How can I find an obstetrician to care for me during my pregnancy?
If you're seeing a gynecologist you like who practices obstetrics as well, you may want to ask him or her to care for you during your pregnancy, particularly if you like the hospital where the doctor attends births.
If you need to find an obstetrician, ask one of your healthcare providers to recommend someone, or talk to friends or relatives who have recently had a baby or who work in healthcare in your area. Childbirth educators are also a good source for referrals.
What criteria should I use to choose my obstetrician?
Only you can decide which are the most important considerations for you. You'll probably want to start with a list of caregivers in your network of providers if that's a requirement for your insurance coverage. Then rule out any whose office or hospital is too far away to be convenient.
Here are some other things to consider:
- Your health history
Do you have any chronic illnesses – such as high blood pressure, epilepsy, heart disease, or diabetes – or previous complications that may require special care? If so, ask the doctors you're considering what experience they have in caring for patients like you. You may need to be cared for by a maternal fetal medicine specialist or perinatologist, both of whom specialize in high-risk pregnancies.
If you've previously had a c-section, think about whether you'd like to try to have a vaginal birth this time. In you do, you'll want to make sure that both the provider and the hospital are supportive of vaginal birth after cesarean (VBAC).
- The doctor's outlook
Find out the doctor's attitude about issues that are important to you, such as the routine use of interventions like IVs, continuous electronic fetal monitoring, and episiotomies. You can't predict what your individual situation will require, but you can get an idea of the doctor's general approach to care and practice patterns from his or her responses to these questions.
You may also want to determine the doctor's feelings about having a doula or other support people besides your partner present during labor and birth. Is the doctor supportive of; natural childbirth, if that's what you're interested in? Is breastfeeding encouraged?
Pregnancy and childbirth are exciting, but they can also be stressful. So the best healthcare partner is one you feel comfortable with and can communicate with easily. It helps to ask yourself questions like:
How comfortable do you feel with the doctor?
Do you find it easy to ask questions of the doctor?
Does the doctor explain things clearly and completely?
Does the doctor seem interested in you personally?
Does the doctor seem like someone who will respect your wishes?
How often will I see my OB for my prenatal appointments?
At some practices, you'll see your obstetrician at all or most prenatal visits. You have the option of seeing a nurse practitioner or another OB when yours is unavailable. It's actually a good idea to meet all the OBs in the practice anyway since one of them may end up delivering your baby.
Some healthcare systems (such as Kaiser in California) will have you see a nurse practitioner for every prenatal appointment unless you have a complication or high-risk pregnancy.
A nurse practitioner knows how to perform the routine procedures that happen at each prenatal appointment and can identify problems that require a doctor's attention. Nurse practitioners must complete a four-year degree in a nursing field as well as a master's level Nurse Practitioner degree, which can take another two to four years.
Some OBs see their patients for every appointment. This allows you to develop a relationship with the doctor. The downside is that you would have to reschedule if your doctor were called to deliver a baby when you have a prenatal appointment.
What are the chances that my OB will deliver my baby?
Many group practices rotate on-call duty, so the likelihood of your regular ob-gyn being on call the day you go into labor may depend on how many doctors are in the practice.
If it's important to you to have your baby delivered by a doctor you know, you may be happier with a smaller practice. That way you can meet them all during your prenatal visits and communicate your needs and wishes to them.
In a larger practice, it might not be possible – or worth the effort – to book time with all the doctors. But you can ask your provider whether all the doctors in the practice tend to handle things the same way.
There may still be some individual practitioners who commit to delivering all their patients' babies. This may seem comforting to you, but ask the doctor what the back-up plan is if she or he has more than one patient in labor at the same time or happens to be sick or on vacation when you go into labor.
In any case, once you're admitted into the hospital in labor, unless you have a complication that requires a doctor's attention, you'll be cared for primarily by the labor and delivery nurses (who come and go according to their shifts) until you're nearly done pushing and ready to deliver. At that point, the doctor on call comes in and delivers the baby.
If you end up needing an emergency c-section, things will likely happen very fast and you may not even meet the doctor who delivers your baby.
How important is the hospital where the obstetrician attends births?
Ideally, you should be comfortable with the hospital where you give birth as well as with your provider. Most obstetricians have admitting privileges to just one hospital. So when you choose a care provider, you're usually choosing the place where you'll give birth.
Some doctors will agree to attend births at an in-hospital birth center if one is available; others won't. If you already know where you'd prefer to give birth – whether in a hospital, a birth center, or at home – it's a good idea to interview providers who practice in that particular setting.
The maternity services in the hospitals in your community may vary. For example, not all hospitals have an anesthesiologist in-house 24 hours a day, and only some have neonatal intensive care units (something to consider if you have a high-risk pregnancy). And again, if you're hoping for a VBAC, make sure the hospital is on board.
Look into choosing a hospital for your baby's birth early in your pregnancy. Some women wait until the third trimester to find out about the hospital where they plan to give birth. By that point, they've already developed a relationship with their provider, and making a change can be a hassle.
What should I do if I'm not entirely happy with my obstetrician?
If you feel you can, try to talk to the doctor about your concerns. If your worries aren't addressed, don't hesitate to change obstetricians or consider whether a midwife might be a better fit for you.