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Choosing the Right Healthcare Provider for You


Giving birth and becoming a mother is an intense, intimate and important moment is a woman's life. The following tips (by the American College of Nurse Midwives) for prenatal care will help you in establishing a positive working relationship with your provider, and ensure that you and your  baby get the attention you both deserve. During a woman’s prenatal period, she is seeking not just physical care, but emotional, social, spiritual and psychological care and support. If your health care provider is not providing theses essentials for you, then you will be dissatisfied with your overall care.

 How the office schedules your visit is important. You want an office that is "on time." Emergencies do occur and can interrupt the flow of the scheduled appointments, but if the provider is chronically late it does suggest a lack of respect for your time. Similarly, if  each visit is so closely scheduled to the next so there is not built-in "chat" time, you probably will end up dissatisfied.

Ask friends and family for recommendations and review the list of providers covered by your health insurance. Check to see which hospitals and birth centers providers use for birth.  Then schedule appointments to interview potential providers. Ask questions about the provider's philosophy of birth and how that philosophy is reflected in the management of a woman's prenatal care, labor and birth. For example, if you talk about a birth plan or about having a natural birth and the provider looks at you like you are "way out there," or their body language indicates they are uncomfortable with that  question, this is not the provider for you.
 

Become well-informed and ask questions. Educate yourself on pregnancy, labor and birth. You'll become more comfortable with the changes your body is experiencing and you can ask educated questions. Understand the changes your body is experiencing. Ask your provider for recommendations on books to read and childbirth education classes that are available. Keeping track of your questions, progress, and feelings will ensure that you don't forget important  information that you want to share with your provider. Becoming educated doesn't mean you can't ask any and all questions you may have.  REMEMBER: there is  no such thing as a silly question.

Share responsibility for your care.  Being informed alllows you to be involved in the decision-making process. Pregnancy and birth are normal physiologic events for most healthy women. Taking responsibility for your own healthcare helps to ensure you will have a safer and more satisfying experience as you journey into motherhood. You may choose to allow your healthcare provider to make decisions for you, but relinquishing that responsbility should be a conscious choice on your part. Some women are uncomfortable with being involved in the decision-making process, or there may be times when it is critical that the provider be the one to make a decision in the best interests of the health of the woman and her baby. It is important to let your provider know if you don't want to be involved in this process. However, even if you prefer that your doctor or midwife makes decisions for your care, you must be informed and understand all risks, benefits, and alternatives available to you. Remember, it is your body  and your baby.
 
Establish a working relationship with your provider so that each of you listens to what the other is saying. You may find that actually writing out a birth plan helps you and your provider focus on what is important to you during labor and the birth of your baby.

Let this be a learning experience. Ask your provider about routine teaching, or teaching done at each stage of pregnancy during your prenatal visits. Nutrition is the cornerstone of healthiness for pregnant women and should be addressed at every visit, especially if there is inadequate weight gain or fetal growth. Be sure you understand about the signs of preterm labor and preterm contractions. Learn how to monitor fetal movement. Discuss whether or not you should have a birth plan and what this should include. As about management of pain in labor. Find out what is considered routine management. Know what your options are, including their risks and benefits.  

Follow-up is essential. Ask about the results of routine tests, such as urinalysis and blood pressure readings, as well as any other lab tests or ultrasounds you may undertake. While the results are probably normal, it is wise to double check and is part of taking responsbility for your own care. This also applies to asking why your healthcare provider has asked you to take a certain test.

Let's talk. While it is important to understand what is happening to your body, it's important to be in touch with your emotions and mental health during pregnancy. Your healthcare provider can help you deal with the myriad of feelings both you and your partner may be experiencing. Talk about your hopes and dreams for your baby's birth, as well as your fears and concerns. If your provider appears rushed or busy, ask to schedule another visit with him/her to discuss your concerns. You should leave your visits feeling emotionally satisfied, reassured and all your questions answered.

