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 Post subject: what are important questions to ask an OBGYN?
PostPosted: Fri Jul 20, 2012 2:08 pm 
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my husband and i have a "family planning" appt with an OBGYN soon.

i literally know NOTHING about babies, children, pregnancy, etc.
literally nothing.

like im afraid to even ask questions because they are probably the dumbest questions ever thought up. it was a horrifyingly embarassing event just to book this appt so it can only get worse from here.

i know this will be the time to get my head in gear and get answers to important things but since i am starting from literally no knowledge i dont even know where to begin.

so far all i can think up is:

asking if all the supplements/vitamins i take are ok
talking about antidepressants and the cymbalta i currently take

ummmm yeah that's as far as i got.

oooph this is hard >_<

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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Fri Jul 20, 2012 4:08 pm 
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Those questions, plus: are there any other health changes I should make BEFORE I get pregnant (are you at a healthy weight, should you be tested for B-12 or D deficiency?, should your thyroid be checked?) and if they suggest any genetic testing if you are of a certain ethnicity (I would definitely do any genetic testing BEFORE getting pregnant rather than after!). They will probably recommend starting to take folate before trying to conceive.

I would also ask your OB any questions about his/her practice to make sure it's a right fit! Ask about any testing they require of or recommend to patients while pregnant, ask about their C-section rate, what hospital(s) they have privileges in (and then maybe tour those hospitals), etc. You can even ask about labor practices (do you tell women not to eat during labor, do your patients routinely get IVs during labor, what's your epidural rate, what's your episiotomy rate, what positions do women in your practice give birth in or labor in). There are a bunch of websites that have checklists for questions to ask OBs/midwives, I may post an example later if I remember when I'm on my home computer.


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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Fri Jul 20, 2012 4:39 pm 
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Yeah, I'd definitely get a full blood panel, if you can. Check for any vitamin deficiencies that you can work on correcting now. If you really dont know anything about babies/pregnancy, you might also want to check out some books on the subject. I know the Academy of Nutrition and Dietetics (formerly the american dietetic association) has a pretty good book on pregnancy nutrition that could help you with anything you'd need to do prepregnancy.

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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Fri Jul 20, 2012 4:55 pm 
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Yeah, besides the titers and genetic testing, I would watch the Business of Being Born. It's a quick overview of a lot of birthing issues that you will be thinking about after you get pregnant. I wish I had read more and know more stuff to ask in the beginning. Its not perfect, but if you don't have time to read a bunch before your appointment, this movie will at least give you an introduction to some of the issues of picking the care giver that is right for you. I watched it on Netflix instant streaming.


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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Fri Jul 20, 2012 7:16 pm 
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thanks for the suggestions. all great ideas! this is exactly what i need!

i just had a full blood panel done in October 2011 as part of a physical. all my levels were normal, even the suspect ones (b12, d, folate).i guess ill have to ask if it's valuable to have another one so soon

i started taking a prenatal vitamin probably a few weeks ago.
ive been weaning off coffee and i cut my cymbalta dose in half (that was fun.....not). just waiting to officially talk to the Dr before i go any further with that.

i read Vegan Pregnancy but although i think its awesome that someone wrote it i felt it was more of a "you go girl you can do it" book than like super helpful. alot of stuff in it i had already read in other vegan nutrition books. would probably be more valuable for people who hadn't read several other vegan nutrition and lifestyle books

today i ordered a book called (i think) Your Vegetarian Pregnancy and the Dr Sears pregnancy book cause a lot of people on here seemed to like Dr Sears.

this thread helped me think about another question. the women's health place im going to is in the town i live in and im assuming they have priviledges at the local hospital which is literally about 5 mins from my house but i also know that the local hospital is associated with UMASS in Worcester and im *guessing* so is the women's health clinic and im debating whether or not i should plan on delivering at UMASS. the local hospital is certainly not a bad hospital by any means but UMASS is one of the best in the country. i had surgery there once and was very happy with my treatment there. but UMASS is about 20-25 minutes away rather than like.......5.
not sure how far away work is. im thinking either hospital would be 20 mins from either hospital.

when i made my appt i literally had not a clue about anything so i just said to give me whatever dr was available, the only preference i had was it be female.
turns out the dr i got *sounds* like a good fit. (please note havent met her yet) her bio says that she is passionate about healthy lifestyles and teaching people about healthy lifestyles. this makes me hopeful i wont get shiitake on for being vegan, having a vegan pregnancy, and then raising a vegan child.

she's pretty young and the person on the phone told me she has a 2 year old herself so it wasnt too long ago that she went through this herself.

thanks again for the suggestions. keep them coming!

