By Silvio Aladjem MD
Not too long time ago, the daughter of a friend of mine, who is planning to start a family, asked me a reasonable question: how to choose an obstetrician when she got pregnant? The more I thought about it, the more I believed this is a question that many women may ask themselves. I thought I would share my thoughts about the subject with you.
There is more to this question than meets the eye. There are a number of professionals who take care of pregnant women: midwives, family physicians, obstetricians and specialists in high risk pregnancies.
Should you wish to deliver at home, your choices are limited. Physicians, be this family physicians or obstetricians, do not, as a rule, attend home deliveries. Neither do all midwives. Therefore, you will have to find a midwife willing to go along with you. In so doing, you need to make sure that the midwife is certified (Certified Nurse Midwife-CNM) and that she has an obstetrician working with her willing to take over care in case of a problem. Home deliveries should never be considered for multiple pregnancies (twins, triplets, or so) or if a medical problem with the mother (diabetes high blood pressure and so on) is already present. There is still a heated debate as to whether home delivery is safe or not. Make sure you are well and realistically informed. The “it will never happen to me” philosophy is a dangerous one. If it happens to you it’s 100% even if that particular complication only happens in 5% of patients.
If you wish to be delivered by a midwife (CNM) in a hospital, that’s fine as long as an obstetrician is available for consultation, in case of need.
Some family physicians take care of pregnant women. However, not all will deliver you. When that is the case, it means that at the time of delivery you will have someone else that you never met before and who may not be very happy about the referral. Most women don’t like that arrangement so, again, do your homework and ask questions.
If you want an obstetrician to take care of you, there are certain criteria that you need to consider. Just because he/she delivered your best friend, doesn’t mean it’s a good choice for you. Make sure that the obstetrician is Board Certified or Board Eligible. Make sure that you talk to him/her about what your preferences are in terms of delivery: free of pain or free of medication, how you feel about being on your back for the duration of labor, as opposed to walking around, hot tub delivery, and a host of other issues that are important to you. Not everybody is willing to comply with your wishes, even if there is no reason not to.
Last but not least, do you already have some medical problems (high blood pressure, diabetes, or other medical problems) or have you had problems in a prior pregnancy, which may have a bearing on the current pregnancy.
In such circumstances it is advisable you consult a Maternal Fetal Medicine (MFM) Specialist. These are obstetricians with special training in high risk pregnancies, which you would qualify for.
Where you deliver is just as important as your choice of who is going to deliver you. If you had any prior complications, it is advisable to deliver in a hospital that can provide Neonatal Intensive Care to the newborn. Not all hospitals have such a service. The last thing you want is for you to deliver in your hometown hospital and as soon as you deliver they have to transfer the newborn to another hospital that can provide intensive care.
Most people never think about all these issues. A baby is a baby, and women have delivered babies since time immemorial. I remember one patient that told me: my mother never had prenatal care and delivered 7 babies at home, and never had a problem. Good for her mother, but with that mentality, why do you drive a car when a horse and buggy will do?
Most people never think about potential problems. They happen, more often than you think. Putting yourself, and your baby, in harms way, when today you do not have to, should never be an option. I grant you that you can do whatever you want for yourself, but when that decision potentially could harm the baby, it is not acceptable. Actually, I think it would be child abuse.
Pregnancy should be a joyous time, with unique emotions and expectations. But the top priority, in terms of expectations, is that you and your baby should be well. While getting pregnant itself may not have been planned, and most aren’t except in broad terms of wanting to have children, once pregnant, its course can be influenced by your decisions. Who is going to deliver your baby is one of those important decisions that you will have to make.
You will have to make many other decisions as you go along, some of which you never thought you will ever have to make. While we can’t ever anticipate how the pregnancy is going to evolve, most of them are perfectly normal. We can make them even better by making informed decisions.
About the Author:
SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. He can be reached through his website, www.drsilvio.com
You can read more of Dr. Aladjem’s posts on Imperfect Women by clicking here. Dr Aladjem also answers questions of medical interest related to pregnancy in a monthly post here at Imperfect Women. You can read more details about this feature and ask a question by filling out the form here.