Ask tough questions. A woman should feel comfortable enough with her healthcare provider to ask awkward questions or to discuss personal issues that are worrying her. Remember that experienced healthcare providers understand that pregnancy is much more than a physical condition. Frankly, they have seen,heard and dealt with most issues, so don't feel like you are the only one who feels a certain way. But they can't help you if you don't tell what is worrying you.

Be honest and direct about these concerns so that your healthcare provider can give you the best possible support. A good healthcare professional will not judge you or your situation. Their role is to make sure that your pregnancy and birth are healthy and satisfying. If you anticipate that you will need extra time (for a lengthy discussion of an awkward question or personal problem), ask to schedule a longer appointment for your next visit so that the provider isn't rushed and can fully address the issues.

Following the above tips for your prenatal care can help you in attaining the best possible outcome for your pregnancy - a healthy baby.


What is My REAL Due Date?

The concept of when your due date is, is based on a gestational length established back in the early 1800’s by Franz Carl Naegele. He officially declared that pregnancy lasted 10 lunar months (10 x 28 days), counting from the first day of the last menstrual period) He assumed that the average woman had cycles that lasted 28 days and that she ovulated on Day 14 of her cycle. He used his data to come up with a mathematical calculation for due dates:

(LMP + 7 days) - 3 months) = Due Date
EX: ((January 1, 2010 + 7 days) - 3 months) =
October 8, 2010

However, Dr. Naegele did not consider certain factors in his calculation. For example: Not every woman ovulates on Day 14. Other situations that he did not factor in were ethnicity, parity (how many successful pregnancies), prenatal care, better nutrition, and screening factors. One study indicates that we need to add 15 days to the Naegele EDD (estimated due date) for Caucasian, first time moms, and 10 days for Caucasian moms having subsequent children (multiparas). African American and Asian women tend to have shorter gestations.

Let’s bring in the ultrasound component into determining your due date. Ultrasound-determined due dates are not accurate. Even first trimester ultrasound measurements have an error bar of +/- 5 days; in the second trimester +/- 10 days, and +/- 22 days in the third trimester.
 
Few healthcare providers appreciate the limitations of ultrasound or clinical data. The due date should not be changed unless the discrepancy is more than two weeks, yet we see healthcare providers changing a due date by a few days, no trivial alteration if a woman will be induced when she exceeds a certain date. Some risk does accrue in healthy postdate pregnancies (notably meconium passage and big babies) but it does not follow that we should induce all women. If we try to eliminate postdate pregnancies on grounds of increased complications, should we not equally logically try to delay labor onset in the early-term group?
- Henci Goer, Obstetric Myths vs. Research Realities, Bergin & Garvey 1994

Carol Wood, Yale nurse-midwifery professor, came up with a method to calculate the due date that takes into account individual variations in the menstrual cycle as well as the effect of a woman's having had previous pregnancies.

1. Add 1 year to the first day of the last menstrual period, then
For first-time mothers, subtract 2 months and 2 weeks
For multiparas, subtract 2 months and 2.5 weeks (18 days)
2. Add or subtract the number of days her cycle varies from 28 days
*1st-time mothers with 28-day cycles: LMP + 12 months - 2 months, 14 days = EDD
*Multiparas with 28-day cycles: LMP + 12 months - 2 months, 18 days = EDD
*For cycles longer than 28 days: EDD + (actual length of cycle - 28 days) = EDD
*For cycles shorter than 28 days: EDD - (28 days - actual length of cycle) = EDD
EDD: Estimated day of delivery
LMP: Last menstrual period
Excerpt from-Anne Frye, Holistic Midwifery Vol. 1, Labrys Press 1995

Most authorities agree that there are many ways to determine an EDD (estimated date of delivery) of a pregnancy, and that not just one factor should be used to determine the final due date. Other events to factor in are:

  Quickening (first time mom feels the baby move)
  Fetal heart tones heard through doppler
  Fundal height (Measurement of the uterus done throughout pregnancy)
 
Keep in mind that due dates are estimates of when your baby will arrive. We generally consider the normal time frame to be two weeks before your due date, until two weeks after your due date.
 
Just remember, no matter how many times your neighbors, family, friends, and even strangers ask you when you are due, smile, because only the baby really knows.


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