Having a baby - Choosing Maternity care

Continuity of carer is important to most couples. The ideal scenario would be to consult one trusted person who provides all your prenatal care, be with you throughout labour, deliver your baby then continue your care during the postnatal period. Find out how big a part your obstetrician will play in your labour. Many commit to being with women throughout whilst others come only for the birth. A few may not show at all. Check his or her schedule for holidays, conferences etc, does anything come close to your due date? An obstetrician being on vacation is not a valid reason for medically inducing birth. Who will deliver your baby in the absence of your obstetrician? Will you get to meet him or her beforehand? If this is important to you, make sure these questions get asked at the first visit.

It is important to establish a good comfortable relationship with your obstetrician so that you can be confident that you are communicating on an equal level. Do not be afraid to challenge set policy if you feel it will not be in you or your baby`s best interests, Most doctors will welcome the chance to involve you more in the decision making process and although some hospital policies seem to be set in stone, there is always room for compromise. Do not always expect to be volunteered information. You must be proactive and ask the questions. Always try to attend prenatal appointments together. I dont know that there is any research evidence to back this up but women consistently report a higher level of satisfaction with their prenatal care if their partner accompanies them. Maybe the whole process is less intimidating and giving support to each other can be empowering. Certainly two people are more likely to remember to bring up the burning issues.

The Czech Republic has a sizeable transient expatriate population which means that couples may not arrive in the country until late pregnancy with little time to research the options. In this instance, try to do your homework beforehand as it may not be possible to physically shop around. Look at the factors that are important to you and discover as much information as possible before you arrive to help narrow your choices. The internet is a useful tool. www.expats.cz provides general information on services as well as personal anecdotal recommendations. Many hospitals have their own websites (usually only in Czech) and www.aperio.cz can provide a general overview of several of the most popular birthing venues.

During normal labour, a woman`s womb contracts and her cervix (neck of womb) gradually opens. The cervix, like vagina and rectum, is a sphincter and only able to function properly if the conditions are right. Think how difficult it would be to make love in a noisy, brightly lit room where strangers barge in without knocking. Imagine sitting on a toilet in a room full of people, all looking at you, waiting for you to go… ! Think about where you would like to give birth if you REALLY had a choice. Down by the ocean maybe or in a darkened quiet corner of woodland, or possibly even your own home.Certainly the survey highlighted a couple`s need to feel welcome and secure in an environment that is more like home than a traditional hospital ward.

If you are disappointed by what you have seen on the tour, dont rush to change your obstetrician. Look at others but also think about how you can adapt the environment. Find out what is provided by the hospital and what you might want to bring along from home in order to make you both feel more at ease. It is possible for women to obtain shared care, consulting one obstetrician during pregnancy for prenatal check ups knowing that they will give birth in their chosen maternity unit where someone else will care for them in labour. This is far from ideal, but a compromise nontheless.

– What is your immediate impression?
– Is the room clean and welcoming?
– How much privacy is there? Will you be sharing a room with other labouring women? Is there a curtain screening the door?
– Are there en suite facilities?
– How much space will you have for movement?
– What facilities/equipment are available to assist mobility and comfort both for you and your partner? Look for subdued lighting, temperature control, facilities for making drinks, facilities for playing music, extra chair, pillows, bean bags, birth balls etc
– Is medical equipment visible or hidden away?

– How many babies on average are born in this hospital each year?
– How many births are induced?
–  Why might you recommend inducing the birth?
–  How many women opt for epidural as pain relief in labour?
–  Do you offer mobile epidurals?
–  Are epidurals available 24 hours a day?
–  What other forms of pain relief are available?
–  What equipment is available to help us through labour? (birth stool, ball etc)
Do you encourage the use of alternative labour therapies – (hypnosis, homeopathy, aromatherapy etc)
–  What is your annual rate for caesarean cection and how does this figure compare with previous years?
–  How many caesareans are planned and how many are performed as an emergency?
–  How often do you perform episiotomy? Can I opt not to have this procedure?
–  Does your hospital have an admission policy for electronic fetal monitoring? If so, for how long?
–  Do you use continuous monitoring for all or some women?
–  Can I opt not to be monitored at all?
–  For what reasons might women have an intra venous drip or cannula inserted on admission?
–  Do you allow more than one person to accompany women in labour? Do labour supporters (including Dad) need to pay a fee for being there? If so, how much and where do we pay?
–  Does your unit have a policy of shaving women for birth?
–  Does your unit routinely offer enemas on admission?
–  Does your unit offer water birth?
–  Are women encouraged to use water in labour?
– Are women allowed to eat and drink in labour? Will the hospital provide food and drink for both of us or only the mother?
– What is the instrumental birth rate? Are forceps or ventouse the method of choice?
– If we arrive at hospital during the night, can we use the normal entrance?
– I may decide to use a TENS unit to help me in labour (Transcutaneous electrical nerve stimulation – a form of non-invasive pain relief in labour but not at all common in Czech Republic). Will I be able to continue to use this once I arrive at hospital in labour?
– Do you allow freedom of movement throughout labour?
– Can women choose a position for delivery?
– If we wish, can we opt for a natural third stage?
– Will my doctor care for me in labour and deliver my baby? Will he/she be available throughout my labour? What are the chances of being cared for by a doctor we have never met?
– How many of the hospital staff will be able to understand us if we cannot speak Czech?
– What will the hospital provide for me and my baby (diapers, baby clothes, sanitary pads etc)? Does the hospital have a list of what we will need to bring from home?
– If our baby needed Special Care, what facilities are available?
– If this hospital is full when we arrive, would we have to go elsewhere? How would that work if I want my doctor to be with me in labour?
– Are any mothers or babies transferred to other specialist units? Why might this happen and where would they go?
– Who is the resident paediatrician? Will we get a chance to meet him or her before our baby is born?
– What tests and treatment will be offered to our baby before we go home? Can we opt not to have these?
– Will vitamin K be given to my baby after birth? Do you use oral drops or injection?
– How long after birth do women spend on delivery suite before being transferred to post natal ward?
– Is” rooming in” encouraged at all times or do staff sometimes take babies away to give mum a rest?
– What security measures does your unit have in place to protect babies?
– Can my partner stay with me overnight during the postnatal period?
– How much help and support is given for mothers choosing to breastfeed?
– How long must I stay in hospital after the birth? Could I stay longer or leave earlier if I wish?
– What aftercare (if any) is provided once we go home?