How To Choose An Obstetrician

This is a question we get asked from time to time and it really is quite tricky. What one person will love in a health care provider is just the thing another woman will not like. But there are some ways to narrow down your search for an obstetrician to find one who will be a good match for you.

1. INSURANCE

Let's start off with the most practical things first. You will need to make sure that the physician accepts your form of insurance or payment. You can find this out usually with a simle phone call to their office. Next you want to find out if the hospital(s) to which the physician goes also takes your form of insurance or payment. This is important too, because if the hospital doesn't take your insurance, but you still want your physician to deliver you at that institution, you may need to pay your account before the baby is even born. Each institution is a little different in how they like to handle these situations, but it is best to know as much about what to expect from the physician and the hospital before you ever have that first contraction!

2. GENDER

For most women, the gender of their health care provider is strictly a preference. I have spoken with women who have only had men physicians, and in fact describe being cared for by a woman as something they would find very odd or discomforting. I have also spoken with women who would never go to anyone except a woman. Personally, I have had both. I like the fact that for the most part a female care giver can have some firsthand understanding about pregnancy, labor, birth and postpartum. But realistically, it is all very subjective. If her experience was blissful and mine extremely stressful, she still can't really relate to what I am going through. If she had vaginal deliveries and I have C-Sections (or the other way around), she can't fully relate to my experience either.

Some women express anxiety and embarassment at being examined by a male obstetrician and I can tell you that is only enhanced when you have to work side by side with them every day! However, I have had male obstetricians whose bedside manner was so professional and gentlemanly that they immediately put you at ease and made you feel confortable. For me, the bottom line is that I find I can talk to a female about female issues easier than I can talk to a man, I feel less inhibited in the discussion and I feel more likely to bring up issues that need to be dealt with.

3. AGE/EXPERIENCE

Age is probably not the word we are looking for here as much as the word, experience. Would you prefer a physician who has been in practice for a long time, has delivered thousands of babies and knows exactly what he's going to do before he even walks in the room? Or would you prefer a younger physician, someone who has recently finished residency and is fresh with the latest techniques and tips, and may be more open minded about what you may want to do?

While there is great benefit in having learned the latest and best recently, (and many physicians do all they can to keep current with trends, standards and techniques), there is also something to be said for that intuition which comes with having watched hundreds and thousands of babies on fetal monitor tracings, or having seen every emergency situation so many times that you don't have to think about what to do.

One advantage of the younger physician is that often, while starting a practice, they have more time to spend with each patient, so you may feel as if you are getting more individualized care. Older physicians may already have a full practice and schedule of patients to be seen each day and time for each appointment may be more limited.

Another thing to consider is where are you in your child-birthing cycle? Is this your first baby, and do you plan to have a few more? Do you plan to space them out over many years? Are you just about at the end of having babies and you might be finished after this pregnancy?

If you are just beginning to start your family, you may want a physician who will be available for you for all your pregnancies. An older physician who may be planning on retiring in a year or two, may not be the optimal choice for you. If you are finishing your family then the age of your obstetrician may not be so much of an issue.

4. CREDENTIALS

Don't be afraid to ask for your physician's credentials. Of course a physician should have graduated from medical school and completed a residency in obstetrics/gynecology. (In some states a graduate from medical school can actually get a license to practice medicine with only one year of residency.)

It is also advantageous if they areBoard-Certified by the American Board of Obstetrics and Gynecology. This means that they have passed a written test, demonstrating that he or she has obtained the special knowledge and skills required for medical and surgical care of women. They must demonstrate that they have experience in treating women's health care and then they must pass an oral examination. This oral examination is given by a group of well-respected national experts. The exam covers the physician's skills, knowledge and ability to treat different conditions. Physicians must be retested periodically to keep this certification updated.

4. PERSONALITY


This is where no one can tell you what you like or dislike, but you! Do you want a physician who is has more bedside manner, or one who is more "straight from the hip"? Do you want someone who is going to bring topics up gently or do you want your physician to just bring the topic up and discuss it boldly? Do you like a quiet person or a more talkative person? Maybe you don't even know!

Most physicians are willing to schedule a "consultation" appointment with you. This is usually an appointment where you can go and meet the physician and ask questions and get a basic feel for his or her personality. This should tell you alot about whether or not you like this individual. If you don't like them during this visit, or for any reason they make you uncomfortable, then this isn't the obstetrician for you.


