The Expectant Father. Armin A. Brott

their own, and all of them go through an intensive training period in which they are taught how to give the laboring woman and her partner emotional and physical support throughout labor, and information about the delivery. Doulas have become increasingly popular over the years, and we’ll talk a lot more about them on pages 165–67. For now, though, as you’re just beginning the process, there’s one very important thing to think about.

      Doulas are not medical professionals, they’re generally not regulated, and they may not be particularly welcome in hospitals. Here’s how childbirth educator Sarah McMoyler and I described, in our book The Best Birth, the sometimes combative relationships that can develop. “The problem is that some doulas have an agenda and see their role as protecting mom and baby from what they believe are unnecessary interventions. Sometimes they take that agenda a couple steps too far and start playing doctor, inserting their non-medical opinion into a science-based hospital arena. As you can imagine, this can create tension and confusion, and is, frankly, completely inappropriate.” Because this kind of attitude can interfere with the medical team’s ability to do its job, a number of OB/GYN practices and hospitals around the country have banned doulas from their delivery rooms. That said, several studies have shown that having a doula can reduce the length of labor. But before you plunk down a deposit, check with your OB.

What to Ask Your Prospective Practitioner

      Besides a medical school degree, OB/GYNs may have little else in common. Each will have a slightly different philosophy and approach to pregnancy and birth. The same (except for the medical school part) can be said for midwives. So before making a final decision about who’s going to deliver your baby, you should get satisfactory answers to the following questions and any others you can think of. (If at all possible, make a separate appointment to do this. You’ll never be able to get everything in a fifteen-minute appointment. And no, there are no stupid questions—we’re talking about your partner and baby here.)

      ESPECIALLY FOR OB/GYNS

      • How do you feel about the father being there for prenatal exams and attending the delivery? Are you enthusiastic about it or just tolerant?

      • Do you recommend any particular childbirth preparation method (Lamaze, Bradley, and so on)?

      • At which hospital(s) do you deliver your babies?

      • Are you board certified? Do you have any specialties or special training?

      • How many partners do you have and how often are they on rotation?

      • What percent of your patients’ babies do you deliver? What are your backup arrangements if you can’t be there?

      • Where do you stand on the natural-vs.-medicated debate?

      • What’s your philosophy about Cesareans, labor inductions, and episiotomies?

      • What’s your C-section rate, and how do you make the decision to proceed with the surgery?

      • Do you permit fathers to attend Cesarean sections? If so, where do they stand (up by the woman’s shoulders or down at the “business end”)?

      • What is your definition of a “high-risk” pregnancy?

      • What kind of monitoring do you recommend? Require?

      • How do you feel about the mother lifting the baby out herself if she wishes?

      • How do you feel about the father assisting at the birth?

      • Do you routinely suction the baby or use forceps during delivery?

      • Do you usually hand the naked baby straight to the mother?

      • Do you allow the mother or father to cut the umbilical cord?

ESPECIALLY FOR MIDWIVES

      • Are you licensed or certified? By which organization?

      • How many babies have you delivered?

      • Which physicians and hospitals are you associated with?

      • How often does a physician get involved in the care of your patients?

      • What is the role of the physician in your practice?

      • What position do most of the women you work with adopt for the second stage of labor?

      • How do you make the decision to transfer the patient to a hospital or the care of a physician? How often does that happen?

      FOR BOTH OB/GYNS AND MIDWIVES

      • Do you have an advice line we can call when we panic about something?

      • What are your rates and payment plans?

      • What insurance, if any, do you take?

      • What percentage of your patients had natural, unmedicated births in the past year?

      • What’s your definition of “high risk”?

      • If labor starts when you’re not on call, will you come in anyway?

      • What and who (besides you, Dad) is allowed in the delivery room (friends, relatives, doulas, cameras, webcams, etc.)?

      • Are you willing to wait until the umbilical cord has stopped pulsating before you clamp it?

      • What prenatal tests do you suggest getting? Which ones do you require?

      • Which tests do you usually order for women like your partner (her age, race, medical history, and risk factors)?

      • How many sonograms (ultrasounds) do you routinely recommend?

      • Are women free to walk, move, and take a shower throughout the early stages of labor? Can the baby be put to the breast immediately after delivery?

      • Are you willing to dim the lights when the baby is born?

      • How much experience have you had with twins or more? (This is a very important question if you and/or your partner have a family history of multiple births or if you suspect that your partner is carrying more than one baby.)

      BILLS

      Having a baby isn’t cheap. Exactly how much you have to come up with will depend on how and where your baby is born, and which of the infinite combinations of deductible, coinsurance, copays, and out-of-pocket maximums you have. According to the Agency for Healthcare Research and Quality, a part of the U.S. Department of Health and Human Services, the average charge for a vaginal delivery is just under $9,000—nearly triple what it was in 1993. And the average charge for a Cesarean is almost $16,000—2.5 times higher than in 1993. Private insurance covered an average of 80 percent of prenatal care charges and 88 percent of delivery charges. But even if you have good insurance, that 12–20 percent can still add up in a hurry. Do keep in mind, though, that what the practitioner receives will almost always be quite a bit less than the sticker price.

      In the sections that follow, you’ll get an idea of how the costs for a typical—and a not-so-typical—pregnancy and childbirth experience might break down. It’s a good idea to look over your insurance policy, find out how much it will be picking up, and start figuring out now how you’re going to pay for the rest of it. Oh, and all of this is in addition to anything you might have paid for fertility diagnosis and treatment. What we’re talking about here are just the costs that come up after your partner gets pregnant. Putting together a budget can be important even if you’re adopting. In many cases, adoptive parents are in close contact with the birth mother throughout her pregnancy and delivery. You and your partner might go with her to the doctor’s appointments, see the ultrasound, hear the baby’s heartbeat, and pick up the bills—most of which won’t be reimbursed by your insurance company—for everything. If you’re doing an international adoption, you won’t have to worry about covering the birth mother’s medical expenses, but you’ll probably need to budget in the cost of several overseas trips. In addition, you’ll need to