Prenatal Care
Choosing a Doctor
Good Vibrations
Choosing a doctor or birth attendant without careful thought has all the pitfalls of an arranged marriage: You don’t know what you’ve committed to until it’s too late. Save yourself and the doctor wasted time and emotional trauma by doing your homework now.
Think about what kinds of personality traits make you the most comfortable. If your doctor is the autocratic type and you want to share in the decision-making process, you’ll be at each other’s throats in no time. If you don’t like to worry about details, a take-charge type may be just your style. Decide what is your style and find someone who’ll “wear well” over the months of your pregnancy. Breaking up after you’re several months into the relationship can be inconvenient, if not painful, for both of you.
If you have insurance with maternity benefits, your first step is to know exactly what is and is not covered. It’s a waste of valuable time to investigate hospitals and doctors if they don’t accept your particular insurance plan. Many plans now contract with certain hospitals and doctors to provide services for their subscribers. You need to know what, if any, limitations apply. You may want to ask your insurance representative the following questions.
Questions for the Insurance Company
- Which hospitals in my area accept my insurance?
- Do you have a list of physician providers from which to choose?
- What’s the total reimbursement you provide for my doctor?
- What’s the total reimbursement allowance for hospital costs?
- How many hospital days do you allow for a vaginal birth and a cesarean birth?
- What type of hospital room does my plan provide for? Private? Semiprivate or ward?
- How is payment handled for services? Direct payment to physician? Reimbursement to me after delivery?
- What obstetrical costs do you cover? Ultrasound? Blood tests? Amniocentesis? Fetal well-being tests (stress and non stress testing)? Medications?
- Is there coverage for neonatal or pediatric care?
- What coverage is there should complications occur?
Before you plunge ahead to find your doctor, give some thought to your birth preferences. If you have some very specific plans for your birth, such as epidural or single-room maternity care, keep in mind that most doctors limit their practice to one or two hospitals. If you find that your chosen doctor doesn’t practice at the hospital which offers these options, you’ll have to decide between your doctor and your preferences and what your insurance allows.
Call the hospitals in your area and ask to speak to a nurse in the labor and delivery department. Explain that you’re pregnant and interested in what the hospital has to offer for birth options. Here are some sample questions:
Questions for the Hospital
- What types of birthing rooms do you offer? Traditional? Single room, labor/ delivery/recovery/postpartum (LDRP), or a combination?
- Who do you allow for support persons? How many? Do you let children attend births? If you do, are sibling preparation classes offered at the hospital?
- Do you allow video cameras during delivery?
- If a cesarean has to be done, do you allow support persons in the operating room?
- Do you offer vaginal birth after cesarean?
- What types of anesthesia for delivery do you provide? Is epidural anesthesia available?
- Do you have 24-hour coverage for anesthesia in the hospital, or do you use on-call people after hours?
- After delivery, how soon can I nurse my baby?
- Does the baby have to stay in the nursery, or can I have unlimited access to him?
- How soon after delivery do you usually discharge patients?
You can add or delete questions to the list depending on what’s important to you. Don’t ask nurses about hospital fees; they usually don’t know about those things. Labor nurses are also great resources for matching you with a suitable doctor based on your preferences. Give the nurse a sample of your high-priority preferences. For instance, if you don’t want an enema or perineal shave and you want to stay out of bed as long as possible, who would go along with your wishes? If you want someone who is flexible or fatherly, ask for the names of doctors who fit your bill. Ask your friends and family for some recommendations. Call a few childbirth educators and get their input. Many resources of information are out there.
When you sit down with your prospective doctor, ask diplomatic questions; no one likes to be interrogated. It’s counterproductive and usually futile to ask such questions as the doctor’s personal cesarean birthrate because most doctors don’t keep track. Hospitals have that information but are unlikely to share it with you. In reality, cesarean birth statistics don’t always give valid insight into the quality of obstetrics being practiced because too many variables enter into the decision to perform a cesarean.
Be friendly and relaxed. You aren’t negotiating a Middle East crisis, you’re just looking for a doctor. If you ask open-ended questions you’re more likely to get the candid answers you need to make your decision. Keep in mind that your mission isn’t to make judgments, you just want to find a doctor whose philosophy and personality are compatible with yours. Here are some sample questions.
Questions for the Doctor
- What do you like best about the hospital where you primarily practice?
- Do the doctors in your call group share your birthing philosophy? How do they differ?
- What is your policy regarding ultrasound exams during pregnancy? How many do you routinely do? If you do an ultrasound, can my husband and children be present?
- If I develop a complication, will you still care for me, or transfer my care elsewhere? If you’d transfer me, where would I go?
- What birth options are you comfortable providing?
- What procedures do you routinely require during labor?
- What is your policy regarding preps, enemas, fetal monitoring, and IVs?
- How do you feel about support persons? Do you limit the number of people?
- What is your approach to episiotomy and positions during delivery?
- What are your preferences regarding medications and anesthesia for labor and delivery?
- How do you feel about vaginal birth after cesarean? Do you offer that option?
Once you’ve made your choice, communicate your desires and preferences clearly to your doctor; mind reading wasn’t a part of his medical training program. Effective communication is the key to establishing the important trust and rapport vital to any successful relationship, and it’s no different with your doctor.