How to find a good OB & Questions to Ask BEFORE You Hire Them

by Austyn Smith | Jan 30, 2017 | Birth, Blog, Pregnancy

You’ve decided to go with an OB/GYN. There are several advantages to using an OB for your care and delivery. Physicians tend to have experience with and knowledge about high-risk pregnancies and complications. If you know you are high risk due to advanced maternal age, diabetes, or any medical condition, you can have peace of mind knowing your OB is equipped to handle it and to manage medications if needed. If your intuition is telling you that you feel more comfortable knowing you have access to all the medical procedures and personnel a hospital offers, this is the route to go. OBs have access to advanced medical testing and screenings, and are connected in a network of specialists and colleagues. If you’re still considering a midwife, there are many midwives that work in collaboration with OBs so you don’t necessarily have the rule that out either. Talk to your care providers and come up with a plan catered to all of your needs.

Where to start in finding the OB that’s just right for you? You’ll definitely want someone you feel completely comfortable with, and that you trust to take care of you and your baby. This is your life (and emotional well-being) and your baby’s health in someone else’s hands, so it’s a big deal. Here’s some ideas to help you get started.

Where to look first

Ask around. Your best bet is going to be word-of-mouth. Talk to everyone you know and trust about their OB/GYNs. What things did they like/dislike about them? What was their prenatal care like? How was their delivery experience? Would they go back to this same person? The more details the better, just start asking. Of course it’s important to keep in mind that not everyone wants the same type of birth experience so the doctor that was a good fit for your sister may not be right for you.

Join Facebook groups in your area. There are many Evidenced Based Birth local groups that you can join where the admins and members are knowledgeable about the OBs in your area and which ones follow evidence based practices. What is Evidence Based Birth?

If you don’t know many recent moms personally, get in touch with your hospital’s Childbirth Educator.  She or He should be familiar with doctors and nurses at the hospital, and know the ins and outs of the kind of care they give (and their bedside manners). She’d be able to give a few recommendations that you can then do more research about. Of course keep in mind that they work for the hospital so may not be able to be completely forthcoming.

Ask for statistics. Hospitals keeps track of things like induction rates, episiotomy rates and cesarean rates so asking for these facts will give you a good idea of hospital practices. Unfortunately, even if you love your OB sometimes the hospital policies limit their ability to provide the care that you may be imagining.

Do you currently have a gynecologist that you like? Do they practice obstetrics as well? Asking a few additional questions can help you get a feel for if it would be a good fit or not. If they don’t deliver babies, they could recommend some colleagues to you, that you could then check out. Keep in mind that prenatal and birth care is MUCH more involved than an annual exam so don’t just go with your current doctor because it’s convenient. You want to make sure it’s a good fit and that their maternity care is in line with what you want for your birth.

Once you have a few names of potential doctors, there’s a lot of things to mull over before the interview process.

Here’s a few considerations:

Your health history

Do you have specific concerns about your pregnancy that not every doctor would have experience with?  Plus-size pregnancy, previous recurrent miscarriages, diabetes, or trying for a VBAC (Read more in our post What you need to know about VBAC?) can be uncharted territory for some practitioners.  Look at the websites and reviews of doctors to find out if they have specific experience in the areas you are concerned about.

Physician’s philosophies

What does the provider value? What is their overall outlook on pregnancy, birth, and labor? Are they super medicalized or do they lean toward the more natural route—and which do you prefer? What are their opinions on certain medical procedures like continuous electronic fetal monitoring, scheduling inductions, episiotomies, and epidurals? Do they tend to take control of how a labor is progressing, or allow the mother to take the lead? How pushy will they be?

Male or Female

Think about your past interactions with doctors and whether you’ve been more comfortable with a male or female physician. It may not matter to you, but if it does, then you can quickly narrow your search down as most health insurance databases have the option to filter your search results based on gender.

Personality

Do you click? Do you feel comfortable? I had a friend who went in for a breast exam and the doctor chatted for a few minutes and then said, “Okay, flash me.” That exchange made her feel so uncomfortable she never went back. Bedside manner and professionalism matter! Do you trust their experience and judgement? Do they listen to your concerns and questions or just plow through the appointment as fast as possible? Are their credentials up to date? What does your gut say?

Support

Are they supportive of you having a doula with you during labor/delivery? How comfortable are they with extra people in the room in general, and does your partner get a good vibe from them as well?

