Everything You Need to Know.
Choosing an obstetrician for a first pregnancy is a tricky business. As a woman who is not yet a mother, there are several hurdles to overcome: naivete, modesty, lack of experience performing bodily functions in front of others. So when the time came to choose an OB for my first pregnancy, I knew very little about obstetrics or even pregnancy. I did what many women do – I asked a friend for a recommendation. I was referred to a practice of three women (two ob/gyns and one nurse practitioner). The clinic was close to my house, the physicians were board certified, and I couldn’t deny the fact that I was made comfortable by the idea of female doctors.
My pre-pregnancy appointments went well, but once I conceived my child, I realized how quickly the doctor-patient relationship can become contentious and counter-productive.
In the first few days of my pregnancy, I became so ill that I lost nine pounds. In the interest of full disclosure, I have to admit that I was about twenty-five pounds overweight at the time of conception. But that fact should not have overshadowed the shear insanity of a formerly healthy 25 year old losing nine pounds in five days – while pregnant. Fearing for the life of my unborn child, I scheduled an appointment with the first available person. What happened next was embarrassing, degrading, and inappropriate. When I asked the nurse practitioner during our appointment what to do regarding my inability to keep food down, the woman opened my chart and said, “Looking here I see you have plenty of poundage. I’m sure you’ll be fine.”
Because hindsight is 20/20, I am able to look back at that moment in time and see the red flags flying around the room, jumping out of the chart, hanging in the windows. I can hear my unborn daughter’s tiny voice screaming, “Blow this joint, Mom!” But at the time I was scared – scared to start over with a new OB, scared to tell my doctor that I wasn’t comfortable continuing with her practice, scared that it would just be the same somewhere else.
I could already see that Seinfeld episode playing in my mind. You know, the one where Elaine reads her chart while waiting for the doctor to enter, and there, in pen, it says, “Difficult.” Was I just being difficult? This was my first pregnancy. Maybe all women get this sick when they’re pregnant. After all, if the OB wasn’t worried, why should I be?
So I stayed with that OB practice, and three months into the pregnancy I was down 28 pounds. I was weak with exhaustion at all times. There were very few things that I could eat without vomiting. I learned to wear layers of clothing for weigh-ins to avoid being hounded by the nurses because the bottom line was this: the doctor’s wouldn’t help me.
Fast forward to week 31 of my pregnancy – By this time I had learned that my complaints and concerns would be listened to, but not responded to in any productive way. But I had also begun to develop my spidey-senses, my mommy instincts. So when I felt something strange happening during President’s Day weekend, I called my doctor’s office and asked to be seen. My OB sounded somewhat concerned and sent me to the hospital to be checked – but not by her. After all, it was a holiday weekend. In fact, I wasn’t seen by a doctor at all that weekend. I spent about ten, maybe fifteen minutes hooked up to contraction monitors, and a nurse did an internal exam. She glibly mentioned that I was “finger-tip dilated” (whatever that meant) and that everything was fine. After a quick phone call between the nurse and doctor, I was sent home and told not to worry. One week later my daughter arrived, two months premature.
The lessons that I learned during that pregnancy and subsequent premature delivery led to the full term delivery of my second child – with a different obstetrics practice. During that pregnancy I was diagnosed with hyperemisis, a condition in pregnancy that causes severe nausea and vomiting as well as significant weight loss. I was monitored closely, given medicine to curb the vomiting, and managed to only lose 18 pounds before the tide turned and I began to gain weight. I was also put on strict bed rest when, around 32 weeks gestation, my cervix began to shorten and dilate. Had my first OB taken the same precaution – had she made the five minute trip into the hospital to examine me – perhaps my daughter would not have suffered the traumatic first days and years of a premature child.
I still love and respect my friend who referred me to her gynecologist – and I even know friends who continue to see one of those doctors, although the second doctor no longer practices obstetrics. But for me – a woman who experiences difficult, high risk pregnancies – my choice of OB was disastrous. If I could talk to my former self, that woman in the room with the condescending nurse practitioner, I would give her this advice on how to choose a new OB wisely:
1. Think first about the hospital where you would like to deliver.
If you are fortunate enough to live close to more than one hospital, seriously consider choosing your hospital or birth center first. What made the frightening early delivery of my daughter even more dire was the fact that my hospital did not have a NICU. Her three week long stay in that hospital was tumultuous at best. I was told later by one of the nursery nurses that she was the “youngest” baby the hospital had ever chosen to not transfer. For more information on choosing a hospital, please read the upcoming post “Lesson Two – Choose Your Hospital Wisely.”
2. Ask your family doctor for recommendations.
Many family doctors have had years of experience referring their patients to obstetricians for pregnancy and delivery. Often they will know if the patients’ experiences have been positive or negative. However, keep in mind that many family docs also just refer a preset list of OB’s based on insurance constraints. When asking for a recommendation, be sure to also ask your doctor why they are referring that OB/GYN.
3. Search for a board certified doctor.
The American College of Obstetricians and Gynecologists maintains a searchable database of doctors who have met and maintained the requirements for certification. By going to their website http://www.acog.com/ and clicking on “Find an Ob-Gyn” at the top of the page, you can easily access this database.
4. Check with your state medical board.
Most state medical board websites will allow you to search by physician’s name for state board disciplinary actions as well as history of malpractice judgements.
5. Interview several physicians.
By interviewing a physician and asking important questions, you will in many ways be able to predict both the experience and type of care you will have with that practice. For example, when I spoke with my OB about how often she performs episiotomies, she avoided directly answering the question by simply stating that in her experience most first time moms needed an episiotomy. I was not surprised when that same physician performed an episiotomy on me during the delivery of my tiny four pound baby.
Other questions to consider are:
a. What pain relief methods do you most often use with your patients?
b. What experience have you had caring for high risk pregnancies?
c. How often do you perform C-sections?
d. Do you perform VBACs (vaginal birth after Cesarean)?
e. Are you open to the presence of a midwife or doula during the delivery?
f. Do you support patients who wish to forgo pain medication and/or constant fetal
g. What is your policy regarding emergency visits?
h. Does your practice deliver all of your patients, or do you work with other associates on a rotation?
Finally, listen to your instincts. That voice in my head that warned me of the bad things to come was not being paranoid and was not being “difficult.” If I had the opportunity to do it all over again, I would have listened to her. She turned out to be a pretty smart lady.
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