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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Fri Jul 20, 2012 7:53 pm 
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I don't know what your politics are, but I would certainly be asking my OBGYN if she is pro-choice. Unfortunately, even desperately wanted pregnancies can go in ways that make them not a viable option to continue and I would want to make sure my OB would support my choice and could either perform or refer me to someone that could do the procedure if ever needed (though I certainly hope you don't need it!).

I would also want to get a good idea of their birthing philosophy--is mama in charge and they're there just to make sure baby and mom are safe? Do they have a plan for timing of the birth? What kind of interventions do they routinely do?

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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Fri Jul 20, 2012 8:00 pm 
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LisaPunk, you already know so much more than you're giving yourself credit for!

A thousand times yes to j-dub's point. When we were getting a bad test result, it was so comforting to know that my midwife worked with an OB who did late term abortions if we needed it.

I personally went with a midwife, and loved the experience. She had a great OB as back-up, but had a wonderful philosophy on birth - she thought every woman had the right to at least try and labor, and she was supportive of all my choices. Plus our personalities were a great fit. I laugh so much with her, and she puts me at ease. She is very calm and competent and when push comes to shove, that is what I wanted in my corner.

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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Fri Jul 20, 2012 8:41 pm 
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wow! i would have never thought of that but its a really good point to bring up.

i know someone who was pregnant and was not able to carry that pregnancy to term (i do not know the specifics) and it was the most horrifying thing to watch a person go through so i cant imagine going through that and then not having your doctor in your corner.

who would be the correct person to discuss vaccines (for the child) with? would i have a seperate pediatrician after the baby is born or would it be the same dr that delivers the baby? (i told you i know nothing)
i have opposing opinions on vaccines in my family and i just want to be educated myself before they start yacking in my ear.
my mother in law is super against vaccines and none of her 4 kids have had many (if any??) vaccines. my husband doesnt think he has ever been vaccinated against anything. my mom on the other hand is an infection control nurse. my brother and i got all the normal vaccines kids got in the late 70s/early 80s so i can tell that im going to have 2 totally different strong opinions shouted at me.
families are so fun! ;-)

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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Fri Jul 20, 2012 9:08 pm 
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I don't post much, but here are my two cents.

You will discuss vaccines with your child's pediatrician. When we went through this with my daughter, we wanted to make sure her pediatrician was supportive of her mostly vegan diet and that we wanted her vaccine schedule spaced out more (only a few at a time instead of a whole bunch at once). Once you find a pediatrician you like, then discuss vaccines/vaccine schedule (or if you are choosing not to vaccine will that pediatrician support that decision?).

No one knows everything going into this whole "becoming a parent" thing. While you are in the parenting trenches, you'll find you change your mind about certain things, or things you thought you'd handle really well you don't handle well at all, or something EVERYONE says works but for whatever reason does not work your your kid/family, etc. Your birth may not go as planned. It may take longer to get pregnant than you thought it would/should (I know a couple going through this right now.). And you know what? It's OK. The fact you are asking questions and researching what it takes to give yourself the best chance at having a healthy pregnancy and baby speaks volumes! Be gentle with yourself and enjoy this time with your partner as you plan to expand your family!


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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Fri Jul 20, 2012 9:37 pm 
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Yes, to what Geanie said (Hi Geani!!!!! So good to see you again!)!

I interviewed pediatricians and talked to friends about who they liked before we had Leela, and I'm happy with the person we chose. She is fine with whatever you choose on vaxes, veganism, co-sleeping (I was completely against it until it turned out it was the only thing that worked for us). and she has raised 5 kids, so I feel like she's really relaxed about choices but still a very good MD generally.

