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How do you find the best doctor?

Posted by on Oct. 12, 2009 at 1:34 PM
  • 13 Replies

I went in for my first prenatal visit this morning and felt like I was in for a regular clinical PAP. We waited an hour to be seen, the office was so cramped and over-crowded that when we finally got in to see the doctor, we were super rushed. It hardly like a momentous occassion for us. I know the doctor is a specialist so she sees like a million people like me a week, but still a little I feel like I just went in for a PAP, not the first prenatal visit.

How did you find your obgyn? And/or how did you find the best one? Are groups a terrible thing if they're in one of the best hospitals in the nation?

by on Oct. 12, 2009 at 1:34 PM
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doulala
by on Oct. 12, 2009 at 1:48 PM

Do you need to see a specialist?    You can also choose from midwives if you're having a healthy, normal pregnancy.

I found my OB through a recommendation.   It was a horrible experience, honestly.   I ended up switching to a midwfe for a total opposite experience--   divine!!

My experience with group care is not a positive one.   Not personally but from dozens of stories, it's very impersonal... VERY.   :-(   
So convenient for the doctors, not so nice for the patients.

You can interview other care providers (OBs or midwives) to see what you think of their personalities and perspectives.   I have lists and info to help, if you'd like.  

Is this your first baby?
Do you know what kind of experience you're hoping for?   (sounds like more individualized, to start with!)



Birth is not only about making babies. Birth is about making mothers ~ strong, competent, capable mothers who trust themselves and know their inner strength.

~Barbara Katz Rothma


When you change the way you view birth, the way you birth will change. -Mongan


BostonareaMom
by on Oct. 12, 2009 at 5:17 PM

Hi! Thanks so much for writing back. This is my first baby and while I know my expectations are a little high probably I would have still liked it if she had asked us a couple questions, for instance she didn't even look over my chart enough to know my husband is in the military and so she never asked about vaccines he gets-- a couple of which he had to tell HER he should stay away from me if he gets them. Which I found ridiculous that we had to bring up a point in my information which she should have read.

The only reasons I am concerned about seeing a midwive over a doctor/specialist are I had a scare with cervical cancer and would need to keep that in check and am 90% sure I'd want to be in a hospital in case anything went amiss (loads of breached babes in my family history for some reason). Is that all possible with a midwife? I know they can't give epidurals, but I know they're some with some kind of medical licensing right?


I'd be very grateful if you tell me anything information about how to pick a doctor and go about interviewing them. My What to Expect book kinda just says to interview them, doesn't really say if that means I have to make an appointment, do the full scope of tests etc..and then decide or if I just go in, talk to them and then bale if I don't like them...

What I would love is a great ob/gyn who is interested in her patients and talking to them, spending more time with them than just a few minutes, who has been doing this for a long time and enjoys her work and doesn't take a ton of vacations, is in practice with maybe another person, not a group, and is affiliated with a great hospital in the Boston area, and doesn't have extremely long waits...I guess that's asking a lot eh?

Any help is extremely appreciated for sure! Thanks!


mrsbovee
by on Oct. 12, 2009 at 5:35 PM

I couldn't be picky about choosing prenatal care.  Only so many people accept my insurance here.  The health department gave me a 3 page list of Doctors and obgyn offices that accept it, all within a 75 mile radius... three... THREE of which were accepting new patients.  I started with a doctor, and he was a creep.  I have seen my MIDWIFE 4 times now, and I love the woman.  She works out of an office with 4 obgyn docs and 2 other midwives, so if anything in my pregnancy were to get too complicated for a midwife to be able to handle, I get transfered to one of the docs.... all of whom I've met and approve of.  I highly recommend going to a midwife.  Some of my friends think they are backwater voodoo women with no medical education.... so untrue.  They make the experience a lot more one-on-one and comfortable!

doulala
by on Oct. 12, 2009 at 6:53 PM

In order of your questions:       :-)

You would have to ask the midwives you interview if you'll "risk out" due to the cancer (that they couldn't take you on as a client due to a high-risk status).    I wouldn't think it would matter, but I don't know~  they would certainly tell you.

I think the stats are about 95% of the midwives in the US (you are American?) are CNMs (nurse midwives) that work in hospitals.   (maybe some of them attend home/birth center births.)