VBAC/C-Section Rates

This is public information that you can request from your hospital. However, doctors don’t usually post their own personal stats. You can get an idea of how things go by calling the front office and asking some questions. Many offices don’t give out specific numbers, or may not even keep track, but you can get an idea by saying something like, “Out of the last 10 deliveries this provider performed, how many ended up being c-sections?” Or “Out of the last 10 attempted VBACs, how many were successful?” Get an idea of how willing they are to work with you. Keep in mind that specific hospital rates are higher than others for cesarean. Which brings us to our next item…

Hospital Policies

What are the c-section stats? You can search online to find this info. In general, what is the hospital like? Do they have natural birthing accommodations and tools if you’d like to go that route? Birthing tubs to labor in? Is the hospital friendly to natural delivery? Do they require IVs, continuous electronic fetal monitoring? Do they have VBAC policies? What are their standard procedures right after the baby is born? Do you get to have skin-to-skin bonding for a while? Does the baby get to stay in your room? Calling the Labor and Delivery floor is your best bet to getting answers to these questions. A nurse can help you out, or refer you to someone else who knows the specifics. Nurses generally want you to be informed about the hospital policies so that there aren’t any surprises when you come in.

Office Protocol—Questions to Consider

• What is the OB clinic experience like?
• How easy was it to get an appointment?
• How many doctors are in the practice?
• Are you a number who is shuttled through the routine, or are you treated like an individual?
• How long do you typically wait in the office?
• What are the after hour policies?
• Will your OB be the one to deliver you, or do they rotate who is on-call, and will that bother you?
• Is there an on-call nurse that is available to answer questions?
• What is the staff like?

Think about how you feel about all of these things.

Once you’ve thought about all of these issues, and researched a few doctors, narrow it down to a couple. You can either take the plunge and make your first appointment with the one you want, or you can be even more thorough and schedule a consultation, where you can bring your list of questions.

Above all else, keep in mind that you are not stuck once you make your choice. If at any time you start to feel uneasy about your care giver, or feel like you don’t align with their philosophies, shop around. It’s completely acceptable, and it happens all the time. If you feel uncomfortable firing your OB, simply call the front desk and ask them to transfer your files to your new doctor. You don’t even have to speak to the doctor you are leaving. This experience will be one of the most important of your life, and you deserve to feel as safe and as comfortable as possible. Follow your gut!

Interview Questions for Potential Obstetricians

General Basics

1. What is your general philosophy on pregnancy, labor, birth, and postpartum care?
2. What is your role as physician? What is your role during labor and delivery?
3. How long have you been practicing? How many births have you performed?
4. How many births do you anticipate attending month? Is there a limit to the number of patients you take on?
5. What is the chance of you delivering my baby? Who delivers when you are not available?
6. What is your c-section rate?  
7. If there is a complication beyond your expertise, who would you refer me to?
8. What is your after-hours policy? Are you reachable during an emergency?
9. How often am I required to meet with other doctors?

Pre-Natal Care

1. How much time do you spend with each patient during an appointment?
2. Are you available in between visits if I have a question or concern?
3. What is your view on nutrition and weight gain?
4. What prenatal tests do you require and/or recommend?
5. What childbirth education resources do you recommend?
6. How do you feel about birth plans? Do you help with writing them?  
7. What experience do you have with high risk pregnancies?  
8. What would the procedure be if I become high risk?

Labor and Delivery

1. When will you arrive on scene? Who will support me in the meantime? How often will you be with me during labor?
2. If you have two simultaneous labors/deliveries, what do you do?
3. How do you feel about a support team? A doula? Other friends and family?
4. What if I approach my due date without going into labor? How long will you let me go past? What is your induction policy?
5. Do you ever recommend induction for an estimated large baby?
6. How long will I be able to labor after my water breaks if no signs of infection?
7. What routine policies during labor do you recommend/require? What does the hospital require? (Continuous fetal monitoring, IVs, etc.)
8. Am I allowed to move around during labor? Eat and drink?
9. What are your views on pain management during birth, both medicated and unmedicated? Will you recommend different positions and coping techniques?
10. What percentage of your patients deliver without an epidural? What resources are available to me, should I want to labor without drugs?
11. What percentage of your patients get epidurals? What is your view on epidurals?  
12.  How do you handle a “stalled labor”? What do you consider a stalled labor?
13.  What birthing positions do you allow for labor and delivery? What is most common for you?
14.  Do you perform episiotomies? How often? How often do you use forceps or vacuum extraction?  
15.  Do you encourage and support VBACs? How many VBAC attempts have been successful? (60-80% is norm). What is the hospital policy for VBAC?
16.  At what point in labor do you recommend c-sections?
17.  Have you ever performed a vaginal breech birth? Twins?
18.  What procedures do you perform on the baby? What can wait?  
19.  Is delayed cord clamping okay?
20.  What happens if there is postpartum hemorrhaging?