And yes, this is a long and very fun process, so you don't need to get everything done today :) We all go into it knowing not so much and learn more and keep learning. What works for me is to ask friends that I really respect and adore (big shout out to my awesome friends JENNA and Ariann!) what worked for them and going with their recommendations. JENNA recommended the woman we both used as our midwife, and she was really great. My doula came recommended by another friend and was the best money I spent in my pregnancy. So start talking to people you like!

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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Fri Jul 20, 2012 10:34 pm 
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I'd also ask about any vaccines that you and your husband might need. In a lot of areas, pertussis is making a comeback, and it's important that caregivers are fully vaccinated. Even people who were fully vaccinated as a child could need a Tdap booster.


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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Sat Jul 21, 2012 1:31 am 
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Good idea, helbury- Tdap has recently started to be given during pregnancy, but you might want to get yourself a booster before you get pregnant.

I second the suggestion of considering a midwife! The main difference between midwives and obstetricians is that midwives are specialists in normal pregnancy and birth ("normal" is not a judgment, it's just used in the medical sense). OB's are surgeons whose training focuses on higher risk pregnancies and births. I can see how some people might prefer to go with a doctor so that in the case of a cesarean, you might be able to have the doctor you know do your surgery. Be aware, though, that some OB's are not very familiar with how to support vaginal birth. Many, however, are awesome at it! Do you have any friends who've had babies and loved their provider?


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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Sat Jul 21, 2012 3:38 am 
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helbury wrote:
I'd also ask about any vaccines that you and your husband might need. In a lot of areas, pertussis is making a comeback, and it's important that caregivers are fully vaccinated. Even people who were fully vaccinated as a child could need a Tdap booster.


I will second that, you should get vaccines before you get pregnant. And hubby needs vaccines.


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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Sat Jul 21, 2012 9:00 am 
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well this is going to be an interesting little adventure for sure. my husband isnt anti vaccine like his mom but he's never really had to think about it. i tell him constantly that he lives in the land of "rainbows, unicorns, and puppy dogs" because he is SO laid back. this is a man who has never worried about a single thing in his entire life. SERIOUSLY. i love him to death but he drives me a little insane on that aspect because i have rampant anxiety and worry about EVERYTHING.

so i can already tell when i say ive been reading it's recommended that BOTH of us get vaccines before having a child his answer will be "meh we'll see how it goes, it will be fine"
"it will be fine" is his answer to EVERYTHING.

he may listen to a dr though.
also i know for him the idea of having a child and an actual physical living breathing human being will be two total different things. i think once the kid is born he will be a little more concerned (god i hope so) but before i dont think he really has wrapped his brain around it. he is still in the "it will be fine"
i mean im not in like full fledged panic mode or anything (im not even pregnant lol) but i do understand this is the time to start thinking about things like am i healthy enough to get pregnant, do i need vaccines. etc.

oy vey. this will be a challenge :-P

also dumb questions about OBs vs midwives.

im completely confused by some of the comments.
some OBs aren't specialised in how to deal with vaginal birth???? wow that literally just blew my mind. im SO confused. isn't vaginal birth like "normally" how it's done? why would an OB not know how to deal wtih that? so lost!!! i know sometimes a caesarean becomes necessary but i guess i was under the impression typically babies are born vaginally.
please explain what you meant so i can understand better :-)

also can midwives deliver in hospitals? i guess i may have an antiquated idea of what a midwife is. i think i would prefer giving birth in a hospital vs at home and to me midwife=home birth but that just may be an antiquated idea stuck in my head.

i have a facebook friend i went to high school with who just gave birth at UMASS about 3 months ago. i think we are friendly enough that she would be happy to fill me in on her thoughts. i was never like super close to her so i dont know how detailed i want to delve in but she may be happy to tell me everything for all i know. lol.
maybe ill try her.
other than that i dont have tons of friends with kids who live in the same area. i think both my nephews were born in western MA (no thank you). our friends have an almost 5 year old son but i think they lived a lot closer to boston when she was pregnant. a girl at work literally just came back from maternity leave but again i think she lives closer to the western part of the state and she and i are so different that i just dont think our values really lie in the same area. nothing wrong with how she did it at all. not a judgement on her we just might not be looking for the same types of things.


all great info. my head is spinning but i think it's a good thing. im all for being educated before hand so at least i can try to make informed decisions. i know that everything will change about 100 times and things will be crazy but we can at least try :-D

i really appreciate all the info on this board because i feel like it's a place i can come where people are similar to me and have similar outlooks and values.