If you are wondering about breech vaginal delivery--  it is more likely to happen outside of a hospital.   Midwives are trained to attend them, but often there are hospital "rules" that breech = cesarean.   So even in a hospital setting, you might be forced to have a cesarean that you can avoid outside a hospital.   (And there are some OBs that will do vaginal breech, but they're usually older as medical school stopped trainined vaginal breech in medical school.)

No midwives don't administer epidurals, but neither do OBs.   If you're in a hospital you may have one if you'd like--  it's the anesthesiologist's job.
Midwives are "Normal Birth Specialists," they will have a lot of helpful ideas how to naturally cope with labor, if you'd like.

I will paste interview questions next...

Midwives can do most everything the OB can (minus surgery), she can order the tests...   IF there is something she can't do then she could consult with the OB in the practice/hospital, not a big deal.  (*Midwives do have better statistics for safer birth outcomes, as well.)

Yes, you can interview several care providers with all the questions you have.   I usually suggest moms write down the responses if they want so they can recall each answer/differences in practices, and to research facts to see how these providers practice according to info/ideas available to moms.   (books, websites, classes, videos, doulas, etc.)

Quick-brief OB prenatal care is standard.   It's about 7 minutes with OB per visit.  :-(     Midwives are 30 minutes (although mine were at LEAST 60).
What you are asking for is NOT too much.   But might not be possible with particular care providers.

While your at it, if approved for midwifery care, check into birth centers, too.   All the same equipment needed for childbirth with a LOT more personal, private, lovlier care.   Seriously!!  :-D

I feel like an advertisement for Midwifery, LOL!!





If you don't know your options, you don't have any.           ~Korte & Scaer

Mothers need to know that their care and their choices won't be compromised by birth politics.                                                                                            ~Jennifer Rosenberg

doulala
by on Oct. 12, 2009 at 6:54 PM


HOW TO FIND A MIDWIFE 
http://www.midwife.org/find.cfm
http://cfmidwifery.org/find/index.aspx
http://birthpartners.com/
http://www.mana.org/memberlist.html 

Questions to Ask a Midwife

Experience

  1. What is your general philosophy about pregnancy and birth?
  2. Do you let us do whatever we want during labor? (Food, positions, water, etc.)
  3. What is your education and training as a midwife?
  4. How many years have you been practicing?
  5. Are you a mother yourself? How old are your children now?
  6. How were your babies born?
  7. Do you work alone or with a partner or assistant? If you work with someone, what is their experience?
  8. Do you participate in a local midwife peer review group?  How many meetings have you attended in the past year?
  9. How many births have you attended as the primary caregiver?
  10. What is your experience with breech births? How many have you attended?
  11. What is your experience with twins? How many have you attended?
  12. What is your experience with VBACS? How many have you attended?

Prenatal Care

  1. How many births are you attending now? Do you have a maximum, and how do you manage to avoid too many commitments?
  2. If I am planning a home birth, do you come to my home any time before I go into labor? Do you provide supplies or literature to help us prepare?
  3. How often will I see you? What do your checkups consist of?
  4. What are your guidelines concerning weight gain, nutrition, prenatal vitamins, and exercise? What are your standards for pre-eclampsia?
  5. Do you require that I take a childbirth education class? Do you teach such a class?
  6. Who takes over for you if you go on vacation or get sick?

Hospital and Obstetrician

  1. Do you attend births in a birthing center, home or hospital?
  2. How do you handle emergencies? Under what circumstances would you transfer?
  3. What is your transfer rate?
  4. Would you stay with me in the hospital?
  5. Do you require that I see a physician during my pregnancy even if everything is all right?
  6. Do you have guidelines or restrictions about who can give birth at home?
  7. Under what circumstances do you induce labor with pitocin?
  8. What is your protocol to induce labor naturally?
  9. What is your c-section rate?
  10. What is your episitomy rate?

General Labor

  1. What kind of equipment do you bring to a birth?
  2. Are you permitted to administer any drugs during labor?
  3. How many people are allowed to be around?
  4. When should I call you after my labor begins?
  5. Do you wait until the cord has stopped pulsating before it gets cut?
  6. Will you allow my partner to be as active at the birth as he desires?
  7. How much time do you allow for the delivery of the placenta?