Post-Partum

1. Will I have uninterrupted skin-to-skin bonding time immediately following birth? For how long?
2. Will the baby stay with me in my room?
3. Do you assist in breastfeeding? Is there someone else available to help me?
4. What if I hemorrhage?
5. Can my partner stay in my room?

Questions to ask yourself after the appointment

1. Do I feel comfortable with this person? Are they flexible?
2. Do our philosophies line up? Or are they willing to work with me? (You want them to enthusiastically support your wishes not just be “willing to let you try that”)
3. Do we have a mutual respect?
4. Do I trust their expertise and judgement?
5. Is the office staff friendly and helpful?
6. What was the wait time? Did I feel rushed in and out?

This guest post was written by Austyn Smith.

What is Evidence Based Maternity Care & Birth

by Austyn Smith | Jan 30, 2017 | Birth, Blog, Pregnancy

Why evidence based maternity and birth care are important

Simply put, evidenced-based maternity care and birth are policies and procedures based on proven scientific evidence from medical research and peer-reviewed journals. It is the practice of effective care with the least amount of harm. Unfortunately in many parts of the world, standard hospital care is not practiced in this way. In fact, many hospital procedures go in direct contrast to recent medical evidence, and increase the risks for healthy mothers and babies.  

Standard care in hospitals can be intervention-intensive. IVs, continuous electronic fetal monitoring, epidurals, restricting food and drink, restricting movement, and having mothers push in the supine position all increase stress to the mother and baby, disrupt the natural flow of hormones, and may lead to complications.  

There are a few reasons for this dichotomy between research and practice

Tradition

Many birth practices in America, were put in place in the 1950s and 60s, using research based on the past rather than looking forward. Although more information and education is now available, it is a challenge to turn research into practice. Traditional methods are simply easier to continue.

Profit

It benefits hospitals financially to use interventions like induction, pitocin, epidurals, c-sections, and lengthened recovery stays.

Liability

OB/Gyns can be nervous about being sued, and for good reason.  They are the second highest sued doctors after neurosurgeons. If worry creeps in to a doctor’s mind about the “traditional potential dangers” of labor (say, if water has been broken for a while, baby’s heart rate is decelerating, labor has stalled at a certain point, or the pushing phase is getting long), he can choose to order a c-section. If he is potentially sued, he can make the case that he took action by doing all he could, rather than waiting it out. The same can happen with other worries before labor—if a woman measures big, or has some minor concerns, a doctor may order induction to prevent possible negative outcomes and being sued.

Convenience

Unfortunately, these situations happen more commonly than they should. An OB might have a vacation coming up and therefore will push an induction to have the birth before he leaves. He might be at the end of a very long shift and ready to go home, so may order some pitocin to be administered to speed up the labor. It’s a sad reality, but it does occur.

Reliance on Specialists

Although doctors are traditionally trained to handle higher risk pregnancies and use many interventions, healthy women with low-risk pregnancies often choose to be under their care. This is certainly a woman’s prerogative and she should go wherever she feels the most comfortable. However, this can contribute to the slow progress of change being implemented in birth. A woman with a low risk pregnancy might be in better care with a midwife.

Lack of education

More support is needed in terms of evidence based maternity research, not only in the healthcare field, but for patients as well. Many women are simply not informed of the data and their options when they meet with their healthcare providers. In addition, there needs to be more awareness and implementation requiring performance measurement, improvement, and reporting in hospitals.

There is great need to close the gap between the evidence and the standard practices in hospitals, especially in the United States. Consider this table.

There is, however, progress being made in certain parts of the country. Some hospitals are starting to encourage natural pain relief methods and utilize tools like birthing tubs, birthing balls, squat bars, showers, and supportive nurses on hand. A local hospital in Portland, OR has midwives deliver the majority of babies, and the doctors handle only the high risk cases and emergencies. These things are certainly encouraging, and a sign that change is possible, no matter how slow.

