him. He needs this till his own lungs are working properly. This often doesn’t take more than a few minutes but some babies need a bit more time. What is the routine in their practice and in the hospital?

Do they actively manage the birth of the placenta or will they just wait. Are you offered  choice in this?

Arom, cutting an episiotomy, cordclamping, active management of placenta are interventions that require informed consent. Permission should be requested  and should be given. But in practice, on a daily basis, women have their membranes ruptured, or are given shots of pitocin without any explanation, without so much as by your leave, just an announcement.

Maybe you think it’s fine, the midwife and obstetrician  are highly trained professionals. But maybe you want to have the final word about what is done to your body, your baby. When in labor you are not up for discussions.

So discuss things in advance!