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HOW TO HAVE A BETTER BIRTH: 10 QUESTIONS TO ASK YOUR CARE PROVIDER

Adapted from the Ten Steps to Mother-Friendly Care, produced by the Coalition to Improve Maternity
Services, a broad-based coalition of organizations and individuals that support woman-centered, culturally sensitive maternity care.

1. Will you allow me to have my choice of companions during birth?
A mother-friendly unit provides unrestricted access to continuous emotional and physical support from family members, friends and/or a
labor support professional (e.g., a doula).

2. Will you allow me to move freely during labor and birth?
A birthing woman should have the freedom
to walk, move about, and assume the positions of her choice during labor and birth, and should not be
required to labor and birth in separate rooms. In particular, the position with the woman flat on her back
with her legs elevated (called “lithotomy” position) should be discouraged.

3. How do you work in collaboration and consultation with other health care providers and social services?
Every care provider should have written, clearly defined policies and procedures for collaboration and consultation with other maternity
professionals and services (for example, in the event of a transfer from
home or a birth center to a hospital) and should provide access to appropriate social services.

4. Will you allow me to eat and drink during labor? Do you regularly use IVs and electronic
fetal monitoring? Drinking fluids is important during labor; some women are hungry and can eat in early
labor. IVs should be administered only when needed. Continuous electronic fetal monitoring should not be
used routinely on low-risk women as data show it increases c-sections without improving outcomes in
this group of women.

5. How often do you artificially break the water bag (a technique that is believed to speed up labor)?
How often do you use drugs to induce (artificially start) labor or increase the strength or frequency of contractions with drugs?
Available studies indicate that breaking the water bag can be an effective means
of stimulating a slowly progressing or stalled labor, but there is no reason to perform this procedure as a
matter of routine. Drugs to induce or stimulate labor should be used only when medically indicated and after
a full discussion between the laboring woman and her provider.

6. How often do you perform episiotomies (a surgical cut to enlarge the vaginal opening)?
What is your c-section rate? Do you encourage VBACs (vaginal birth after cesarean)?
A woman-friendly practice performs episiotomies only when necessary, primarily when there is concern for the baby’s
well-being. A primary c-section rate (that is, a c-section for a woman who has never had one before)
under 15% is a reasonable target in many hospital settings. Most women who have had one cesarean
should be offered the option to birth vaginally the next time.

7. Do you encourage rooming in, allowing mother and baby to remain together 24 hours a day?
If there are no medical complications, how long is a baby separated from its mother?
How soon after birth? The best arrangement for mother and baby is 24 hour rooming in, unless there
are specific medical reasons for the baby to stay in a nursery. If that is the case, parents should be
welcomed into the nursery and encouraged to touch, hold, breastfeed and care for their babies to the
fullest extent possible.

8. What support will I receive for breastfeeding?
Mother-friendly care providers encourage breastfeeding within 1 hour of birth, and provide mothers with appropriate tools and resources to
breastfeed successfully.

9. What types of pain relief do you provide during labor and birth?
Your care provider should know about and offer non-drug methods of pain relief – massage, shower/bath, walking, etc. – and
should not promote the use of drugs except as specifically required or requested.

10. Where can I get more information about your procedures and other options for birth?
Request accurate, descriptive and statistical information about the full range of choices for birth.