If you’re considering or have decided on private obstetric care for the birth of your baby, the next steps are to choose an obstetrician and book into a hospital. Choosing a care provider is one of the most important decisions you’ll make during your pregnancy – and it’s also one of the first you’ll have to make. So how do we go about choosing an obstetrician that will suit us best?
Online reviews and recommendations from friends are a good start but can’t really provide a complete picture since they are not you, and their experience will not be yours. Interviewing a few obstetricians, asking specific questions and trusting your instincts is a good approach to take, and being specific early on can avoid the need for changing care providers later in your pregnancy (although this is always an option if they no longer feel like the right fit for you).
Myself and one of my amazing back-up doulas Amanda Bernstein have co-written this blog piece. Below are a selection of questions that might be useful to ask during the interview with your prospective obstetrician.
WHAT HOSPITALS DO YOU HAVE RIGHTS TO WORK AT?
Obstetricians typically work in more than one hospital, they might all be private or a mix of private and public. All hospitals have different facilities, for example one may have a night nursery, where another might have a state of the art NICU (neonatal intensive care unit). Some have better birthing facilities for example one may have only a shower to labour in, and another may have a birth pool or other props like a mat and fit ball.
HOW MANY BIRTHING WOMEN WOULD YOU TAKE ON DUE PER MONTH? HOW DO YOU WORK YOUR ON CALL AND OFF CALL CALENDAR? WHO ARE YOUR BACK-UPS / TEAM?
All obstetricians operate their practice differently. Getting a sense of their commitments and comparing how different providers balance their patient load may give you a good idea of how their practice is run. Many obstetricians will have set and regular times in their schedule that they are ‘off call’ and unavailable, during these times other obstetricians will be ‘on call’ for you and your birth. Be comfortable with the time that your obstetrician is available and know who their back-ups are – after all, there’s a chance that they will be caring for you on the day. It may be a good idea to meet their back-up in advance of your labour too.
ARE YOU PLANNING ON BEING ON HOLIDAY DURING MY PREGNANCY AND ON CALL PERIOD?
It may feel like a silly question but obstetricians taking holidays around your due date is not uncommon so if it’s important to you to know that they will be around then it’s a good question to ask. Of course, birth is unpredictable and babies come at a range of times but knowing when they are available is worth asking.
IS IT YOUR PRACTISE TO GIVE ME AN ULTRASOUND AT EVERY APPOINTMENT, OR CAN YOU OFFER PALPATIONS AND DOPPLER TO MONITOR MY BABY?
Most obstetricians will offer an ultrasound at each antenatal appointment. But some birthing women have concerns around the safety of regular exposure and wish to limit their ultrasounds to only those that are medically necessary. So, if this is something you’d like limited, does this obstetrician offer alternatives to ultrasound such as palpation, fundus measurement and doppler monitoring.
WOULD YOU BE HAPPY IF I HIRED A DOULA?
Being happy for you to choose your support systems is a great sign of an open-minded care provider and understanding the benefits of doula support would show that they are a supportive of physiological birth.
HOW DO YOU FEEL ABOUT BIRTH PLANS?
Of course, you can’t plan birth, but writing a birth preferences document serves 3 functions – to educate you about your options, to form a discussion document with your care provider during pregnancy and as a tool to communicate your wishes with the staff that are caring for you during your labour. Having an obstetrician that is open to having educated patients and open communication is something important to look for.
ARE THERE ANY CIRCUMSTANCES FOR WHICH YOU’D RECOMMEND AN INDUCTION?
Obstetricians are all individual and independent. They all have different approaches to birth and perceptions of risk. Some common situations that different obstetricians may recommend inductions are: developing high blood pressure, where the birthing woman is regarded as being older (often 40+), having a ‘big baby’ or a ‘small baby’, being pregnant over 40weeks, having gestational diabetes, or simply that they might be on holidays... Asking questions around induction will help you to identify your obstetrician’s attitude to the ‘range of normal’ pregnancy issues and risk and you’ll be able to see how this fits in with your own philosophy for your birth.
WHAT PROPORTION OF YOUR CLIENTS GIVE BIRTH VAGINALLY VS VIA CESAREAN? CAN YOU SHARE YOUR RATES OF INTERVENTION (EG: ELECTIVE CESAREAN, EMERGENCY CESAREAN, INDUCTION, EPISIOTOMY AND ASSISTED DELIVERY)?
