Don't be afraid to do background research about potential doctors ahead of time. If you have any friends who have had babies, ask them about their doctors. The best way to find a doctor is usually by word-of-mouth. I went through three different doctors (and three babies) before I found the doctor who was right for me (for the last two babies). I wouldn't suggest that route. It was nicer to have the same doctor for several babies at that point I felt as if the doctor and I were friends, and she had a vested interest in me.
Another factor to consider is whether or not you're more comfortable with a man or a woman. I've had both three babies with three different male doctors; two with the same female doctor. If you get an empathetic man (like Dr. John, of course), a male doctor is just fine; however, I found the female doctor to be more in tune with me (plus her hands were smaller those exams, you know). The important part is that all of my doctors were there when I needed them and were highly competent physicians.
Remember, you're not just interviewing the doctor, but also his staff. Pay attention to the details. Do the nurses and assistants seem friendly and concerned? Do they answer your questions? How long is your stay in the waiting room?
Point-Counterpoint... "The Patient's"
OK, I admit that I once walked out of a waiting room after waiting for over two hours for my first appointment with a new doctor. Hey, I think my time is as valuable as the doctor's time. While I appreciate that doctors may have emergencies, I thought the staff should either have rescheduled me or gotten me in to see someone else. I crossed that doctor off my list and made an appointment with someone else.
Point-Counterpoint... "The Doctor's"
It's hard to tell why the doctor is running late if you haven't been seen in an appropriate amount of time. Some situations are unavoidable, but that doesn't excuse the fact that the staff should keep you informed of how long your wait will be, have you see another provider if available, or reschedule you for another visit. However, sometimes there are emergencies that the doctor must attend to, or the patients ahead of you may be taking more of the doctor's time than he or she had planned. Unfortunately, this happens a lot. On the other hand, most doctors will try to give you the same amount of care and attention as needed.
What Questions Should I Ask?
Here we list some questions to ask the doctor when interviewing him, and then give you how the doctor should (or should not) answer the questions.
After Dr. John responds (in italics) how he would answer the question with his patients, then he tells you what you should look for in the responses of your doctors.
1. How long have you been delivering babies?
My response is that I have been delivering babies for over 10 years.
However, there is no magic number here. Obviously, a doctor who has been practicing three years will probably have fewer babies delivered than one who has practiced 20 years. But again, that is not always the case. For example, you may have a doctor who only delivers a few babies a year vs. one who delivers all the time. On the positive side, the doctor who has only delivered a few will probably spend more time with you. On the negative side, he probably hasn't seen as many complications as a doctor who delivers more frequently. This is a subjective answer, depending on what you're looking for. My suggestion is that you look for someone who has the experience that you're comfortable with as a patient. You want to make sure that the doctor you're entrusting your pregnancy to has the right amount of experience to handle your case.
2. How many babies have you delivered?
Personally, I have delivered over 800 babies, but I worked at a military hospital where I saw a lot of patients.
Also, keep in mind that while a new doctor may not have delivered as many babies in her practice, she may have delivered quite a few as a resident. Again, this answer is similar to the one above. Not an exact number, but someone who has delivered 100 babies or more probably has some experience, rather than someone who has delivered fewer than 10. What is your comfort zone, i.e., the answer that gives you comfort? It's subjective and differs from one patient to another. Basically, what you want is a doctor who has had some experience and can handle problems with confidence and competence.
3. Do you have a preference for obstetrics or gynecology?
In my case, I like both I like a balance. I like taking care of pregnant women and delivering babies, and I also enjoy women's health care in general.
Usually, OB/GYNs do have their preferences. Often, a doctor will decide to just pursue gynecological patients after a stint at delivery. Delivering babies at all hours does impede on a doctor's home life, so there is a high burnout rate. Also, if a doctor chooses a specialty such as high-risk OB, she probably likes it more.
Obviously, some OB/GYNs have a good balance in their practice and enjoy covering both areas. But there are some doctors who would rather do more gynecology than obstetrics. Asking the question, depending on the answer you receive, may let you know if the doctor is someone you want to follow your pregnancy. Another good reason is that if you want to have more children and you find out that your doctor is getting out of delivery soon, you might want to start with another doctor who will last through all your pregnancies.
4. What percentage of your deliveries is C-section?
My percentage of C-sections is probably around 18%.
This question should be answered with a percentage figure because you will probably not get exact numbers. In the U. S. we are seeing an increasing trend for babies to be delivered by C-section. That figure will probably get higher. Currently, the average number of C-sections is 22 24% in the U.S.
If your doctor quotes a higher percentage for C-sections or complications, it may not mean that he has a preference for doing that surgery, but rather that he has more high-risk patients. However, if your doctor follows relatively uncomplicated patients in his practice and has a higher percentage rate than the national average, you might want to follow up your question with "why."
