Navigating pre-natal care
April 6, 2010 7:03 AM   Subscribe

How did you find a good medical professional/practice to care for you during pregnancy? Did you visit several? How did you decide?

I just found out I'm pregnant, and it turns out my insurance is amazing. I'm hoping to make the most of this fantastic luck by finding a doctor/midwife/practice where I feel comfortable. Things I want: patience (this is my first pregnancy - I think I'll need a little hand-holding), attentiveness, flexibility, and openness to alternative approaches. Things I do not want: disinterest, condescension, long wait times, rude staff, and being scolded for doing it wrong. Thing is, I have no idea how to go about finding such a magical place where everything is sunshine and roses. Did you pick a hospital where you want to deliver and go from there? Or did you find a great practice and assume they have admitting privileges at good hospitals? Or decide on some class you wanted and go from there? Are there good (free) review sites for this sort of thing?
Full disclosure: I don't have any friends in the area who've gone through this, I don't have a regular primary care physician, and my regular ob/gyn stopped practicing about 6 months ago. I'm in the Twin Cities, in case it matters (extra points for just telling me about your fantastic doctor in the Mac/Groveland area of St. Paul). And I've read previous related threads, including this and this which were very helpful but didn't quite do it for me.
posted by phisbe to Health & Fitness (15 answers total) 7 users marked this as a favorite
 
Or did you find a great practice and assume they have admitting privileges at good hospitals?

This. Once you find a practice that you feel safe with, it’ll be easy to trust their decisions. Read this previous comment I made about the hospital my midwives delivered in and why it turned out to be a godsend for me. Not only was the hospital great, I also went with the birthing classes my midwives recommended and was very happy.

I found my practice by looking in the phone book and making a couple phone calls. I visited one of the practices that sounded good and had a consultation with one of the midwives. She gave me all the time I needed and answered all my questions. I knew it was the right place for me, and I went with it.

Congrats on your pregnancy!
posted by yawper at 7:20 AM on April 6, 2010


Response by poster: Yawper, what questions did you ask when you made those phone calls? What was it on the phone that made you visit the one practice?
posted by phisbe at 7:31 AM on April 6, 2010


I'm sure there's an excellent internet forum or mailing list for parents in your area. Join it and ask around. Find the practice first. For one thing, you're not as well equipped to choose the hospital as your midwife will be. The patient experience at a good hospital is often worse than at a bad hospital. In other words, health outcomes don't correspond to how friendly the hospital feels. Maybe you're willing to trade some safety for comfort, maybe not, but a midwife should be able to help you decide.

Personally, I'd rather be in a hectic-but-very-good institution with a strong advocate at my bedside than at a warm and fuzzy place where they'd be less equipped to handle a really bad emergency or where the person stitching me up wasn't very talented with the needle and thread.
posted by paanta at 8:09 AM on April 6, 2010


Ask a nurse.
posted by raisingsand at 8:24 AM on April 6, 2010


My wife and I teach natural childbirth classes (Bradley Method). I think what I'm about to say would apply even if you're looking for a conventional medicated birth, but it's probably a bit more relevant if you're trying to avoid meds.

After having something like 130 couples in our classes, one of the biggest sources of stress for healthy pregnant ladies is feeling like their birth team has different goals. We always emphasize that you can switch if you don't like the folks you end up with, but it is better to end up in the right practice in the first place. So good on you for asking.

We have been handing out printouts of this PDF at the beginning of class to encourage people to evaluate whether they're with the right team. There's a lot of other good stuff on that site, too - MotherFriendly.org.

I will also say that our naturally-inclined moms seem to feel happier with CNM's than with OB's. (Certified Nurse Midwives are professional hospital-only midwives in Colorado; state laws vary widely and I have no idea what is and is not allowed in Minnesota.) One of the videos we show has a great quote that goes something like this:
~The countries with the best maternal outcomes (the fewest maternal deaths, infant deaths and so on) use midwives for normal pregnancies, and bring in the OB when complications arise.~
I think there's a lot of wisdom in that.

We also find that "who you're working with" is a very hot topic when our students first meet each other - everyone is wondering if they've picked the right folks. You might find a birth class, discussion group, etc. helpful in that it gives you a social network for these kinds of questions.

So to sum up, I'd recommend you to find some moms to talk to about their experiences, interview prospective practices before you choose one, and start your search with the midwiferies in your area.

