How do I choose a doctor?

[Traci422]

I just found out I'm pregnant with my first child and find myself excited and looking for direction. First thing is to find a doctor, right? But how do I choose one that's right for me? Anyone have a recommendation in the Puyallup area? What questions do you wish you'd asked of your doctor before your first baby? Any help is much appreciated! Thank you!

[Mommal]

Congratulations on the baby to come! The first one is really exciting, and so are the ones that follow.

The first thing I would do is look for a midwife instead of an obstetrician. Midwives specialize in normal birth, and are generally more patient and skilled at attending natural deliveries. Obstetricians specialize in high-risk and surgical birth, and are more likely to push interventions that make a natural birth less likely.

When looking for a midwife or obstetrician/family practice doc, a good place to start is by talking to other moms. They are almost always eager to talk about their experiences. Your local La Leche League meetings might also be a good place to start.

Off the top of my head, here are a few questions to ask when interviewing providers:
- What is your c-section rate? (Anything over 10% is too much.)
- What percentage of your moms are induced, and when and why do they get induced? (You're looking for a small percentage, inductions only for medical necessity, and routine induction only after 42 weeks.)
- Have you ever delivered a breech baby?
- If I choose your practice, will you be catching my baby or am I likely to have someone else in your practice attending my birth? If the latter, am I going to meet these other people during my pregnancy? And do they have the same attitudes towards birth that you do?
- How often do you use forceps or vacuum?
- How many ultrasounds do you recommend during pregnancy? (1 is all you need, and even that is optional.)
- Who is your back-up? (Question specifically for midwives.)
- If my pregnancy goes over 40 weeks, what will happen?
- How do you feel about doulas and birth plans?

[sweeetpea]

1. Contact the ICAN chapter in your area to find out which midwives/doctors their members have have good experiences with.

2.Contact doulas in your area (even if you are not planning to hire one, however I do recommend your hiring one...) and talk to them about midwives/doctors they have had good experiences with.

3. Consider a home birth. Many first time moms discount the possibility of having a home birth because "they have never done this before" and think they should have baby in the hospital because that is what everyone does, and what if they can't do it, etc. A home birth is such a much healthier birth for mom and baby (provided you are low-risk), and you don't have to submit to all the unnecessary hospital policies that are in place to protect them from liability.

Happy gestating!

[AlexisT]

10% is an unrealistically low CS rate IMO. I would expect to see 10% for a CNM (possibly higher in some clinic based settings where they handle higher risk patients) and higher for an OB. There are a rare few OBs with a rate below 20%. Keep in mind that the average is 32%, so an OB with a section rate of 25% is still better than average!

I am not a fan of judging providers by rates except at the extremes. When I selected my infertility clinic, I didn't pick the one with the highest IVF success rate. I excluded any clinics with impossibly high and low rates, and then went by reputation. A provider's overall stats don't always lead to good conclusions about your particular situation. If an IF clinic handles a lot of older women, and gets bad IVF stats as a result, that doesn't say much about how they'll handle me. Even if I ask for their stats breakdown for women with my factors, the pool may be too small to be meaningful.

IMO, you are better off asking about policies and how things are handled, rather than focusing on numbers. How they handle long labors, postdates, are they a watch and wait or jump to induction type.

[Galatea]

Choose a midwife. I had my first two kids with a Certified Nurse-Midwife at a hospital. I had the choice of drugs or no drugs, and was in a hospital, but the CNMs were very kind and respectful and not at all pushy. They were patient while it took me 26 hours to birth my first, and I know I would have had a section if I had an OB as it took 3 hours to push him out.

Now, I had my 3rd at home, and that was even better than the hospital with CNMs, but not everyone is comfortable with that.

To convince you of how a midwife will be better for you, read this book. It is full of hard scientific data and is what convinced me and my dh to go with a CNM.

[kltroy]

There are some great resources for helping you choose a care provider whose philosophy is aligned with your own at http://www.childbirthconnection.org. Now is the time to start thinking about what sort of birth you want, and what sort of environment you want to have it in. Hospital vs. birth center vs. home? Midwife vs. family practice doctor vs. OB/GYN? Are you planning a natural birth? Interested in a water birth?

You might have no idea WHAT you want at this point - I agree that talking to other mothers - especially those in your local ICAN group (since they have often seen the best of the best AND the worst of the worst) can be very helpful. I'm a local chapter leader and we often have a few women who come to our meetings who are pregnant with baby #1 and are just looking to educate themselves better on their options and the process. I think (?) they've found it pretty informative hearing other peoples' experiences.

[kltroy]

There are some great resources for helping you choose a care provider whose philosophy is aligned with your own at http://www.childbirthconnection.org. Now is the time to start thinking about what sort of birth you want, and what sort of environment you want to have it in. Hospital vs. birth center vs. home? Midwife vs. family practice doctor vs. OB/GYN? Are you planning a natural birth? Interested in a water birth?

You might have no idea WHAT you want at this point - I agree that talking to other mothers - especially those in your local ICAN group (since they have often seen the best of the best AND the worst of the worst) can be very helpful. I'm a local chapter leader and we often have a few women who come to our meetings who are pregnant with baby #1 and are just looking to educate themselves better on their options and the process. I think (?) they've found it pretty informative hearing other peoples' experiences.

[donutmolly]

Definitely consider using a midwife! I highly recommend reading "Ina May's Guide to Childbirth" by Ina May Gaskin.

And pop over to the "finding your tribe" section, there are lots of options for midwives in Western Wa, and the ladies there will be able to give you some great suggestions, and connect you with local resources!

[MegBoz]

Originally Posted by AlexisT

IMO, you are better off asking about policies and how things are handled,

emphasis mine

Exactly! I always recommend open-ended Qs! You want to know how this HCP (health care provider) normally practices - NOT if they will "let" you do things you want (like gestation past 41W, eat & drink in labor, forgo an IV, not have lots of VEs (vaginal exams), not be hooked up continuously to EFM (electronic fetal monitoring), etc.

You want to know the HCPs "default settings" for healthy, normal birth & make sure they correspond with what you want. Not ask if they'll "allow" you to do things your way.

TOTALLY AGREE - read "The Thinking Woman's Guide to a Better Birth." FANTASTIC book! it's what got me on the path from thinking, "Of course I'll get an epidural! Why go through all that pain if you don't have to?!" to switching to a midwife. I'm SO GLAD I got educated about the truth (and, unfortunately, "getting educated about the truth" can't be accomplished from reading "mainstream" publications like "What to expect when you're expecting" or "The Mayo Clinic Guide to a Healthy Pregnancy." Sad, but true.