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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Sat Jul 21, 2012 9:04 am 
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yup i just mentioned to my husband that it might be wise for both of us to get certain vaccines and he made a face at me and said "how likely is it that i get pertussis and then give it to the baby? how likely is that to actually happen?"

oy vey. :-/

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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Sat Jul 21, 2012 9:54 am 
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Pertussis is on the rise in the US. I actually have a friend who got pertussis a few years ago. He was quite sick for months, but he did get better without any issues. Pertussis in a young baby is much scarier and potentially life threatening though.

News article on it: Pertussis Outbreak May Be Worst in 50 Years


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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Sat Jul 21, 2012 10:17 am 
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Midwives absolutely can and do deliver at hospitals.

My most important question would be where do you want to deliver? Ask friends about regional hospitals in the area and look up c-section rates. I travelled 45 mins for a hospital with lower c-section rates than the one near me. Ask doulas about where they feel people get a good experience. Ask vegans where they got a good meal (a friend of ours delivered twins and then got her vegan meal which was a few leaves of ice berg and a fruit cup. Another friend only could get pb&js. I got veggie burgers, pastas, all sorts of yummies including soymilk and oatmeal for breakfast). Everyone will say they can do vegan food but you need to figure out who can and what they mean by that. Best is if they have a vegan menu already done. I know this sounds minor now, but when you are starving and trying to BF food is your best friend. Do you want a water birth? Only some hospitals have tubs.

Once you find a good hospital, then start looking at practitioners with privileges there. It sucks to love a midwife and then feel that you have to leave her to go to another hospital.

I really regret not advising two friends more zealously against the hospitals they picked. THey loved their MDs at a hospital with a superhigh c section rate and although both wanted to birth naturally both ended up with c-sections and were very upset. At the time i'd thought it would be rude and pushy of me tosay anything but looking at how it all went, next time i'd speak up more.

And to second moooo; (making a huge geneeralization) to a surgeon every issue looks like a problem for a knife. To a midwife there may be a host of non-surgical solutions to try first. And in my experience, MDs all operate on the I can afford to spend 15 mins with you while my midwife always made me feel like she had all the time I needed. Can you tell I loved my midwife?

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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Sat Jul 21, 2012 4:25 pm 
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The university hospital I went to has their own midwives and I used them. They work with MDs if any issues come up. I didn't see an OBGYN until my placenta wouldn't come out. They took my placenta out and sewed me up.


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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Sat Jul 21, 2012 5:16 pm 
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Pertussis is very dangerous to babies but to an adult, it can appear to be the common cold. Basically, an adult can get it and never really know that they have it and it is often suspected to be pertussis AFTER the infectious stage is over. All adults with regular exposure to young children should have the pertussis vaccine.

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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Sat Jul 21, 2012 8:03 pm 
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There are two different types of midwives, which is why it can get confusing on where midwives attend births.
Certified Nurse Midwives - CNMs - are the midwives you see in hospitals and some freestanding birth centers (and in some states, they facilitate at home births). They have an RN license and normally a master's degree in nursing (I think that's right - someone else here might know more.)

Certified Professional Midwives - CPMs - are the midwives who only attend home births and freestanding birth centers in the US. They usually come into the practice through apprenticeships and training at midwifery schools (we have a midwifery school in my state - it's a three year program, plus at least one year apprenticeship, and they have to sit a national certification exam). It's not as regulated of a training (something they're trying to work on for the future), but many of them come from medical backgrounds. I birthed with CPMs, and one of them was a CNM for many years before moving to a private practice, and the other was an RN for ten years.

Don't feel bad interviewing midwives and OBs! We set up appointments with a few CNMs, OBs, and CPMs in the area before choosing who we were going to birth with. Birth is major, and you need to have a good team on your side. I chose home birth, but if I found a great birthing team in a hospital setting, you bet I'd go there.


