How and Why to Choose an Obstetrician Carefully

Choosing an obstetrician for a first pregnancy is a tricky business. 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. Fearing for the life of my unborn child, I scheduled an appointment with the first available person at my doctor's office. 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.

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. The rest of the pregnancy continued much the same, with the physicians doing little to nothing to address my concerns, and one cold February morning, 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. 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, please read my article on Type-A Mom, "How and Why to Choose Your Delivery Hospital Carefully."

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 monitoring?
• 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?