Top 5 Things to Consider When Choosing an OB/GYN for Pregnancy
Choosing an excellent OB/GYN is one of the first steps towards an optimal pregnancy. When choosing the right provider for prenatal care, your health and your baby’s health are the number one concerns; yet the whole prenatal and pregnancy experience is important too.
Today, there are not only several types of locations and facilities to give birth in, there are also many different types of providers. When giving birth in the United States, you can choose a hospital, birthing center, homebirth or hybrid model. The hybrid model is usually a combination of both. It includes the ambiance of a comfortable (non-hospital type setting) but with immediate access to emergency care such as an operating room, high level neonatal intensive care units (NICUs), imaging facilities and a blood bank. The hybrid model is quickly becoming the fastest growing option as it gives women a sense of the best of both worlds.
A hybrid model is usually a birthing area or pavilion within a hospital. Many hybrid models are located in or near a hosptial, yet have entirely separate entrances or wings for women and children. This often includes separate units, rooms, ERs or triage areas and seperate operating rooms (should the need arise).
Many women report that a hybrid hospital model gives them a feeling of both comfort and safety.
Women enjoy the flexibility to eat and drink in labor, walk around, doula support, having the choice of varying levels of monitoring all the while having access to epidurals and emergency services like NICUs and operating rooms.
On top of choosing a location, women must also choose the right provider to help them navigate all of these choices. We’ve compiled a list of the top 5 things to consider when choosing an OB for your pregnancy and childbirth.
The amount of experience in a doctor or midwife can be tricky to discern or even find out because even if a doctor/midwife has been practicing a long time, they may not have done that many deliveries per year. Conversely a doctor/midwife who has only been out of residency or training for a few years may have several thousand deliveries under their belt.
An expert is one who has spent 10,000 hours doing something which would roughly be about 2,000 deliveries. A very busy OB would do about 250 a year and take about 8 years to become an expert. A great question for your OB would be: “How many deliveries do you do a year?” Multiplied this by the amount of years they have been out of training you should get a rough idea of how much experience they have.
There are many conditions and situations that come about in pregnancy and childbirth that have a (thankfully) low prevalence rate. It’s important to have a provider who has seen it all and is comfortable with the unlikely but unpredictable.
2. Cesarean Delivery Rate
Unless a group or an individual has a low cesarean rate, this is often something that is not advertised and you will have to ask. The WHO (world health organization) has deemed that a safe cesarean delivery rate is around 15%. Most OBs have cesarean delivery rates of 30-40% and even higher in some states.
Cesarean delivery rates are often higher for first time moms. When you are looking around for the right group for you, be sure to ask about cesarean delivery rates overall and for first time moms separately. It is also possible that if a practice works with primarily high risk women the cesarean rate may be higher. Anything more than 25% would be too high, even for a high risk practice.
3. Cross Coverage
This is an often overlooked question. Who covers your doctor/midwife or group when they are on vacation, sick or at a special event? Even with a solo practitioner, there are instances when they cannot be available 24/7. It is important to familiarize yourself with who could possibly be there in all circumstances.
Many groups will not have an outside provider cover them, but some groups will cover with other groups on weekends making this an important question to ask. If your OB/GYN group is on the smaller side 5 or less, be sure that they do have other groups cover them. Most large groups will boast always knowing who could potentially be there as a benefit and encourage you to meet all of their providers.
Further, a solo practitioner can often push themselves too hard and be fatigued or tired. It is helpful to know what happens in these situations. At what point does a solo provider call in another doctor or midwife to cover them? Is it after 48 hours of work? 72? All good questions to know the answers to.
4. Induction Policies
This is an essential question and one that is often forgotten and left until the end of pregnancy when changing providers may not be an option. Each group and practitioner feels differently about induction as do most women. Some women want to be allowed to progress until 42 weeks and some women want elective inductions at 39 weeks. Even if you are early on in your pregnancy and childbirth education and are not sure on where you stand on induction, you want to know that you have both options open to you.
There is a growing amount of research that inductions at 39 weeks or 40 weeks may reduce a woman’s chance of cesarean delivery yet there are some providers and hospitals that have not adopted this policy yet. Furthermore if you wish to avoid induction as long as it is safe for you and your baby, you want to have a group that supports you in this choice as well.
There are some groups that do not allow 39 week inductions as well as other groups who will push for induction by 40 or 41 weeks and do not favor 42 week inductions. Find out early on in your pregnancy how your group feels about induction.
When you are at the beginning of your pregnancy, thinking about your strategy for pain management can feel far off. Asking your provider about how they feel about doulas can give you a lot of insight as to what type of provider you are working with.
Doulas are an essential part of the birth team, and absolutely critical for a woman who wishes to avoid an epidural in childbirth. They can even be paramount for a woman whose pain management plan includes an epidural as they are a wonderful luxury for stress reduction and enhancing the birth experience.
If you find that your doctor or midwife is not supportive of doulas, this may reveal a lot about their character and philosophy of childbirth. It is often a very revealing question.
Choosing an OB/GYN is so important but does not have to be daunting. This article was written with the help of Kristin Mallon, CNM, MS, RNC-OB. Her practice is Integrative Obstetrics in Jersey City & Bergen County. Their group delivers out of Hackensack University Medical Center in. NJ a Hybrid Birthing Hospital Model. All of the providers in practice she works with are experts, support all types of induction, love doulas and have a cesarean birth rate of 14%. It would have to be a zombie apocalypse for them to allow anyone else to deliver their patients. Furthermore they support vaginal breech birth and vaginal twin birth.