UPDATE -- I think I need a new OB (long) -- please advise!!!

[himom]

Thanks all!

I went to the "new" doc yesterday and it seems like he'll be okay. The practice only has him and his partner. Apparently they also usually have one midwife on staff but the last one recently moved away and hasn't been replaced yet. We had a chat re: epidurals, induction, episiotomies etc and he seems to be supportive of my wishes for as little intervention as possible.

He also gave me a brief history of OB/GYN medical training, telling stories of how when he was in school they did episiotomies every single birth no matter what, and now they don't do them unless it's extreme. He also seemed really surprised that I wanted to switch doctors, as he had a lot of respect for my former doc. This helped me feel better too, as I really did love my former doc but switched for the "too many people" reason.

Things look good, and I'm much calmer now. Thanks again!

Jodi

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I need some help please!

I never thought I'd be in this situation, because I really did like my OB and his practice, but it seems as though it's time for a change. I've just been informed that the practice has combined with a medical school and the doctors are now professors. Consequently, when I go into labor, I can get any one of 12 or 15 different doctors that belong to this group of professors -- no telling which one, and no way to make sure I get one that I know.

This really bugs me, because I was so happy with my first delivery. My OB and his partner both knew I wanted to do as much as possible on my own. When I was in transition and changed my mind about getting an epidural, she talked me out of it because she KNEW I didn't want it and gave me something else instead -- turns out I didn't need it, DS was born less than an hour later. This particular doctor doesn't even do deliveries any more, so no chance of getting her at all.

So...now I'm faced with 1:15 odds of getting a doctor that actually knows who the heck I am. Time for a new doctor?

I'm already 22 weeks, and this is scaring me. Several people have recommended a practice that is close by and its physicians have been rated "top doctors" by the Best Doctors in America -- bestdoctors.com -- but honestly, I have no idea if this even means anything. Both OBs in the practice are older, so I'm worry about old school attitudes re: episiotomy, laboring flat on the back, C sections, etc. On the plus side, up until recently they have had midwives operating out of the office too but have just phased them out for some reason -- the fact that they were there in the first place has me hoping things are a caught up with modern times.

I have an interview early this week, and I can't find the list of questions to ask. Does anyone have this list stashed somewhere, or any words of wisdom? I'm more nervous about this second birth than I was about my first. That time, I had everything completely planned out, and this time things are just a mess. I hate feeling out of control.

Any advice wil be very welcome.

TIA!

Jodi

[bcky2]

i would look elsewhere also. i dont like the idea of there being so many different docs that could deliver me. i dont have a list but i would ask about episiotomy rate, c section rate, how often the induce and how far the usually let you go without an induction. i had an older doc(heck he retired about 3 months after my first ds was born. well i had a really bad episiotomy, we are talking major stitches. when i went to the nicu to see my ds one of the nurses asked me if i had alot of stitches and i said yes (i couldnt sit at all!) and she said she figured because dr. noname ;) likes to cut. i was so upset. my second doc had to fix the damage done by first doc. it was a nightmare. not saying that all older docs do that. i have heard good things about some of the older ones also.

i say sit down and write out a birth plan then take it with and see what they agree on and what they dont agree with. that will give you a good idea if you even want them to deliver you. good luck!

[SnuggleBuggles]

Hi Jodi,

Rest assured that many moms have switched practices even later than you.

I would personally switch practices because that one is just too huge- I would hate to have to worry about what kind of Dr. was going to show up for the birth of my baby. I like to have relationships with the people who will be involved with such a milestone event. (Of course, with some Dr.s it hardly matters who is there since they don't do much besides relay orders and "catch"...a doula or someone that you choose would be the one to provide labor support.)

But, I would find out if your current Dr. would be an exception for your birth and be willing to be "on call" for you regardless of when you go in to labor. I had a CNM through a 4 OB practice and my CNM tried very hard to be at the births of any patients who wanted her. So, maybe you can get someone to agree to be your personal DR..

