How to decide on a doctor / hospital?

[mom to little e]

With DS, we were active duty military and saw whomever (doctor) we were assigned. Same thing with the hospital - no choices there. Fortunately, we had good doctors and a good experience with the delivery (even though it turned into an unscheduled/surprise c-section).

Anyway, DH is not on active duty any longer and after 12 years, having a choice of doctors' and hospitals is all new to me. I have an appt. with a doctor that many acquaintances of mine visit and gave good referrals, but is there anything in particular I should ask? This is so new to me I am not even sure where to begin. How did you decide who to go with? My biggest concern is that I had a c-section and should the second be a c-section, also.

Thanks!

Maryann
Momma to Ean...the little love of my life!
AND Baby #2 EDD 01/08/06!

[american_mama]

Hi Maryann:

I moved when I was 7 months pregnant and had to choose from 4 different insurance plans and hospitals. I decided to pick a hospital first and a provider second, in part because the hospital is a guaranteed thing, whereas you can pick the greatest ob, but it's potluck whether he or she will be on call when you deliver.

So you know my experience, I choose my hospital in Minneapolis because I liked their labor environment (rooms, nurses' personalities,and institutional policies,... everything) AND the hospital sent a free visiting nurse to every new mom's home the day after discharge. She helped me a lot with nursing and assessing mild jaundice. I think these programs are becoming a bit more common, so ask about it in your area. Once I decided on that hospital, I was limited to the the large ob practice or midwife practice that delivered at the hospital. I chose the midwife practice because I favored low intervention births, and I choose my particular midwife based solely on who had the first appointment!

Regarding a hospital, you may find some questions to ask through this initiative:
http://pregnancytoday.com/reference/articles/tensteps.htm

Also, call the labor unit and ask if you can tour the hospital, maybe by piggybacking on a scheduled childbirth class tour or ask for a personal tour. (We did this.) Questions to ask:

1. private rooms for post-partum? private showers AND/OR tubs in every labor and every post-partum room? any limits on visitors during labor or during post-partum (including dad)?

2. is there a nursery for healthy babies or do all babies room in? what about for babies born by c section?

3. distance from labor room to c section room (since this is a concern for you)?

4. what comfort measures are commonly used for a laboring woman? for example, does hospital have birthing balls, tubs for soaking in, rocking chairs for labor, tape or cd players in the labor rooms? how adjustable is the bed and are stirrups standard? do women usually give birth laying on their backs in this hospital or can women choose whatever position feels best? are water births allowed (even if you don't want one, if your hospital allows water birth, you can probably assume it is very open-minded towards non-interventionist labor practices).

5. what's the hospital epidural rate? c seection rate? episiotomy rate? if labor assistance is needed, is it vaccuum or forceps or depends on the provider? (the link above has some guidelines to help you interpret these statistics.)

6. if you have an epidural, does the hospital have certain standard procedures like a a catheter or internal monitoring? do nurses ever use just a handheld, intermittent monitor?

7. what happens when you first arrive at the hospital in labor? what and where is the paperwork done, is there a triage room?

8. does the hospital welcome doulas, if you plan to have one?

9. what procedures are in place if there is an emergency for you or the baby?

10. how many lactation consultants on staff? what is the procedure for visiting new moms?

As for choosing a doctor, ask if you can make an appointment for a "meet and greet" as a potential new patient. Many people do this with pediatricians (and it's usually free), so I hope ob/gyn's will do it too. I'm losing steam here, so I'll be more general.

1. how many women vs. men in practice, how many doctors share a call schedule, who will deliver baby and does it differ if it's daytime, evening, or weekend?

2. what are his or her feelings towards VBAC (if that's what you want) or repeat c section? how supportive is he? VBACs are a huge topic that I don't know much about, but you can read all about them here.

3. how common is it that his or her patients have an epidural, episiotomy, or c section? (the link above has some guidelines to help you interpret these statistics.)

4. what is his or her attitude towards a birth plan or doula or family at the birth or whatever things you are thinking of for labor?

5. are there midwives or nurse practitioners in the practice? what role do they play in prenatal care and birth? if a midwife is at the hospital, can she deliver the baby and direct the patient's care, or is an ob always ultimately in charge?

5. why did he or she become an ob/gyn?

I don't think it's easy to get answers to these questions, but you can usually get a sense of a person's attitude by reading between the lines.

Good luck. It's a learning experience!