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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Sat Jul 21, 2012 8:28 pm 
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One thing that I don't think I realized re: OBs before I was pregnant was that an OB doesn't generally stay with you for much of your labor. (Midwives typically do.) For both of my pregnancies, the OB pretty much caught the babies and sewed me up. You still want to have a good relationship with your OB obviously, but you don't need to be BFFs with them as long as you trust them and see eye to eye with them on medical decisions. Ideally you'll have other support people (spouse, the L&D nurses, and a doula if you hire one) on hand during the labor part of labor.

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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Sun Jul 22, 2012 1:58 pm 
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I don't know how far outside Boston you are, but I delivered at the Birthing Center at Mt Auburn in Cambridge with the midwives. The birth was very positive, I had a midwifery student there with me almost the whole time, but after 2.5 of hours pushing they brought in an OB because intervention ended up being necessary.


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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Thu Jul 26, 2012 11:31 am 
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LisaPunk wrote:
im completely confused by some of the comments.
some OBs aren't specialised in how to deal with vaginal birth???? wow that literally just blew my mind. im SO confused. isn't vaginal birth like "normally" how it's done? why would an OB not know how to deal wtih that? so lost!!! i know sometimes a caesarean becomes necessary but i guess i was under the impression typically babies are born vaginally.
please explain what you meant so i can understand better :-)


Yes, I can explain! It's not that an OB would not know how to deal with vaginal birth; of course all OB's have attended many vaginal births. It's just that their training focuses on learning how to do surgery and procedures that are sometimes necessary, not on labor support and what's called "expectant management" when no intervention is necessary and a woman's body is doing what it's supposed to do. On the very extreme end, some OB's believe that vaginal birth causes damage to the pelvic floor and that elective c-sections with no medical indication are a good idea. The evidence absolutely does not support this belief. C-sections do save lives and are estimated to be necessary in somewhere around 5-10% of births worldwide, but when a U.S. hospital has a 40% c-section rate, it's because the doctors who work there are making decisions that lead to that situation. I just read a new book that's really accessible but it is sort of written like a textbook for healthcare providers, so it's probably way more detail than you're interested in, but it's all about how the research evidence shows that less intervention in childbirth is usually the safest way to go, and explains how we've gotten to where we are.

http://www.optimalcareinchildbirth.com/about-the-book/


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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Sat Jul 28, 2012 9:31 am 
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thanks for the explanation Mooo!! it makes sense though is definitely scary.
our family planning appt is this thursday so i will definitely be asking about the c-section rate. i dont want one unless it's medically necessary!! the dr we are goign to see has priviledges at 2 UMASS affiliated hospitals, the one ridiculously close to our house and then UMASS in Worcester so i wonder what the difference between the two hospitals will be and then her personal rate.

i totally understand the "surgeon point of view" of wanting to solve things with a knife that can happen. ive seen it myself.
the surgeon that did my jaw surgery is an amazing surgeon and pretty much saved my life but a year and a half later i told him i was having some pain in the joints of my jaw that were bad enough that i needed to mention it to him and his first reaction was he wanted to shoot botox into my jaw joints!!!!!! :-O
i was like "ummm no thanks!!!"


can someone tell me what the difference between a midwife and a doula is? i sort of have an acquaintance that is a doula (not someone i know very personally but ive met her and know her through people)
from google and wikipedia it seems like they do similar things but a midwife is medically trained and a doula is not?

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 Post subject: Re: what are important questions to ask an OBGYN?
PostPosted: Sat Jul 28, 2012 11:02 am 
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LisaPunk wrote:
a midwife is medically trained and a doula is not?


A nurse-midwife (the kind of midwife who works in hospitals) has a master's degree in nursing and is licensed to provide primary care to women, prescribe drugs, provide gyn care, prenatal care, attend births, and care for babies for their first month of life. A doula provides non-medical labor support and usually attends a weekend-long class in order to be certified. Doulas are awesome and very important! There is a lot of research that shows that having a doula at your birth leads to a better outcome. What they do is completely different from what midwives do, though.


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