Good luck! Babies are awesome! :^)
posted by richyoung at 8:26 AM on April 6, 2010 [2 favorites]


I asked my general practitioner and I e-mailed a women's group asking for recommendations. I got nearly 80 recommendations back, and the two practices that were recommended the most often by the women were the two my GP had recommended. From there, I did a little research on the practices, chose the one that seemed to fit my needs better, and made the call. (Now, I did this before I was pregnant so I was able to go in for my yearly pap and get a feel for the practice that way, but early appointments will work just as well.)

I made the hospital decision second and separately, for a few reasons: First, I wanted to feel good about the DOCTORS (and CNMs) I was seeing, since I'd see a lot more of them, and surely they decide what hospitals to pursue privileges at for good reasons. Second, I couldn't know how the pregnancy would progress; while a birth center would be fine for an uncomplicated pregnancy, a small hospital would be necessary with minor complications, and the big, Level-I trauma center hospital with the neo-nate unit for major complications. (I ended up choosing a small hospital for my uncomplicated pregnancy, which then got complicated in week 38 when the baby turned undeliverably breech, but I was able to have my C-section at the small hospital, and it was all very nice.)

Just so you know, ob/gyn practices often have wonky wait times. Mine was pretty good, but you have to assume that as it gets later in the day they will get further behind schedule as the practitioners have to race off to deliver babies. :) In fact, my C-section was delayed about 30 minutes because the surgeon got stuck in a simple surgery that went wrong. She had a big gap between that surgery and mine, and it went wrong enough that it ran way over. The extra 30 minutes was not my favorite thing ever, but my son ended up born at 3:33 so I guess it worked out. :)

One thing my practice does, which I didn't think I'd like but I turned out to like a lot, is rotate among the practitioners. By the middle of my pregnancy I had seen all four of the obstetricians and all three of the midwives, so that whoever ended up doing the delivery and whoever ended up on call during an emergency, I'd met them all already and felt comfortable with them. It also gave me a chance to get to know the different personnel and decide whose style matched mine the most closely. I actually liked everyone at the practice, but I had decided one particular midwife "felt" the most supportive and calming to me personally and had planned to deliver with her. When I had to have the C-section, I knew all the OBs and was able to choose who would do my surgery and manage my aftercare. So while that initially seemed sort-of "factory" to me, it actually turned out to be very personable and added a lot of flexibility for me in choosing how the delivery would go.

But yeah, e-mail a parents' group or women's group or something, lots of good recs.
posted by Eyebrows McGee at 8:28 AM on April 6, 2010


A minor point: even if you interview a lot of them, there's almost no way of knowing how much time the doctor will spend with you after your initial conversation. Through two pregnancies my wife and I have used a highly respected OB and a highly respected Midwife. The thing about highly sought-after doctors is that they often take on a lot of patients. During your routine visits throughout the pregnancy, they might not have a lot of time to sit and chat. Midwives (CPMs) often set limits on how many clients they take on per month (I am referring mostly to out-of-hospital births here so this might not be what you are looking for--it depends on what kind of birth you want). Some doctors are better at giving your more attention than others during those visits so I think it's worth asking how many patients they have delivering in any one month.
posted by mattbucher at 8:36 AM on April 6, 2010


I Did This Wrong for my first pregnancy-- started out at the big nearby Ob/Gyn with the shiny new 3D ultrasound, and ended up having to switch 2/3 of the way through because I just couldn't stand the poor quality of care any longer. Everything worked out beautifully at the second (midwife) practice, but it made for an unnecessarily tense and unhappy first and second trimester. You're definitely wise to want to get this right the first time.

The suggestion above of checking out local parenting boards is a really good one; no substitute for firsthand knowledge in these situations. But a few additional things I'd recommend are:

-- When you call to schedule an interview, be very clear that it is only an information-gathering thing, that you're not sure about signing on yet. Otherwise, you may end up getting shunted into a first-checkup type visit instead of a proper interview, and what with the multiple doc/nurse handoffs it can be hard to switch midstream.

-- Read up on the differences between midwives, D.O.s, and M.D.s beforehand, and compile your shortlist accordingly.

-- Come to the first visit armed with a written list of questions. Good starters: ask what the C-section rate is for this practitioner, and for the practice as a whole. Ask about their feelings on epidurals, and in what circumstances they think they're appropriate. Ask about their rate of episiotomies, and under what circumstances those are appropriate. Ask what types of prenatal testing they offer, and what types they recommend (this can be a good test of how interventionist the practice is). Ask whether any of their patients have used doulas during labor, and how they feel about that practice. Ask how many practitioners there are in their group, and whether you'll be able to work with one particular person for the duration of your pregnancy.

-- If at all possible, bring your partner to the initial interview.

