On paper, the obstetrician was perfect. She took Kate’s insurance. She had graduated from a prestigious medical school. She was well regarded in the medical community. In fact, the obstetrician seemed so perfect that Kate (who has asked that her last name not be used) was willing to ignore her rushed manner on her first visit. “It was a red flag, but not a deal breaker,” Kate said of the doctor’s flurried manner and lack of conversation with Kate’s husband. “But then when I miscarried at 13 weeks—a really devastating loss when you’re 40—her manner was so cold and she actually referred to the fetus as ‘shriveled up,’ which just felt unkind,” Kate recalls. It wasn’t long before Kate and her husband “fired” the obstetrician they had so carefully chosen and decided to entrust their next pregnancy to a physician who was in many ways her total opposite—an older man who was both kind and warm. For many women who are trying to conceive or are already pregnant, choosing an obstetrician doesn’t require a whole lot of trial and error: They call up their health insurance company or pull up the company’s provider list and they choose a name of a provider who is located somewhere near their home. But some are lucky to find a provider at all. An estimated 11 percent of women between the ages of 19 and 64 don’t even have health insurance. But for those who do—and for those who have a choice in the matter—the decision of who should serve as your obstetrician is one that can’t be taken lightly. After all, an obstetrician does a lot, specializing “the care of pregnant patients, labor, and birth,” explains Lisa Valle, DO, an obstetrician and gynecologist from Providence Saint John’s Health Center in Santa Monica, California. While some moms prefer a midwife to deliver their baby, obstetricians still deliver more than three-quarters of the babies in America. These are the physicians in whose hands we literally place our babies.
Questions to Ask an Obstetrician
Whether we pay them out of our own pockets or our health insurance picks up the tab, obstetricians are like any other physician: They work for us. Now imagine hiring someone to work for you without asking them a few basic questions before you hand them a keycard and offer them access to your computer system. You wouldn’t do it, would you? Of course, some women already have a gynecologist, a physician who specializes in the care of a women’s reproductive system, whom they love and trust. “In the United States, our training for obstetrics and gynecology is combined into one four-year residency,” Valle says. “As a result, many elect to practice both, however, not all gynecologists elect to practice obstetrics.” If you feel safe and comfortable with your current gyno, ask them if they’re an OB-GYN, meaning they practice obstetrics as well as gynecology. On the other hand, if you’re starting fresh in a new town or just want to see a new provider, setting up an interview to learn if they’re the right fit for your health needs (and those of your baby) is A-OK. But what should you be asking your future obstetrician? Here are a few questions to help you make heads or tails of this big decision.
Will my obstetrician be there when I deliver?
Sure, you may want this one doctor to be there for every single appointment and there on the day you give birth, but obstetricians are human beings too! Instead of asking if they will be there on the day you deliver, ask what their procedure is for delivery. Do they recommend that you see a range of physicians in their practice so you know everyone and therefore have a familiar face in the delivery room? Do they guarantee there’s always someone in their practice who will be on call? Obstetricians want the best for their patients, but they also want patients to know that if they’re not right there the minute they pick up the phone, it’s nothing personal. “I wish patients knew that it is not possible for one doctor to be available all the time and to handle all issues that come up,” OB-GYN Janelle Cooper, MD, tells HealthyWay. “I wish patients knew that although we are dedicated to our careers we also have lives outside of medicine and we cannot be available 24 hours a day. “Many pregnant women have a hard time with that when they have only seen you their entire pregnancy but they have to be delivered by one of your partners. Often this is because we have been working all night the day before and went home to rest or are seeing other patients in the office.”
Where does this obstetrician deliver?
Where you plan to give birth will play a big role in who you choose to deliver your child. After all, if you want to give birth at home, you’re probably not going to find an obstetrician who will show up at your door with a doctor’s bag in hand. These days most home births are attended by midwives, so if you’ve got your heart set on birthing in your bedroom, you may want to find an OB who works with a midwife, or you could go to a midwife directly. If giving birth at a hospital or birth center is more your speed, you’ll still need to find out where your obstetrician has privileges, a special relationship that allows doctors in private practice to provide care in a hospital. Keep in mind how far that hospital is from your home and how difficult it might be to get there when you’re ready to give birth. You probably don’t want to choose an obstetrician whose privileges are at a hospital that’s four hours from home!
