Pregnancy: Interviewing Your Doctor

Complications and pain meds

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.

Beware

• Of a doctor who is inflexible about meds.
• Of a doctor who doesn't offer any meds.
• Of a doctor who overuses pain medicine (there are risks to fetus and mother in this case).
• Of a doctor who says you won't have any pain at all (giving too many meds or giving them too early can harm the patient or the baby).