-- Read up beforehand on the qualifications of the doctors/midwives at the practices you're considering. Did they go to good med schools? Are they properly accredited?

-- Lastly, trust your gut feelings about the doctors/midwives you interview. This is a person you're going to have to interact with during some of the most intimate, difficult and vulnerable moments of your life. It doesn't matter if they're Mother Theresa, Gandhi and Einstein rolled into one; if they don't click with you, then you don't want them in that delivery room.
posted by Bardolph at 8:44 AM on April 6, 2010 [2 favorites]


Phisbe, you’re asking me to go back almost 8 years :) But here is what I can remember asking (I had a lot of the same criteria that you did):

- How many midwives are in the practice and how long have they been practicing?
- How long are appointments?
- Who will I see at the appointments?
- What if I have to miss or reschedule an appointment?
- At which hospitals do you deliver?

At the consultation, I asked a lot more questions like those richyoung linked to.

The single most influential factor in deciding on the practice was the calm, relaxed feeling I got during the consultation. The office was peaceful and inviting. I was never rushed, and that translated into the appointments as well.
posted by yawper at 8:48 AM on April 6, 2010 [1 favorite]


"Good starters: ask what the C-section rate is for this practitioner, and for the practice as a whole."

Ask what the C-section rate is for relatively uncomplicated pregnancies. My practice is known for its expertise in high-risk pregnancies, and my primary OB is known as the best obstetric surgeon in town. Women at high-risk seek them out, and my primary OB gets to attend very few normal deliveries because he is in very high demand for surgical deliveries. My practice's C-section rate for their "normal" patient population is in line with other area OBs, even a bit lower, but because they see such a large proportion of the high-risk patients, their overall practice's rate is high. The higher rate in this case speaks to their expertise, rather than otherwise.

Several women told me, "I started with Dr. So-and-so but when we found out I had triplets, he referred me to Your Practice" or "when I developed unusual condition X, my doctor suggested I have Dr. Surgeon do the C-section ..." Which is why personal recs are very helpful! What was MOST telling to me was the number who said, "And we decided to stay at Your Practice because they were just so much warmer and more caring than My Original Practice ..." (And yes, I do feel happy with my sunshine-and-roses practice of expert "high" medical care + warmth and kindness + CNMs!)
posted by Eyebrows McGee at 8:59 AM on April 6, 2010


Ask women, even if they are not your friends. If your city is like my city, a few different OBs will emerge from your informal searching. Many women with kids like to give advice. If you don't know in-person women, find some local google or yahoo groups for parents and ask there.

I'd also recommend being open minded. Even though you think that you imagine yourself with this particular type of OB, you may find a match that isn't as flexible as you are currently imagining but that his/her compassion makes up for it... or something like that.

My favorite trait in my OB is that she never seemed rushed during my appointments even though I'm SURE that she was. She was also funny. She respected that we were/are the kind of parents that did obscene amounts of research. (And she was surprised when we hadn't done research for particular things...) She also let us make our own choices while letting her MEDICALLY INFORMED opinion known. For example, she wanted to induce me (for medical reasons, not scheduling - her induction rate was low). I was all "let nature take its course la la la la la" and talked her out of induction twice. Well, when baby finally came, he had medical issues and a NICU stay that were quite possibly could have been avoided if we had induced.

Wait times: And, as a final note - long wait times are the way it goes with OBs because they are busy delivering babies. (I told my sister, who was searching for a GYN while I was pregnant, to avoid OB/GYNs for this reason.) Probably half the time at my OB, the receptionists said, "She's over at the hospital, but she'll be back pretty soon..." I figured that my pregnant ass could sit and wait a little longer. ;)
At my OB, I tried to get the earliest morning appointments, but you never know if the OB was up all night delivering babies and needed to sleep a little later.
If you're currently working, make sure that you give yourself a lot of time to go to these appointments because of the long wait times.
posted by k8t at 9:05 AM on April 6, 2010


I found my ob/gyn by doing a search on the best hospital near work (NW) and from there I looked for the head of the department or a high-level professor. I felt that either way, I would at least get "the best" and go from there to see if there was a personality match.

I've been with her for 15 years prior to my pregnancy and I would hands down recommend her to anyone (and have). Unfortunatley she is in the Chicago area so that won't help you.

But no matter what I need for healthcare and/or a speciality, I always find the department head, look to see if they teach as well, and then see what their bio says. You can also look at doctor review sites and/or Yelp too for more patient feedback.

