How to choose an obgyn
It’s a big decision, so how do you choose the best OBGYN for you? Dr Clare Thompson advises mamas-to-be on how to approach this important task…
One of the most frequent questions I am asked by both patients and friends alike is ‘how on earth do I choose an OBGYN?’ followed by ‘who does the best C-section in town?’
Most expectant women use their girlfriends as a barometer of who is any good, and most doctors will often refer to their friends from medical school or work colleagues from their residency program. So how to know?
Such a difficult question to answer and so subjective. But really the question is ‘what are you looking for in your doctor?’ since every OBGYN has their own approach. Often I find it is more like a matchmaking service when deciding who to choose for my patients.
Part of my job is to know who is good at what and why. The only way to be sure is to meet these doctors and to get honest feedback from their patients over many years. Given that patients rate their doctor based on outcome it can be hard to differentiate on absolute standards. For instance, a complicated pregnancy will be complicated no matter how amazing the OBGYN is and so a patient might have a not-so-great experience of the pregnancy and judge the doctor’s skills on this basis alone.
Personally I really listen to what my patients say when I ask them about their experiences with an obstetrician. Did the secretary pick up the phone and accommodate their schedule properly? Did the doctor take time to listen to their concerns and address them appropriately in an unhurried manner using terms they understand? What was the follow up like? Does the obstetrician do their own scanning and blood testing or are they sending the patient to another center to have these investigations performed?
Meeting the team
Another problem with babies is that they tend to have their own timeline and so booking an obstetrician for a specific date is fraught with potential re-scheduling drama. Your doctor will also have a life and family of their own with vacations planned well in advance to try and account for this but either way you will need to expect the unexpected. I would highly recommend meeting two obstetricians from your chosen doctor’s team so that you are comfortable with the emergency cover if your own doctor is away and your baby arrives earlier than scheduled. This takes away a lot of stress of the unknown and improves the care you receive.
An excellent doctor will be a victim of their own success and it can be seemingly impossible to get an appointment, or even get onto a shortlist to get an appointment! I know mothers who put their names down for an initial consultation even before they have conceived. This seems like complete madness but when you consider that this professional will be guiding you and your partner through one of the most amazing, yet terrifying, experiences of your life it sort of seems rather worth it.
Your personal health history
If you suffer with any chronic illnesses such as diabetes, high blood pressure, heart disease, epilepsy or a previous antenatal complication that might require special care then it is wise to try and see an OBGYN who has a special interest in caring for high-risk pregnancies.
Some doctors will have a special interest in IVF pregnancies and twin births which is a growing field as more women than ever are having their first baby after age 35 and often with the help of an IVF clinic to conceive.
Choices for delivery and pain relief
Some mothers are very clear about wanting to try for a vaginal birth the first time around and others opt for a cesarean delivery. Make sure that you discuss both options fully with your chosen OBGYN and listen to any reasons why one or other may not be appropriate for you. Often a complicated vaginal delivery will have to be reverted to an emergency cesarean if the life of mother or baby is at risk. It is best to always be prepared for both scenarios and understand what the usual procedure is during a C-section.
If you’ve previously had a C-section, think about whether you would like to try and have a vaginal birth at the next delivery. If this is something you feel strongly about speak to the OBGYN about this option and see whether the hospital are supportive of vaginal birth after cesarean (VBAC). Remember that some hospitals don’t allow VBAC for insurance reasons.
Those mothers planning on a water birth should also inquire about whether or not they need to make a reservation in advance for the water-birthing-suite.
Try to check your obstetricians C-section rate. Around 15-20% is ideal but this percentage can be a lot higher in those doctors who specialize in high-risk pregnancies.
Have a conversation with the doctor about pain relief and make sure you are well versed on any potential side effects of epidurals vs gas and air. They may even schedule an appointment for you to discuss this with an anesthetist who would be responsible for siting an epidural during labor. Many women have a ‘birth-plan’ and this is a great way of letting the team know what your wishes are for the delivery process. However, I have rarely seen many birth plans going exactly as the mother had hoped as there are so many variables during the laboring process. The key here is to have a degree of flexibility and to keep in mind that the safety of both you and your baby is paramount.
Investigations on site
A lot of obstetricians will perform their own scans and have facilities to do blood tests within their office. But many will choose to delegate these tasks to another center, which can be frustrating for a busy mother trying to juggle work, the school-run and clinic appointments.