How to know if your care provider is using evidence based birth methods of care

Get familiar with the science. Here is a great article about evidence based birth and 6 key practices to a safer delivery for mother and baby. Essentially, induction, epidurals, and c-sections are overused, whereas labor tubs, labor support, changing of positions, eating and drinking during labor, and delayed cord clamping are all underutilized. Know your options for these procedures. Learn about other standard procedures like vitamin K shots, failure to progress, the science about mothers over the age of 35, the truth about waterbirth, etc,  Evidence Based Birth is a great resource with many scientific articles.

Discuss your findings with your current care provider. How do they feel about each of the practices? What are the local policies if you will be delivering in a hospital? Is your doctor flexible and willing to allow modifications to certain “standard” procedures? The better informed mothers become, the easier these implementations will be for communities.

Resources for learning more about Evidence Based Maternity Care and Birth

Evidence Based Maternity Care: What it is and What it Can Achieve

The American Congress of Obstetrics and Gynecology

Biomed Central

Evidence Based Birth

When it comes to evidence based maternity care and birth practices, education is key.

This guest post was written by Austyn Smith.

Meaningful and Practical Push Present Ideas

by thebirthhour | Jan 30, 2017 | Birth, Blog, Pregnancy

First of all, what’s a push present? It’s a gift that a partner gives to the mother as a ‘thank you’ for all of those hard months carrying their child and eventually ‘pushing’ that baby out through the ultimate gift of birthing their baby. I struggle with the term “push present” because a.) it sounds pretty dumb; and b.) it excludes mama’s who birthed through cesarean. But terms aside, I do love the idea of honoring the mother in this way. Many men choose jewelry that commemorates the baby’s birthstone or name which is lovely but I thought it would be nice to share some practical and meaningful ideas that might be out of the norm.

Postpartum Herb Baths

I talked extensively about herb bath in the Must Have Postpartum & Breastfeeding Items post. Such a meaningful gift as it promotes bonding for mom and baby and relaxation for mama. My two favorite herb baths are here and here.

Postpartum Doula

A postpartum doula supports the new mom with evidenced based information on breastfeeding and physical and emotional recovery from childbirth. She will assist with mom/baby bonding, nursing, basic newborn care, care associated with mother’s cesarean or vaginal birth and soothing the infant when mom needs sleep. Postpartum doulas can be essential to new parents who don’t have family (or helpful family) to come in the days and weeks right after birth. You can hire a postpartum doula to come for a few hours each day or even to sleep overnight and help with those exhausting night feedings and care.

Comfortable rocker

@mel_jensen

With all of the expenses that quickly add up on a baby registry, it can be easy to move this one to the bottom of the list but the truth is mama will be spending endless hours in her nursing chair so surprising her with the one she was swooning over at the baby store would be an awesome push present. A few of my favorites are this recliner, this rocker+ottoman and this double rocker which is perfect for an older sibling to feel included and snuggle up next to mama while she’s nursing!

New phone or camera

New moms spend a TON of time taking pictures and videos of their precious babies. In the digital age don’t spend a lot of money printing photos but we do get to capture every adorable thing our babies do. Having the most recent camera specs on a new phone will make those pictures practically professionally taken. You can also opt for a nice DSLR camera if mom is really into photography.

Massage or massage subscription

After you give birth your body sometimes feels like it’s been hit by a truck—you used muscles you’ve never used before sometimes for days and then once baby arrives you find yourself contorting into all kinds of crazy positions to nurse and care for the baby. A postpartum massage is a VERY meaningful and practical gift. You can opt for a one-time deluxe massage at a local spa or a massage subscription that gets her regular massages at a more affordable price.

Photoshoot

We are huge fans of postpartum and breastfeeding photoshoots. These early newborn days are truly such a blur and having a professional photographer come to your home and document this time is a priceless gift. Many mothers enjoy herb bath photoshoots as well.

Weekend Getaway or Family Vacay

It’s surprisingly easy to getaway with a newborn—they are free to fly, require very little (boob and diapers) and usually sleep through flights. Although we recommend taking the first few weeks to bond with your baby in the comfort of your own home, a surprise trip to a relaxing spot would be a welcome gift for many mothers who feel isolated or swallowed by the sometimes intense postpartum experience. If you have older children maybe arrange for a sitter for them and getaway just the two of you with baby.