Want to go unmedicated? Here are some questions to ask your provider

1. How often, on average, do you support patients who deliver without medicated pain management?

   If unmedicated birth is your goal, you want a provider who is comfortable with attending unmedicated births. There are varying opinions about pain and discomfort in the medical community - some providers believe that pain is unnecessary and something to be fixed. You’ll likely feel the most supported by a provider who understands pain as a part of physiological birth, believes in your capacity to cope with it, and has successfully supported other unmedicated births.

2. How do you/other doctors at your practice support patients who prefer an unmedicated delivery? What about the L&D nurses?
   It’s one thing for a provider to say they’ll support you, it’s another for them to be able to describe how. The support techniques they offer will give you a good picture of whether they’ll proactively offer the type of support you’re looking for or simply tolerate your preferences.

3. What tools are available to me at this hospital for coping with labor pain, and how can the staff assist me in finding the best ways to use those tools?
   There are a lot of ways to manage pain and discomfort in labor that do not involve medication. From peanut balls to birth tubs, counter pressure to standup comedy on the TV, knowing the tools that will be available to you allows you to mentally prepare for which ones you might want to try. Most labor and delivery nurses will be well-versed in the tools they have on hand, but if there is a technique you really want to try, you might want to read up on it (or let your doula know so that they can help you out in the moment).

4. What percentage of births at the hospital include an epidural?

   Knowing this stat will help you gauge how used to unmedicated births the staff are. If you’re at a hospital with high rates of epidural usage, you might end up with an L&D nurse who has a difficult time seeing you in pain and is tempted to offer an epidural as a solution. If this happens, stating your intention for an unmedicated birth up front and specifically requesting a nurse who has experience with them may improve your chances of receiving the support you want. Your doula can also help fill any gaps in the nurse’s comfort with unmedicated birth, helping to advocate for your preferences and providing continuous physical and emotional support that the nurse might not be able to give.

5. How often do your deliveries start with an induction? At what point in pregnancy do you consider/recommend that a patient be induced? Is there a point after 40 weeks when an induction becomes necessary? What other factors would lead you to recommend induction?

   While being induced does not mean that you cannot go on to have an unmedicated birth, it can make it more difficult. Understanding the circumstances under which induction would be deemed necessary will help you determine if your provider is the right one for you.

6. If my water breaks or I go into labor, do you have anything specific that you want me to do? How do those instructions change if I’m preterm?

   Once your water breaks, many providers want you to come into the hospital in order to mitigate risk of infection. If you’re hoping to labor at home, make sure you understand any precautions they’d like you to take to minimize the potential for infection as well as any symptoms to look out for that would be cause for concern.

7. After my water breaks, are there progress markers that you’re looking for after a certain amount of time? (ie: is it important to you that I be in active labor or pushing within a certain amount of time after my water breaks/membranes are ruptured?)
   Although they aren’t always transparent about it, many hospitals have rules about how long they will let someone labor after their water breaks. Knowing this up front will help you decide if this facility is right for you and manage your own expectations for labor.

8. Is there any reason I wouldn’t be allowed to labor in the tub?

   Some facilities do not allow you to labor in the tub after your water breaks. Some will allow you to labor there, but have you get out to push. Knowing what your facility allows empowers you to make the choices that work for you. If you happen to get a provider who is more strict than your facility’s policy, your doula can help you navigate finding a staff member who will be a little more flexible.

9. Is there anything that would prevent me from delivering in a position other than on my back in bed?

   If you are hoping to push in a position other than laying on your back in bed, you’ll want to confirm that your provider will allow it. If you simply ask, “What positions can I push in?” or “Can I push in positions other than my back,” you might end up with a provider who agrees to let you push however you want but insists that you flip onto your back to deliver. By using the wording above, you are more likely to be able to figure out the conditions under which you would be required to deliver on your back.

10. What is your cesarean birth rate? What conditions lead you to determine that a cesarean birth is necessary?

    The cesarean rate in the US is about 30%. In many of our local hospitals, the percentage of births without epidurals is also right around 30%. Understanding how your hospital stacks up against both stats, and the conditions under which they would deem a cesarean necessary, will help you pick the facility that is best equipped with staff, tools, and policies to support you in the birth you are hoping for.