Only once did I find a real jerk who wanted to do an experimental procedure on my sinuses. I went elsewhere and the head of that department said 'now why on Earth would you ever want to do such an unfounded, risky procedure?"

Yea, I was pretty much sold on him.
posted by stormpooper at 9:40 AM on April 6, 2010


I'm sure there's an excellent internet forum or mailing list for parents in your area. Join it and ask around. Find the practice first.

This. Local parents' groups are a treasure trove of information, and finding good pre-natal care is only the first of many many questions you will have. Sometimes they are free to join and sometimes there is a fee; don't let this put you off, a good parents' group is a fantastic resource for so many things it should pay for itself quickly. I've used my local parents' group to find childcare, find out about discounts to children's museums, suggestions for things to do with a toddler on a rainy day, as well as the HVAC guy who fixed our furnace last winter and the plumber who is replacing the disposer in the kitchen at this very moment.

The one thing that I would say about hospitals, is this: what is the ratio of private to semi-private rooms? You may not have a choice in the matter, but if you do, you definitely want a private room. Two moms and two babies sharing a hospital room is a formula for nobody getting any rest.
posted by ambrosia at 9:45 AM on April 6, 2010


Congratulations on your great news. Best wishes for your pregnancy.

I kind of went backwards. I chose the hospital first and then selected a small (two MDs, one NP) obstetrical practice right next door to the hospital.

I liked the hospital because it was new. I wanted a pleasant place to stay. (As opposed to an older hospital with shared rooms and cramped spaces.) It was close to me and it wouldn't be a problem to get to in traffic (that's something to consider in Atlanta, where I life). And, (obviously) it was covered on my insurance plan.

The location of the doctor to the hospital turned out to be awesome because I was sent to Labor & Delivery a few times for lab tests and for monitoring. It was very convenient to walk across a pedestrian bridge to get to the hospital. The maternal-fetal medicine specialists were also in the same building which was also convenient (I had some complications).

It turned out that I do like the physicians, too. I have had some jerk doctors in my time that acted so unconscionably uncompassionate that I have broken up with them. But most doctors are OK even if you don't strike up a friendship with them. I was listened to and my opinion was respected, but I wasn't looking at this like I was going to many any and all clinical calls. Keeping an open mind is a big part of pregnancy, because things can change quickly and many things are out of your control (complications). Trying to maintain perspective--and getting that emotional type of support from your physicians--is important. What's most pressing is having a healthy pregnancy. (I still see the physician who delivered me for gynecological exams, cysts and other problems.)

I liked that there were three practitoners. I was confident in their abilities. I liked that it was busy because I knew that other women trusted them. Another poster was right--you are going to wait because the doctors are going to sometimes be attending to other patients.

I also like that they had a lab tech right there. You didn't have to drive somewhere else for routine blood draws or the glucose tolerance tests.

The only thing I wished was different was the ultrasound tech. At my doctor's practice, the ultrasound tech only comes once a week. I think that's pretty standard, but it would be nice to have him or her there more than that. If you need an ultrasound and the tech isn't there, you have to go the hospital to get it done.

I can't comment on midwives because I didn't utilize one. But if I were to, I'd get on review sites and moms-to-be message boards and ask around.
posted by FergieBelle at 10:25 AM on April 6, 2010


I was in a similar situation couple of years ago since I wanted to find the right fit given my natural birth preferences. I began with a doctor/midwife practice that I found decent reviews for on some mom forums (which I landed upon by simply searching for reviews for the practice). I ran into problem with the doctor there after disagreement over the 20-week u/s which i didn't want unless clinically indicated and they didn't have a good reason for other than "it's routine" and "everyone gets it done". I realized that the practice was mainly run by doctors with midwives having only residual power to affect decisions. My midwife at the practice (who I really liked) suggested a midwife-only practice given my preferences. The decision was hard both because i was quite far along in my pregnancy and this practice was out-of-network for me. However, I made the switch and I am happy I did because I finally found the right fit. Needless to say I went on to have a natural birth, free of medications and other interventions. Finding the right fit for my pregnancy also automatically directed me to the right fit for my baby's pediatrician who was recommended by my midwives and who took us immediately despite having a long waiting list.

In short, to gather information look everywhere - ask neighbors, coworkers, search online forums, and midwife directories (http://www.midwifeinfo.com/practitioners/). Once you have narrowed a few options go back and Google them for reviews. The last step would be to visit them and ask them questions. The more questions the better. These questions would be based on your preferences for the kind of birth you want. I can send you some in a separate email if you'd like.

Good luck!

Mama Mango
posted by Papa Mango at 7:35 AM on April 8, 2010


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