5. PERSONAL BELIEFS

During a consultation appointment is a good time to ask your prospective obstetrician some questions about their personal beliefs that may impact your care or your birthing experience. You may want to ask how they feel about unmedicated deliveries and are they generally supportive of that. How do they feel about labor inductions, and what percentage of their OB patients are induced. How do they feel about breastfeeding and are they supportive of that. How do they feel about epidurals and when do they allow them to be given. How do they feel about visitors in during the birth. What is their current C-Section rate? Anything that you can think of that would be important to you for your delivery would be a good thing to ask at this appointment.

You will want to notice the general attitude of the physician as they answer these questions. Are they truly interested in what you are asking and are they respectful in their answers? Then you may find that they are interested in you and about whether the issues are important to you. Are they generally flippant or dismissive about the questions? Are their answers disrespectful or frivolous? Then you might find that they may be dismissive and frivolous about other issues that are important to you as well. If you leave the consultation appointment feeling as if someone really took time with you, cared about what you had to say and made you feel special, you might be on your way to choosing an obstetrician.

6. SOLITARY OR GROUP

Most women don't think about this issue until they begin realizing that delivery is just around the corner and by then it's too late. Is your prospective obstetrician in a solitary practice, meaning that he or she is the only physician in the group, or is he or she in a group with other physicians?

This may not seem to make much difference as you go to visits monthly, or even toward the end of pregnancy when you begin to go weekly. But one visit to Labor & Delivery with a run of false labor can show you the importance of this question.

If your physician is in a solitary group, then chances are pretty good your physician will deliver your baby. Now even in a solitary group, your physician will have a physician from another group (usually another solitary physician) to take call on some weekends, or if he/she has to go out of town, or on (don't say it!) vacation. But still, most of the time they deliver their own babies.

If your physician is in a group with other physicians, they usually rotate the calls, both nights and weekends. The more physicians in the group, the fewer the chances are that your physician will actually be the one to deliver your baby.

7. AFTER THE CHOICE IS MADE

After you have chosen your obstetrician, if you find for some reason it was not the right choice for you, you can change physicians. However, it is recommended you do so very early in the pregnancy as many physicians will not take a new pregnant patient later in pregnancy. You might find your physician's nurse can help you with the issue if you take a few minutes to talk with her, or leave your number with her and have her call you during a slow spot in her day.

If you have gone the whole pregnancy and still are not happy with your choice of obstetrician, there is no reason for you to continue with a physician with whom you do not have a good relationship. Women change physicians all the time. Just make sure you change after your last postpartum checkup and in time for your next scheduled checkup.

If you have found the perfect obstetrician for you then by all means, tell everyone! The greatest compliment you can give your physician is to spread the word to every woman you know of the wonderful job he or she is doing!

Preterm Labor -- Signs

Yesterday I admitted the sweetest couple who needed to be treated for Preterm Labor. I was very impressed with one of the statements the physician made to the couple regarding preterm contractions. The mother had been relating the fact that she had been feeling tightening for awhile, but having read about Braxton-Hicks contractions, she felt this was normal.

The physician told them that whenever a pregnancy is earlier than 37 weeks (which is considered term), contractions do not have to be considered painful to be effective. She added that by the time these contractions are painful, labor can be too far progressed to stop.

The truth is, there are many signs of preterm labor that may actually be ignored or not even noticed by the mother until preterm labor is much too advanced to be stopped. Some signs of preterm labor are:

• Contractions (which may only feel like "tightening" or the "baby knotting up", which occur more than five times in an hour
• Change in vaginal discharge, leaking fluid or spotting
• A dull, low backache
  
• Cramps that feel like menstrual cramps or gastrointestinal cramps
  
• Pelvic pressure, the feeling that the baby is pushing down

You do not have to experience ALL of these to have preterm labor. If you experience ANY of these symptoms, you need to contact your health care provider. You may worry about making a "false run" to the hospital, but this is one situation where everyone will be pleased if it does turn out to be a "false alarm"!

There are a few things you can do to minimize your chances of preterm labor:

• Be aware of the signs and symptoms of preterm contractions
• Keep all your scheduled visits with your health care provider
• Keep yourself well hydrated
• Be aware of the signs and symptoms of urinary tract infections (a major cause of preterm contractions)

- sharp burning and pain when urinating
-the urge to urinate more frequently than usual
-a strong urge to urinate that can't be delayed
-soreness in the back and sides
-small amount of blood when urinating

If you do experience any signs of either preterm contractions, or urinary tract infections, notify your health care provider as soon as possible.

Next we will discuss how preterm contractions are treated.