Finding a Health Care Provider
Even if you have a model pregnancy, you will be seeing a lot of your health care provider over the next nine months. The American College of Obstetrics and Gynecology (ACOG) recommends that women see their provider every four weeks through the first 28 weeks of pregnancy (about the first seven months).
After week 28, the visits will increase to once every two to three weeks until week 36, after which you'll be paying your doctor or midwife a weekly visit until your baby arrives. If you have any conditions that put you in a high-risk category (for example, diabetes, history of preterm labor), your provider may want to see you more frequently to monitor your progress.
So who should guide you on this odyssey? If you currently see a gynecologist or family practice doctor who also has an obstetric practice, he or she may be a good choice. If you don't have that choice or would like to explore your options, consider:
An ob-gyn: An obstetrician and gynecologist is a medical doctor (M.D.) who has received specialized training in women's health and reproductive medicine.
A perinatologist: If you have a chronic health condition, you may see a perinatologist — an ob-gyn who specializes in overseeing high-risk pregnancies.
A midwife: Certified nurse-midwives are licensed to practice in all fifty states. They provide patient-focused care throughout pregnancy, labor, and delivery.
Nurse practitioner: A nurse practitioner (N.P.) is a registered nurse (R.N.) with advanced medical education and training (at minimum, a master's degree).
Combined practice: Some obstetrical practices blend midwives, N.P.s, and M.D.s, with the choice (or sometimes the requirement) of seeing one or more of these throughout your pregnancy.
Networking and Referrals
Finding Dr. Right may seem like a monumental task; after all, this is the person to whom you're entrusting your pregnancy and your childbirth. Unless you're paying completely out-of-pocket for all prenatal care, labor, and delivery expenses, your first consideration is probably your health insurance coverage. If you are part of a managed-care organization, your insurer may require that you see someone within its provider network. Getting a current copy of the network directory, if one is available, can help you narrow down your choices by coverage and location.
What is a doula, and is it too early to get one?
A doula is a pregnancy-and-birth support person whose job is to provide emotional assistance to both the mom-to-be and her family. Doulas can assist you at any point in pregnancy, from preconception to postpartum issues.
Many women choose a physician solely for logistical reasons (for example, insurance will cover all of his fees, or she's near your place of work). Although money and convenience are important factors, these won't mean much if you aren't happy with the care you receive and with the role they ultimately play in your pregnancy and birth.
Whether your first or your fifth, this pregnancy is a one-time-only event. You deserve the best support in seeing it through. Talk to the experts — girlfriends and other women you know and trust — and get referrals. Be aware that not everyone looks for the same thing in a health care provider; what one woman emphasizes, you may downplay. With this in mind, you might find it more efficient to limit your survey to friends and family you know well rather than canvass your office or gym (since as word spreads you'll be getting unsolicited recommendations from your manicurist's daughter's sister-in-law).
Need a referral? The American College of Obstetricians and Gynecologists (ACOG) can help you find a physician in your area (all ACOG fellows are board-certified ob-gyns). To find a nurse-midwife, contact the American College of Nurse-Midwives.
If you've just moved to a new area or simply don't know any moms or moms-to-be, there are other referral options available. The licensing authority in your area (the state or county medical board) can typically provide you with references for local practitioners. You may also try the patient services department or labor and delivery programs of nearby hospitals and/or birthing centers. Most medical centers will be happy to offer you several provider referrals, and you can get information on their facilities in the process.
Ask the Right Questions
Once you've collected names and phone numbers, narrowed down your list of potential providers, and verified that they accept (and are accepted by) your health insurance plan, it's time to do some legwork. Sit down with your partner and talk about your biggest questions, concerns, and expectations. Then compile a list of provider interview questions. Some issues to consider:
What are the costs and payment options? If your health plan doesn't provide full coverage, find out how much the remaining fees will run and whether installment plans are available.
Who will deliver my baby? Will the doctor or midwife you select deliver your child or another provider in the practice, depending on when the baby arrives? If your provider works alone, find out who covers his patients during vacations and emergencies.
Whom will I see during office visits? Since group practices typically share delivery responsibilities, you might want to ask about rotating your prenatal appointments among all the providers in the group so you'll see a familiar face in the delivery room when the big day arrives.
What is your philosophy on routine IVs, episiotomies, labor induction, pain relief, and other interventions in the birth process? If you have certain expectations regarding medical interventions during labor and delivery, you should lay them out now.
What hospital or birthing center will I go to? Find out where the provider has hospital privileges and obtain more information on that facility's programs and policies, if possible. Is a neonatal unit available if problems arise after the baby's birth? Many hospitals offer tours of their labor and delivery rooms for expectant parents.
What is your policy on birth plans? Will the provider work with you to create and, more important, to follow a birth plan? Will the plan be signed and become part of your permanent chart in case he or she is off-duty during the birth?
How are phone calls handled if I have a health concern or question? Most obstetrical practices have some sort of triage (or prioritizing) system in place for patient phone calls. Ask how quickly calls are returned and what system the practice has in place for handling night and weekend patient calls.
Some providers have the staff to answer these sorts of inquiries over the phone, while others might schedule a face-to-face appointment with your prospective doctor or midwife. Either way, make sure that all your questions are answered to your satisfaction so you can make a fully informed choice.
Comfort and Communication
As with any good relationship, communication is essential between patients and their providers. Does the provider encourage your questions, answer them thoroughly, and really listen to your concerns? Does he make sure all your questions are answered before concluding the appointment? Are the nursing and administrative staff attentive to patients' needs and willing to answer questions as well?
Good health care is a partnership or, more accurately, a team effort. Although ultimately you call the shots (it's your body and your baby, after all), your provider serves as your coach and trainer, giving you the support and training you need to reach the finish line. If your doctor doesn't listen to your needs in the first place, she won't be able to meet them. Remember as well that communication works both ways. Your provider has likely been around the block a few times and has a wealth of useful information to offer you, particularly if you're a rookie at this baby game.
When you phone potential providers, pay close attention to how the support staff handles your call. If the receptionist is rushed or rude or you're put on perpetual hold, that could signal a problem. Midwife and obstetric practices are notoriously busy, but a competent office staff will be both polite and reasonably timely with patient inquiries.
Although experience, education, and practice philosophy are key considerations in selecting a care provider, your comfort is equally important. Is the doctor warm and compassionate, cold and humorless, outgoing and chatty, or reserved and distant? Even with a short introductory phone call or appointment, you should be able to get a feel for your potential provider's bedside manner. Is it a personality style you can effectively deal with for the next nine months? If you're regaled with bad jokes or mind-numbingly boring clinical explanations at the doctor's office, just imagine how you'll feel hearing it in the delivery room.
Gender may also be an issue for you. Some women feel more at ease with a female physician. Making an issue of gender may seem silly or, at worst, discriminatory and hypocritical. The subject is serious enough to merit a number of clinical studies and patient surveys in the medical literature both for and against a clear gender preference.
Some reasons given for choosing a woman doctor include communication style and the fact that the physician may have been through pregnancy herself. Other women may find that they prefer a male doctor for various reasons. The bottom line is that you are the one who has to live with your provider choice for the next nine months, and to spend it feeling awkward, stressed, and inhibited — emotions that can ultimately have a negative effect on your pregnancy — is not healthy. Whatever your choice, make sure it's one you'll be comfortable with.