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Choosing an Obstetrician

Published December 14, 2007        by Kim

Your pregnancy involves very many people besides yourself and your new baby. Your family, of course, is affected. You may have a Lamaze teacher and an exercise instructor. And you will certainly have a doctor; your obstetrician is a partner in your pregnancy. He or she will have the responsibility for you and your baby's health, so you want to be sure the doctor is qualified and competent. In addition, he or she will intimately participate in a very special event in your life-you want someone with whom you can cooperate and feel comfortable.

Finding the right obstetrician may take some work. You may need to talk to people and visit a few doctors before you are satisfied. You can get recommendations from many different sources. Friends and relatives may suggest their obstetricians. Another doctor, such as your internist, may provide a name. Maternity nurses, or obstetrical residents [doctors in training], at your local hospital often know which obstetricians in the community are good. You can ask the department of obstetrics and gynecology at the nearest university hospital for the names of graduates, or faculty members who work n your area. If these avenues fail, try contacting a childbirth education group, such as the International Childbirth Educational Association, or a local Lamaze instructor.

When you have the name of an obstetrician who sounds promising, your next step is to find more information about her. To be sure she is a competent doctor, check out her training. An obstetrician should have completed an obstetrics residency at a registered hospital and should be certified by the American Board of Obstetrics and Gynecology.

Next, find out which hospital she is affiliated with the hospital should be accredited by the Joint Commission on Accreditation of Hospitals [JCAH]. Find out whether the hospital is a teaching institution. If it is, be sure you understand how residents will participate in your delivery. The hospital should be covenant for you, and it should have the facilities you want or need for your delivery. Some hospitals have only the traditional separate labor and delivery rooms. Others have elaborate birthing centers. If you are at risk for having problems during pregnancy or delivery, the hospital should have an infant intensive care nursery.

Find out about the people the doctor works with. If she works with a group of doctors, they probably take turns being on call at night, if you go into labor on a night your doctor is not on call, will she come in or will one of her partners perform the delivery? If one of her partners may deliver your baby, you will have to be sure that you are comfortable with the other members of the group and that they have the same attitudes towards childbirth as your doctor. Otherwise, the delivery you so carefully planned may be changed at the last minute. Some obstetricians employ nurse practitioners or midwives to do checkups or even perform uncomplicated deliveries. If this is the case, be sure you understand and are comfortable with the arrangement.

Finally, don't be afraid to ask about finances. Be sure your insurance will cover the doctor's charges and find out how and when payment is expected. Find out what happens to the charges if there are any complications.

When you have collected your information, you are ready for your first meeting with the doctor. It is a good idea for Dad to accompany you so he can ask questions and form an opinion of the doctor as well. If you haven't been seeing an internist or gynecologist regularly, it is a good idea to choose an obstetrician before you conceive; arrange a pre-pregnancy appointment to make sure there are no medical conditions that make pregnancy inadvisable at the time. If you have been receiving regular medical care, your first appointment should occur as soon as you think that you are pregnant, usually two weeks after the missed period. During the first visit the doctor will take a complete medical history including discussion of past and present illnesses and past pregnancies. A complete physical exam, not only a pelvic exam, should be done. You should have an opportunity to discuss with the doctor issues about your pregnancy and delivery. Be prepared for this part of your visit. Make a list of questions you want to ask. The obstetrician should be willing to answer any questions and discuss the type of care you will receive. She should be flexible about issues that are important to you, but if she feels that something you want will compromise your care, she should be willing to explain to you why.

You will want to talk about pregnancy and delivery. Important issues during pregnancy include nutrition, exercise, illness, and monitoring the baby's development. Discuss with the doctor what you should eat. How many more calories will you need? How does she feel about you drinking coffee or other caffeinated beverages? What about alcohol consumption? She will probably recommend vitamins and calcium supplements. Discuss with her how much exercise you should get. Would she recommend an aerobics class? Find out what you should do if you become ill. What medicines can you take and what should you avoid? An obstetrician can monitor a pregnancy with blood tests, urine tests, ultrasound studies and amniocentesis. What does she think is appropriate for you?

There are many decisions regarding delivery that should be made beforehand. You need to decide where you want to give birth-in a regular delivery room or in a birthing center. If you want your husband or other children there, be sure your doctor agrees. If you have strong opinions about the medical treatment during labor and delivery, be sure to discuss them with your doctor. For example, some women do not want an intravenous line, anesthesia or an episiotomy [a surgical incision to enlarge the external opening to the birth canal and make delivery easier]. Fetal monitoring is another topic you wish to inquire about. You may want to find out your doctor's opinions about inducing labor and cesareans. Ask her how many cesareans she performs. If her rate is high, try to find out why. Does she have a high risk population or is she just quick to operate?

By the time you are finished discussing all of these topics, you should have a good idea how well you like the obstetrician. Do you feel at ease with her? While you may not agree on very subject, you should feel confident that you can develop a working relationship and that you can discuss a problem and reach a compromise that will be satisfactory for both of you.

Finding an obstetrician may be easy, or it may require an extensive search. Because the doctor plays such an important role in your life at this time, it is worth the effort to find someone you like as well as trust. Only in this way can you be sure that your pregnancy and baby delivery will be as safe and as joyful as possible. And when all is said and done, if she has made your life and the pregnancy process much easier, don't forget to treat her with something special like doctor cookies or a nice thank you gift. She deserve it!