10 Questions to Ask

Have you decided how to have your baby?  The choice is yours.  Here are some things that can help you decide which type of birth would be best for you:

First, you should learn as much as you can about all your choices.  There are many different ways of caring for a mother and her baby during labor and birth.

Birthing care that is better and healthier for mothers and babies is called “mother-friendly.” Some birth places or settings are more mother-friendly than others.

A group of experts in birthing care came up with this list of 10 things to look for and ask about. Medical research supports all of these things. These are also the best ways to be mother-friendly.
When you are deciding where to have your baby, you’ll probably be choosing from different places such as:

• birth center,
• hospital, or
• home birth service.

Here’s what you should expect, and ask for, in your birth experience. Be sure to find out how the people you talk with handle these 10 issues about caring for you and your baby. You may want to ask the questions below to help you learn more.

“Who can be with me during labor and birth?”

Mother-friendly birth centers, hospitals, and home birth services will let
a birthing mother decide whom she wants to have with her during the birth.
This includes fathers, partners, children, other family members, or friends.

They will also let a birthing mother have with her a person who has special training in helping women cope with labor and birth. This person is called a doula or labor support person. She never leaves the birthing mother alone. She encourages her, comforts her, and helps her understand what’s happening to her.

They will have midwives as part of their staff so that a birthing mother can have a midwife with her if she wants to.

“What happens during a normal labor and birth in your setting?”

If they give mother-friendly care, they will tell you how they handle every part of the birthing process. For example, how often do they give the mother a drug to speed up the birth? Or do they let labor and birth usually happen on its own timing? They will also tell you how often they do certain procedures. For example, they will have a record of the percentage of C-sections (Cesarean births) they do every year. If the number is too high, you’ll want to consider having your baby in another place or with another doctor or midwife.

Here are numbers we recommend you ask about.

• They should not use oxytocin (a drug) to start labor for more than 1 in 10 women (10%).

• They should not do an episiotomy (ee-peezee-AH-tummy) on more than 1 in 5 women (20%). They should be trying to bring that number down. (An episiotomy is a cut in the opening to the vagina to make it larger for birth. It is not necessary most of the time.)

• They should not do C-sections on more than 1 in 10 women (10%) if it’s a community hospital. The rate should be 15% or less in hospitals which care for many high-risk mothers and babies.

A C-section is a major operation in which a doctor cuts through the mother’s stomach into her womb and removes the baby through the opening.

Mothers who have had a C-section can often have future babies normally.

• Look for a birth place in which 6 out of 10 women (60%) or more of the mothers who have had C-sections go on to have their other babies through the birth canal.

Ask, “How do you allow for differences in culture and beliefs?”

Mother-friendly birth centers, hospitals, and home birth services are sensitive to the mother’s culture. They know that mothers and families have differing beliefs, values, and customs.

For example, you may have a custom that only women may be with you during labor and birth. Or perhaps your beliefs include a religious ritual to
be done after birth. There are many other examples that may be very important to you. If the place and the people are mother-friendly, they will support you in doing what you want to do. Before labor starts tell your doctor or midwife special things you want.

Ask, “Can I walk and move around during labor? What position do you suggest for birth?”

In mother-friendly settings, you can walk around and move about as you choose during labor. You can choose the positions that are most comfortable and work best for you during labor and birth.   (There may be a medical reason for you to be in a certain position.)

Mother-friendly settings almost never put a woman flat on her back with her legs up in stirrups for the birth.

Ask, “How do you make sure everything goes smoothly when my nurse, doctor, midwife, or agency need to work with each other?”

Ask, “Can my doctor or midwife come with me if I have to be moved to another place during labor? Can you help me find people or agencies in my community who can help me before and after the baby is born?”

Mother-friendly places and people will have a specific plan for keeping in touch with the other people who are caring for you. They will talk to others who give you birth care. They will help you find people or agencies in your community to help you. For example, they may put you in touch with someone who can help you with breastfeeding.

Ask, “What things do you normally do to a woman in labor?”

Experts say some methods of care during labor and birth are better and healthier for mothers and babies. Medical research shows us which methods of care are better and healthier. Mother-friendly settings only use methods that have been proven to be best by scientific evidence.

Sometimes birth centers, hospitals, and home birth services use methods that are not proven to be best for the mother or the baby. For example, research has shown it’s usually not helpful to break the bag of waters.
Here is a list of things we recommend you ask about. They do not
help and may hurt healthy mothers and babies. They are not proven to be best for the mother or baby and are not mother-friendly.

• They should not keep track of the baby’s heart rate all the time with a machine (called an electronic fetal monitor). Instead, it is best to have your nurse or midwife listen to the baby’s heart from time to time.
• They should not break your bag of waters early in labor.
• They should not use an IV (a needle put into your vein to give you fluids).
• They should not tell you that you can’t eat or drink during labor.
• They should not shave you.
• They should not give you an enema.

A birth center, hospital, or home birth service that does these things for most of the mothers is not mother-friendly. Remember, these should not be used without a special medical reason.

Ask, “How do you help mothers stay as comfortable as they can be? Besides drugs, how do you help mothers relieve the pain of labor?”

The people who care for you should know how to help you cope with labor. They should know about ways of dealing with your pain that don’t use drugs. They should suggest such things as changing your position, relaxing in a warm bath, having a massage and using music. These are called comfort measures.

