I'd gone to the same gynecologist for years, so when I became pregnant with my first child, I stuck with him. I wished I had done some comparison shopping instead when I realized that at every checkup he seemed annoyed by even simple questions. When I went into labor -- surprise -- he was on an unannounced vacation, and my baby was delivered by the obstetrician on call at the hospital. Everything turned out fine (my daughter is almost 3 and thriving), but the experience would have been a lot more positive if I'd had a doctor with whom I could communicate.
Particularly if this is your first pregnancy, you may not be sure about what's most important to you until you start asking questions. To help you zero-in on your priorities about pregnancy and labor (and see if your practitioner can accommodate them), we've outlined some questions to ask your obstetrician or midwife during the first couple of checkups, or during an interview-only appointment if you're still in the planning stages.-- Where do you deliver? Ask for written information about the hospital or birthing center your doctor or midwife is affiliated with, and visit it now to determine if it has the features that are most important to you, says James Marquardt, M.D., an obstetrician-gynecologist at Brigham and Women's Hospital in Boston. You may be looking for a facility that's close to your house or for one with an impressive neonatal intensive-care unit. Perhaps you're more concerned that it has doulas (labor coaches) on staff or allows you to keep your baby in your room after delivery. Mary Weatherhead, of Cleveland Heights, Ohio, was pleased that she had her baby at a hospital that was breastfeeding-friendly. "I knew that some of my friends hadn't gotten much support from the staff at the hospital where they'd delivered. The obstetrician I chose worked at a facility that had lactation consultants on staff," she says.
-- What tests do you advise? What if they show that something might be wrong with the baby? Ask your provider to explain each option, including what it tests for, how accurate it is, at which stage of the pregnancy it's performed, and what the risks are. Ideally, he'll give you all the details you need to make an informed decision, and not pressure you into having -- or not having -- a particular test. If you're over 35, for instance, he'll probably bring up amniocentesis, which involves extracting fetal cells from the amniotic fluid and examining them for signs of genetic abnormalities, such as Down syndrome or spina bifida. If you've decided not to have the test, however, it makes a big psychological difference to have a practitioner who'll respect your choice.
In the unlikely event that a test shows something might be wrong, you'll want a doctor or midwife who'll support your decision about whether to continue the pregnancy. When Ellen Vaugh's (not her real name) amniocentesis showed her baby had Down syndrome, she still wanted to keep it. "But when I told my obstetrician, he practically recoiled in horror. I could tell he thought I was making a huge mistake, which made an already traumatic situation all the more unsettling. I stayed with him through my pregnancy, but I wish I hadn't because I didn't feel as comfortable with him after that," she says.
To avoid unnecessary tension, ask up front about your options, then listen carefully to the response. If you're brushed off with a line like, "Let's not worry about that now," the doctor may not be a good fit for you.
-- At what point do you recommend a C-section? In some situations -- your baby is in distress or in a breech position, for instance -- surgery is unavoidable. But doctors vary as to how long they typically allow a woman to push in the delivery room before they perform a Caesarean: Some will let you try for up to four or five hours, while others have a limit of an hour or two, so ask your provider to explain his policy. You can also inquire about his Caesarean rate (the national average is roughly 21 percent), but remember that doctors who handle a large number of high-risk pregnancies will, understandably, have higher numbers than those who don't.
If you're strongly committed to a vaginal birth, ask your provider about what he does to avoid surgery. Possibilities include everything from administering oxytocin, a medication that speeds up labor, to allowing you to squat while pushing. If you've had a Caesarean section and would like to try a vaginal birth after Caesarean (VBAC), ask the doctor if you're a good candidate (women who've had a vertical incision aren't, for example), and his policy about VBACs. Many doctors strongly encourage a VBAC, preferring to stay away from surgery unless necessary; others are fine with letting a patient elect to have a repeat Caesarean.
This article first appeared in Parenting magazine. (C) Parenting magazine. Dist. by United Feature Syndicate Inc.