What you want to find out is if your doctor is going to recommend a C-section for you in circumstances that are equal with another doctor who might choose to do a vaginal delivery. In general, C-sections carry more risk for the patient and baby; however, there are times when it is necessary and the risks of a C-section are outweighed by the risks of a vaginal delivery.
5. What is your complication rate?
This is a good question. My complication rate is low. I'm very pleased with that. I think I'm very fortunate, but I'm also well trained. I have very few problems or outcomes associated with the patients I manage. I also realize that complications are a fact of practicing medicine. The real question here is whether or not your doctor will be honest with you. You won't know until you ask, although frankly, this question may take him/her by surprise. If the doctor gets defensive, is evasive, or offended, you may think twice about using that particular doctor. If the doctor is confident in his abilities, he will probably tell you. Most patients don't ask their doctors this question, so I'm sure I'll get some mail from doctors asking what in the heck I was thinking of...
What we're talking about is what percentage of deliveries is associated with problems as a result of the doctor's management of the patient. Granted, doctors have big egos, so they won't admit this very often. But hospitals do track internally the statistics on complications and doctors' names are attached to these cases, although hospitals don't advertise these numbers. Any doctor will have complications it could be anything from something that happened in surgery to a readmission to the hospital from infection after a pregnancy. And some outcomes that are considered complications are unavoidable. Remember that the vast majority of doctors do want to take care of their patients.
6. What are your feelings about doing episiotomies?
I only do episiotomies if they are clinically indicated. I do not routinely do them, nor do I shy away from ever doing them. If a situation arises where I deem it necessary to improve the patient's delivery outcome, I would not hesitate to do one. However, I don't think they should be routine, although some doctors claim they have really good outcomes with them.
Some doctors routinely do episiotomies because they figure that a natural tear (if you let it tear naturally) can be more difficult to repair than a deliberate episiotomy. That can be true; however, a woman doesn't always tear. A doctor may also decide to cut if the woman is already starting to tear, or if it looks like it would improve the delivery of the baby.
7. How do you handle pain medication during the delivery? How early do you offer it?
I think it's important that the patient be as comfortable as possible, so I do offer medications to relieve discomfort during the labor and delivery process. I would discuss it in advance with my patient and respect her opinion if she wanted to have a natural birth without pain medications. If she changed her mind, I would offer her something.
Keep in mind that there are risks involved in taking pain meds and timing is important as well. For example, giving an epidural too early has been linked with an increased C-section rate because studies suggest that the epidural slows down labor. The medicine can slow down labor to the point where it doesn't allow further dilation of the cervix, so a C-section results.
The OB determines when you should get the pain medicine, not the anesthesiologist, who is basically a consultant. Doctors rarely will say that a patient can't get pain meds unless there is a medical contraindication for giving them. On the positive side, a patient who is comfortable with pain medication will likely increase her chances of having a successful vaginal delivery. There are some women who don't want any pain medication, and we should respect that choice. If a doctor says he'll always give it, that woman might not like that response and should choose a different doctor.
I will do my very best to be the doctor who will deliver your baby; however, it is possible I may not be available on the very day you go into labor. If that situation does arrive, then a close associate of mine would be asked to deliver you and manage your labor and delivery. And I would introduce you to various providers in my group who might deliver you.
The doctor should know her vacation schedule and more or less whether or not she will be out of town around the time of your delivery. All doctors have backups. You need to know who the backup is and have a name to call if necessary, although the hospital should also have the backup name on file for your doctor and will also place the call.
9. Will my charts be available if you're not the doctor?
Yes the short answer.
If you were to deliver at a different hospital than planned, your records would be sent over or faxed from the hospital you'd chosen. If the delivery is after hours, there is someone who may have access to the doctor's records. Some hospitals still use paper documentation, but increasingly, more hospitals use electronic documentation, so they will have immediate access to files.
10. When should I call you if I have a problem and what type of problem would necessitate a call?
Whenever you have a concern that you're not sure about, then that's good enough for me. Call and ask because you may have a serious question or problem. If you're unsure, then call anyway. It's better to be safe.
At times, symptoms may be considered minor, yet at the same time, they may provoke anxiety or concern in the patient about how well the pregnancy is going. If a patient is concerned, she should not hesitate to call her doctor. At other times, symptoms may be more obvious, for example, vaginal bleeding or unusual pain that is not improving or any type of leakage that could indicate her bag of water might have broken. At this point, there would be concerns about infection. Or perhaps the baby hasn't moved when the mother knows it should. These are all examples of problems that should be addressed immediately.
Reproduced from Absolute Beginner's Guide to Pregnancy, by John Adams and Marta Justak, by permission of Pearson Education. Copyright © 2005 by Que Publishing. Please visit Amazon to order your own copy.
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