At some practices you will see your obstetrician for every antenatal visit whereas other clinics might offer you to see a nurse practitioner for some of the check-ups or where the doctor is unavailable. Some healthcare systems will want you to see a nurse practitioner for every antenatal appointment unless you have a complication or a high risk pregnancy. Nurse practitioners will have the skills to perform routine check-ups that happen at each antenatal visit and will identify and escalate any problems that might require a doctor’s attention. Seeing your own obstetrician for every appointment will allow you to develop a better professional relationship but the downside is that you may have to reschedule sometimes if they are called away to deliver another baby that day.
Recommendations from your family doctor
I do think it is worth asking a trusted family doctor who they would choose themselves and why. Listen to the reasons they give you for their own choices and think about it carefully. Personal recommendation from a doctor themselves is usually a good point of reference and most often based on a good standards of clinical care.
Visit the delivery suite and ensure the neonatal unit is on site
Most doctors will have admitting rights to one hospital group and deliver at one or two main sites. It can be very reassuring for you to take the time to visit the delivery suite and be happy with the facilities. I can’t stress enough the importance of having a decent neonatal unit on site at the delivery suite as you will want to ensure that your new-born will receive the best possible care should any complications occur with the baby at or after the birth. This means having a competent and experienced neonatal consultant and their team in a department that is well equipped with the appropriate resources to look after premature babies. Some units will stipulate that babies born prior to 28 weeks will need to be transferred out to other sites so be sure you know exactly where that would be if the worst case scenario were to unfold.
Alternative options and home births
Whilst most babies born in the United States are delivered by obstetricians, you do have other options including certified nurse-midwives (CNMs), direct-entry midwives and family physicians.
I must also give mention to those mothers who choose to have home births as this has been a growing trend for the past 15 years or so. Home births can be a wonderful experience for the mother during the delivery as long as everything goes to plan. Plan B must be considered well in advance to accommodate the emergency scenario in labor. It is often midwives who will attend a homebirth and I would strongly recommend that you should have access to a local hospital who knows you well. The most frightening labors are those in which the doctors have not had the opportunity to meet the mother in the antenatal period and then do so in an emergency setting for the first time. It is always worth being extra vigilant about attending your antenatal appointments if you are planning a home birth to avoid any unforeseen medical emergencies at home. Even still, labor is unpredictable and sometimes a home birthing mother will have to go to hospital either way if the baby’s or her own life is at risk. Safety must be the top priority here.
You may also want to determine the doctor’s feelings about having a doula or other support professional besides having your partner present at the birth.
It is worth checking your insurance policy to see whether it covers any of your hospital outpatient appointments, scans, blood work, fees for the delivery and postnatal care. Some policies require you to pay into the scheme a year prior to conceiving which can be quite cost effective for those who are planning a baby in advance.
A few key points when you choose your OBGYN:
One way of being sure you have chosen the right OBGYN is just to meet at least two different doctors in person as soon as you find out you are pregnant and then see how you feel during each consultation. Most mothers will go on to have their second and third child with the same consultant and so the first-time birthing experience is hugely important to a mom. Being prepared and thoughtful when you attend the first consultation and arming yourself with a few key questions can help you make the right decision for you and your family.
- How responsive are they? Are they answering your emails and phone calls fairly quickly (*within reason)
- What are their secretaries like? A polite and efficient team is an absolute essential.
- Are all of your questions answered properly at each consultation? Does the doctor listen to and try to respect your wishes?
- Do you feel listened to and were you given full explanations in a way that is easy for you to digest and understand?
- What is the doctors scheduling like? Do they have appropriate vacation cover? Who does it for them?
- Who does the doctor work alongside? Have you met at least two of the doctors from the team?
- Does the OBGYN do their own scanning on site or do you need to be seen elsewhere for investigations and blood tests?
- What is the follow up like? Does the doctor call you as soon as your results are in? Who is your contact in the case of an out of hour’s emergency?
- Does the doctor work at a facility with a decent neonatal unit on site? If not, where would your baby’s care be transferred to and would you be happy with this arrangement?
- Ask your trusted gynecologist or family doctor who they would see and why. Alternatively The American College of Obstetricians and Gynecologists will have a register of all the OBGYNs in your locality as well.
Ultimately the choice of whom to choose as your OBGYN is such a personal decision but safety and good communication between mother and doctor really must be tantamount to everything else. If you are dissatisfied with the level of care that you are receiving then it is perfectly reasonable to change to another doctor, especially within the first trimester. You should always feel confident that your doctor will take excellent care of you and your baby from pregnancy to the delivery.