Many obstetricians will claim that they are supportive of ‘normal’ or physiological birth, and so their patient statistics should reflect this. If their statistics tell a different story, ask them why as there may be a good reason (such as taking on a high proportion of women who may be considered ‘high risk’).
DO YOU SUPPORT DELIVERIES IN ACTIVE POSITIONS? WOULD YOU SUPPORT ME TO LABOUR AND DELIVER IN WATER?
Being active in labour and birth works with your body, allows your pelvis to open and gravity to assist you. But this, and delivering in a bath, can provide limited access to your care provider so if you are wanting to be active in labour or have a water birth, it is important to find a care provider who is comfortable with supporting this.
IF YOU’VE HAD A PREVIOUS CESAREAN AND WANT A VBAC, ASK IF THEY SUPPORT VBAC WOMEN. FOR INSTANCE, WHAT PERCENTAGE OF VBAC WOMEN IN YOUR CARE ACHIEVE A VAGINAL BIRTH? WHAT ARE YOUR POLICIES FOR THEIR CARE DURING LABOUR?
Again, different obstetricians will have a different perception of risk. Success rates for VBAC women vary widely and can be anything from 23% - 85% (normally sitting around 60% - 80%). Much depends on their risk factors and support from their care providers. You could research recommendations for VBAC care, including the most recent (April 2019) recommendations from NICE in the UK and compare this to the policies of the obstetrician. Does their care feel like it’s in line with what you’re looking for?
HOW MUCH OF MY LABOUR AND BIRTH WOULD YOU NORMALLY ATTEND? ARE YOU THERE ONLY FOR THE FINAL PUSHING STAGE? OR DO YOU CHECK IN REGULARLY OR STAY WITH ME DURING MY LABOUR TOO?
Understanding what care you’ll receive in labour from your obstetrician can help set your expectations and understand how they practise.
HOW DO YOU FEEL ABOUT INTERMITTENT MONITORING RATHER THAN CONTINUOUS MONITORING?
There is no evidence that continuous monitoring in labour is any safer that intermittent monitoring. And even when it’s wireless, being continuously monitored can feel invasive and disruptive - things that do not promote a journey towards physiological birth.
WHAT ARE YOUR THOUGHTS AROUND A PHYSIOLOGICAL THIRD STAGE VS. ACTIVE MANAGEMENT IF I HAVE AN INTERVENTION FREE BIRTH?
Don’t forget to discuss birthing your placenta! Weigh up your options and find out what the obstetrician’s perspectives are.
WHAT DOES DELAYED CORD CLAMPING MEAN TO YOU?
Again, different obstetricians will take differing views on delayed cord clamping. Some don’t think it’s necessary at all, some believe you need just 60 seconds, and some are happy to wait until the cord is fully drained and white.
IF I NEED A CESAREAN, CAN MY PARTNER AND DOULA COME THROUGH TO THE THEATRE WITH ME?
Having 2 support people in a cesarean birth can mean that one person can focus on the baby and one person can continue to support the birthing woman. Having your doula (an independent set of eyes) in the room will mean you can process the birth by discussing what happened afterwards in your birth debrief session.
IF I REQUIRE A CESAREAN BIRTH, WHAT WOMAN/MOTHER-CENTRED OPTIONS DO YOU INCORPORATE INTO YOUR PRACTISE? AND, CAN MY PARTNER AND DOULA COME INTO THEATRE?
Although some cesareans are performed in an emergency and it is not possible to include mother-centred practices, often there is time and scope to improve the experience. It’s a good idea to understand an obstetrician’s philosophies and willingness to incorporate such care.
WHAT KIND OF POSTPARTUM FOLLOW UP OR CARE CAN I EXPECT?
Some obstetricians have midwives, mothercraft nurses and lactation consultants as part of their team and this expertise is then available for you to access as a patient of the obstetrician. Sometimes this is either by appointment or as a drop-in clinic. Finding out what they offer will help in your postpartum planning, and whether it’s included in their birth package, or is an additional fee.
Just to recap, choosing a care provider that is right for you is one of the most important decisions you can make during your pregnancy. Trust your gut and follow your instincts to make this choice, and when making any decisions in the lead up to and during your birth. It can set you up for the best possible journey, no matter the outcome.