If you stick with this practice I would request an on call list so you know who will be there on what day. My CNM was on vacation during my 40th week and I had some issues with 1 of the OBs on staff. So, I had the list and I knew I would just stay home till shift change if the OB I didn't like would be on call. ;)

If you stick with them I would write out a birth plan and have some of the Dr.s sign off on it and put it in your file. At least that will help the Dr. and nurse you get on labor day will get to read about what you are hoping for out of the birth experience (beyond healthy baby/ healthy mom).

Can you make consult appts to meet with all the Dr.s?

I'd worry about the new, recommended practice- why did the midwives leave? That would be a big factor to me. Did the OBs find that they didn't like working with the mws or their patients? I lurk over on an OB/Gyn message board and there have been some OBs that have hired mws but then found that they weren't on the same page with birth philosophy of the patients they sometimes get. But maybe the mws just decided to go elsewhere. It would be good to know one way or the other. Poke around and see what you can find.

Also, "best" is in the eye of the beholder. Sounds to me like you are a low risk mom and may be leaning towards fewer birth interventions. These Dr.s may be great for high risk moms and used to birth with interventions.

Are you strictly looking for an OB or would you want to look for a CNM (that either delivers in a birth center or hospital)? I had good luck with my solo practice CNM. I'm a big fan of the solo or small practices so you really get to know who you are working with. Small practices are just better all around when it comes to really feeling like a person and less like a patient. I really like CNMs for my births since they tend to be on track with my personal pregnancy and birth beliefs. However, I learned you can't judge them by title alone and some CNMs practice more like OBs and vice versa. So be sure and really talk to them.

My main question that I would use to weed out practices is: why and when do you induce labor? what drug/ method do you prefer? The "why" so I can find out if they really reserve this practice for true medical need or not. The "when" so I would know if I was up against a practice that would want to induce me at 40w1d because I was "overdue" (I am in favor of practices that go with the ACOG and let pregnancy take it's course till 42 weeks but begin monitoring at 41w). The drug/ methid question is so I know if they use Cytotec since that would be a deal breaker for me.

C-section rate is usually good but if they manage a lot of high risk patients the results could be skewed. A rate of 10-15% would be great if they usually have low risk patients.

Here is a link to a good list of q's to ask:

http://www.mother-care.ca/questions.htm

You really do have lots of time. Try not to stress too much. You will find the right fit for you. I know moms who have switched at 36 weeks and have been really happy they just did it. Take a look around and see if you find somewhere you like better. I hope you do. :)

Take care,
Beth

[SnuggleBuggles]

So sorry to hear about "Dr. Scissor Happy"! How miserable. I'd have someone on scissor watch if I couldn't trust my care provider to not do an episiotomy unless really necessary. Horrible to think we should have to do that, especially if we had said no cutting unless absolutely necessary.

Sorry, I got side tracked. I was just reminded about old vs young. 1 personal experience- my practice had this young, female OB from the Bay Area of CA and I really thought she would be more "naturally" oriented but she was the most in favor of interventions of any of the Dr.s in the practice. I was so surprised. 2nd is an observation from that OB message board and the old Dr.s were complaining about how the young Dr.s arent even trained for forceps/ vacuum and are all about c-sections. Old, young...I guess they have to prove themselves on the issues since I have been surprised that they don't always practice like I would expect. Are they stuck in their ways if they are old or do they like to research and stay current? My dentist is old but fascinated with every new study and technology. :)

Ok, enough rambling.

Beth

[JTsMom]

>
>But, I would find out if your current Dr. would be an
>exception for your birth and be willing to be "on call" for
>you regardless of when you go in to labor. I had a CNM
>through a 4 OB practice and my CNM tried very hard to be at
>the births of any patients who wanted her.
>would be a deal breaker for me.


Yeah, that. :) MY CNM would do that too, for a select few who begged. :)

[megs4413]

maybe a midwife practice would be a better fit for you? you might look into that.

i think i woudl definitely switch practices. i switched with DD at about 20 weeks and with this one I switched at 12 weeks.

if you're hoping for a drug-free and limited intervention birth, your practitioner really has to be on board....

i hope you find the perfect fit!

[o_mom]

A friend of mine had great luck by touring the maternity unit of the hosptial she was considering and asking the nurses who they would recommned for a natural birth.