What’s an obstetrician’s c-section rate?
C-sections happen, and sometimes there’s no avoiding it. But if you have your heart set on natural childbirth, taking a look at an obstetrician’s c-section rate can help determine whether they’ll be likely to support you if you plan to give birth vaginally. “C-section rate is the number of c-sections a doctor or institution does over a specific time period,” explains Nichole Mahnert, an OB-GYN at Banner – University Medical Center Phoenix in Arizona. Determining whether your possible doctor has a “low” rate or a “high” one comes down to doing a little compare and contrast. The World Health Organization, for example, recommends a c-section rate of no more than 15 percent of births, while actual rates in the U.S. range from 23 percent to 38 percent, depending on your state. “Generally we like to see c-sections below 30 percent,” Mahnert says. “Most hospitals should have information available to patients about their [c-section] rate because this is something they should be tracking.” Keep in mind that there are all sorts of reasons that a doctor might perform a c-section, from fetal distress to an issue with mom’s health to patient preference. And a particular obstetrician’s c-section rate may be affected by their clientele. Are you talking to an obstetrician who primarily sees high-risk patients, for example? That may jack up their c-section rate, so be prepared to ask follow-up questions on why their rate is what it is. Mahnert also suggests asking an obstetrician to differentiate between their first-time patient c-section rate and their repeat c-section rate, as it’s more common for a patient to have subsequent c-sections due to medical necessity.
Do you perform VBACs?
While giving birth via a c-section may necessitate another surgical birth down the line, for many folks, it doesn’t. That’s where the VBAC or “vaginal birth after a cesarean” comes in. And an obstetrician’s opinion on VBACs can be the difference between living the dream of trying a vaginal birth or being sent back into the operating room. “If you have had one to two [c-section deliveries] and want to try for a vaginal delivery this is something very important to discuss with your OB,” Mahnert says. “They can tell you your chance of a successful vaginal delivery based on your characteristics and history. You also want to make sure your OB feels comfortable with the plan.” Some obstetricians will not offer VBACs at all, but that’s not always within their control. Some hospitals simply won’t support the practice. It’s worthwhile to work this into your questions about where the obstetrician delivers and how they feel about c-sections overall.
What’s your take on the birth plan?
A birth plan is exactly what the name implies: a plan you put together about what you want to happen during delivery. Studies have found that mapping out a birth plan can help make the person giving birth feel more empowered, and a birth plan can ensure that you walk away from birth feeling like it was a positive experience. But that birth plan is unlikely to be successful if the practitioner who’s helping you bring your child into the world isn’t on board. “All OBs should discuss your birth plan with you to make sure we are all on the same page and to make sure the items are doable,” Mahnert says. “It is important to have a realistic birth plan and understand that labor and delivery is sometimes out of our control and we need to be flexible. OB doctors want mom and baby to be healthy and happy and have your best interests in mind!” Many obstetricians have birth plan templates, so don’t be afraid to ask your potential obstetrician if they have one that they recommend. Review it and ask questions. “Your OB should be willing to talk this over with you and answer your questions or concerns,” Mahnert says.
What are the obstetrician’s fees?
The cost of delivery will likely come down to a mix of your health insurance company (if you have one) and your decisions on where to give birth and who you want at your side. For example, some health insurance companies will cover the costs for pre-approved doctors, which they call “in-network,” whereas you may only see part of the fees of another doctor or “out-of-network” provider covered. Although you can ask the obstetrician about their fees, most of those questions should be directed to the front office staff, Mahnert says, as they are more familiar with the ins and outs of insurance billing. You may also want to call your health insurance company directly, as they can outline other delivery-related fees such as the cost of anesthesia or the fee for a private room—bills that don’t come from the obstetrician’s office. If you don’t have health insurance, be sure to mention that to the billing department. Some doctors offer sliding scale fees for patients who are paying their own way.