Comfort measures help you handle your labor more easily and help you feel more in control. The people who care for you will not try to persuade you to use a drug for pain unless you need it to take care of a special medical problem. All drugs affect the baby.

Ask, “What if my baby is born early or has special problems?”

Mother-friendly places and people will encourage mothers and families to touch, hold, breastfeed, and care for their babies as much as they can. They will encourage this even if your baby is born early or has a medical problem at birth. (However, there may be a special medical reason you shouldn’t hold and care for your baby.)

Ask, “Do you circumcise babies?”

Medical research does not show a need to circumcise baby boys.  It is painful and risky. Mother-friendly birth places discourage circumcision
unless it is for religious reasons.

Ask, “How do you help mothers who want to breastfeed?”

The World Health Organization made this list of ways birth services support breastfeeding.

• They tell all pregnant mothers why and how to breastfeed.
• They help you start breastfeeding within one hour after your baby is born.
• They show you how to breastfeed. And, they show you how to keep your milk coming in even if you have to be away from your baby for work or other reasons.
• Newborns should have only breast milk. (However, there may be a medical reason they cannot have it right away.)
• They encourage you and the baby to stay together all day and all night. This is called “rooming-in.”
• They encourage you to feed your baby whenever he or she wants to nurse, rather than at certain times.
• They should not give pacifiers (“dummies” or “soothers”) to breastfed babies.
• They encourage you to join a group of mothers who breastfeed.
• They have a written policy on breastfeeding. All the employees know about and use the ideas in the policy.
• They teach employees the skills they need to carry out these steps.

This information is taken from the Mother-Friendly Childbirth Initiative
written for health care providers. You can get a copy of the Initiative for your doctor, midwife, or nurse by mail, e-mail, or on the Internet.

To Get a Copy by Mail
For a copy of both this brochure and the Mother-Friendly Childbirth Initiative by mail, send a stamped, self-addressed envelope with
$5 (US) to help cover the costs ($6 Canada or Mexico, $10 all others).
Bulk prices are available. Mail to:
Coalition for Improving Maternity Services
1500 Sunday Drive, Suite 102
Raleigh, NC 27607

To Get a Copy on the Internet
Log on to to www.motherfriendly.org

Contact CIMS
Tel: 888-282-CIMS (2467) • Fax: 919-787-4916
E-mail: info@motherfriendly.org
© 2000 Coalition for Improving Maternity Services (CIMS).
Permission granted to freely reproduce in whole or in part along with complete attribution.

Maternity Care, Beware Quiz from Consumer Reports Health

Consumer Reports Health also has an interesting article titled “Back to Basics for Safer Birth.”

If you are unsure about midwifery, please look at the “Midwifery Model of Care,” which should help you get a clearer perspective on midwifery. After that, visit Choosing A Caregiver Based on Best Evidence at Childbirth Connection.

One of the best places to learn about maternity care is the Coalition for Improving Maternity Services, home of the Mother-Friendly Childbirth Initiative.  Whether you choose to have your baby in a hospital, birth center, or home, CIMS has worked tirelessly with one goal in mind: the health and well-being of mother and baby.

For more great research links, visit The Medical Literature on the Safety of Homebirth, maintained by James J. Hughes, PhD.

If you are interested in learning more about VBAC, visit VBAC.com for some wonderful information.  Another great resource is Unnecesarean.com.

If you are considering circumcision, there are some things you should know before making that decision.  Visit Nurses for the Rights of the Child and NoCirc.org.

Another good article is “Doctor or Midwife: Which Would You Choose?“

Mother-Friendly Childbirth

A mother-friendly hospital, birth center, or home birth service:

1. Offers all birthing mothers:

• Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;
• Unrestricted access to continuous emotional and physical support from a skilled woman—for example, a doula,* or labor-support professional;
• Access to professional midwifery care.

2. Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.

3. Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s ethnicity and religion.

4. Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.

5. Has clearly defined policies and procedures for:

• collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
• linking the mother and baby to appropriate community resources, including prenatal and postdischarge follow-up and breastfeeding support.

6. Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:

• shaving;
• enemas;
• IVs (intravenous drip);
• withholding nourishment or water;
• early rupture of membranes*;
• electronic fetal monitoring.

Other interventions are limited as follows:

Has an induction* rate of 10% or less;

Has an episiotomy* rate of 20% or less, with a goal of 5% or less;

Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;

Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.

7. Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct
a complication.

8. Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their
conditions.

9. Discourages non-religious circumcision of the newborn.

10. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:

1. Have a written breastfeeding policy that is routinely communicated to all health care staff,

2. Train all health care staff in skills necessary to implement this policy;

3. Inform all pregnant women about the benefits and management of breastfeeding;

4. Help mothers initiate breastfeeding within a half-hour of birth;

5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;

6. Give newborn infants no food or drink other than breast milk unless medically indicated;

7. Practice rooming in: allow mothers and infants to remain together 24 hours a day;

8. Encourage breastfeeding on demand;

9. Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics.

© 1996 by The Coalition for Improving Maternity Services (CIMS).  Permission granted to freely reproduce in whole or in part along with complete attribution to:
CIMS National Office, POB 2346, Ponte Vedra Beach, FL 32004, (888) 282-CIMS, (904) 285-1613, Fax: (904) 285-2120, <www.motherfriendly.org>, <info@motherfriendly.org>