What you should know about your OB

Finding the right obstetrical provider is an important key step on the road toward parenthood. Your OB should be someone whose skills you have the utmost confidence in and someone you can trust. Obstetrics is a unique field in that the patient/provider relationship often goes deeper than the typical provider/patient relationship based on the number of visits in a short amount of time as well as the intimacy of the experience. Finding a provider that has a similar birthing philosophy can put you at ease and make the journey that much more enjoyable and empowering.

Location, location, location:

Ask your OB about where they attend births. Most groups or solo providers will have only one place where they deliver, but some providers or groups are affiliated with two or three hospitals. Also, some midwives may attend births in both the home and birth center or hospital.

Coverage:

Ask your provider how the on-call schedule works. If there is only one OBGYN in the practice, who covers that person when they are unavailable? If there are two or more people in the practice, how is the call schedule divided up? Who works on the weekends or holidays? Is the provider available to you 24/7? Since the baby will come on his or her own time, it’s important to have an idea of how all the different scenarios will play out beforehand.

Cesarean Rate:

Ask your provider about their cesarean rate. If they are in a group, ask about the group’s rate, in addition to their personal rate. Take into consideration if they have a population that includes multiples, breech deliveries, and VBACs (vaginal delivery after cesarean). The national cesarean rate is around 32-35%, but the World Health Organization states the ideal rate for safety is around 15%. Most birthing institutions in the United States range from 17-45%. A single provider may have a rate as low as 15-20% andsome midwives may have rates as low as 2-8% because they only work with women without medical or prenatal conditions.

Birth Philosophy:

Asking a provider to explain their birth philosophy can seem vague, but asking specific questions such as their opinion on VBACs, elective cesarean deliveries, vaginal breech delivery, episiotomies, and continuous fetal monitoring may help to more cogently explain how they feel about birth, labor, and delivery.

Induction Policy:

Asking an OBabout their induction policy is something most women don’t think to do until the end of their pregnancy, but it could be helpful in deciding upon a provider. The American College of Obstetricians and Gynecologists (ACOG) recommends waiting until 39 weeks for an elective, non-medical induction, not inducing a patient with an unfavorable cervix, and inducing all women by 42 weeks. If a medication free delivery is your desire, it is generally advisable to avoid an elective induction, especially when the cervix is closed.

Timing:

Ask your provider when you can expect them to show up at your delivery. This is another question that is often overlooked. The answer will run the gamut. Some physicians only arrive when a woman is full dilated—10 centimeters—and ready to deliver, while some arrive at the birth location the minute the woman is in labor or gets admitted to the facility.

Students:

Does the practice work with students or residents? Some providers are affiliated with a teaching institution or train birth professionals in their practice, not only during prenatal care, but also in the hospital. Is it possible that a student or resident will be at your birth or caring for you while you are in labor? Also if a cesarean is necessary, who will be assisting the surgeon? Most surgeons are assisted by a medical resident during a cesarean.

Insurance and Pricing:

Does your provider take your insurance? Are there any additional fees? Make sure you are aware of all fees up front and there are no hidden costs.

Other questions that may be important:

• Your provider’s experience
• Where your provider trained
• Weather or not your provider has children or has given birth themselves
• If your provider supports hydrotherapy or water birth
• If your provider encourages the use of a doula or labor companion
• Though things don’t always go exactly as planned during labor and delivery, having an OBGYN who knows and understands your birth plan is extremely important and can put your mind at ease.

Going further:

When interviewing and evaluating providers, consider where you are in regards to pregnancy. If you are looking for an OBGYN before you become pregnant, your frame of mind will be different than if you are in your second or third trimester. Many women shy away from finding the right fit before they are ready to conceive because they feel it is jumping the gun. Actually, this is a great time to look for a provider because there is less urgency and you can evaluate each provider without the emotional and spiritual effects of pregnancy influencing your decision making process.

On the other hand, if you are interviewing providers when you are newly pregnant, it can all seem surreal. Most women do experience a mild form of disbelief or even denial when they first become pregnant, and important questions about labor and delivery seem far away. Women in the middle or end of pregnancy looking for an OBGYN may feel a sense of guilt for leaving a previous provider, but they also may be more motivated to find the right fit because the labor and delivery experience is starting to seem more real to them.