Financial Matters

  1. What are your fees and what do they include?
  2. Can you submit your charges to my insurance company?
  3. What payment arrangements do you make?

The Baby

  1. Have you ever had to resuscitate a baby?
  2. Do you examine the baby after birth?
  3. Do you give eyedrops or shots to the baby?
  4. Do you have a pediatrician you work with or recommend?
  5. Will you help me with breastfeeding?
  6. How do you feel about circumcision?
  7. How often do you come to see me after I give birth?
  8. Do you provide or know of anyone who will help new mothers after birth?


The knowledge of how to give birth without outside intervention lies deep within each woman. Successful childbirth depends on an acceptance of the process. ~Suzanne Arms


Birth is not an emergency. It is simply an emergence.” - Jeannine Parvati Baker

doulala
by on Oct. 12, 2009 at 6:55 PM

This is a helpful bit of info to differentiate between the kinds of midwives.

Demystifying Midwives


By Jacque Shannon-McNulty


Midwifery is enjoying an explosion of popularity with moms-to-be. More and more women are choosing to give birth with midwives. The term “midwives” used to be a one size fits all label for a woman helping another woman give birth naturally. In the United States, however, there are now several classifications of midwives, making it finding the right midwife complicated for even the savvy mom-to-be.

Choosing the right kind of midwife is critical to assuring that you have the best birth experience possible. Every birth is unique and every mom-to-be has different needs in pregnancy and birth. Understanding the differences between different types of midwives will go a long way to helping you to choose the right midwife for your pregnancy and birth.


All midwives have a number of commonalities; these characteristics in general are what distinguish the care that midwives provide from a doctor’s care. Midwifery literally means “with woman” and is a holistic, woman-centered care philosophy. Midwives spend more time in prenatal appointments with their clients than most doctors do. Midwives are trained to prevent many common pregnancy complications through preventive care practices. Midwives spend time educating their clients about nutrition, exercise and stress reduction to help maintain healthy pregnancies. Midwives tend to be less interventive, relying less on technology and more on personal care to attend to the needs of their clients. Midwives also tend to provide more individualized care, offering more flexibility and open discussion of your personal preferences and your birth plan.

Certified Nurse-Midwives are nurses who continue on to complete an advance practice graduate degree program in midwifery. Certified Nurse-Midwives (CNMs) are trained in hospitals and generally practice within the medical system. CNMs attend just over 10% of births in the United States, according to the American College of Nurse-Midwives, and 96% of CNM attended births are in hospitals. Though most CNMs have never witnessed birth outside of a hospital, a small number of CNMs attend births at independent freestanding birth centers and a handful attend homebirths.

Certified Nurse-Midwives often work in teams with physicians and are required to have physician back up. This enables easy continuity of care should your pregnancy or birth develop problems. Conversely, it can add some extra restrictions for a CNM to practice under physician supervision. Due to medial malpractice insurance restrictions, hospital policy or rules laid down by supervising doctors, many CNMs are unable to attend VBAC births (Vaginal Birth After Cesarean), even healthy and uncomplicated VBACs. Most CNMs are unable to attend breech births or twin births in hospitals, though some are able to at birth centers and at home. In hospitals, some CNMs can even attend births where a mother chooses to use an epidural or other medication, though most CNMs prefer to practice with a focus on natural childbirth.

Certified Professional Midwives are apprentice-trained midwives (direct-entry midwives) who have completed the certification process through the North American Registry of Midwives. CPMs practice holistically outside of the medical system, they are not dually trained in the medical system and nurses and they usually practice independently, without physician supervision. This freedom from institutional restrictions enables many CPMs to provide individualized care without blanket risk-out protocols. Many CPMs attend healthy VBAC births and some very experienced and specially trained CPMs even attend healthy, uncomplicated twin births and breech births.

CPMs are experts in homebirth. The credentialing process for CPMs is the only educational route that requires homebirth experience to achieve certification; no CNM or MD program has this requirement, and the vast majority of CNMs and MDs have never even witnessed an out of hospital birth. With this extensive training and specialized experience in homebirth, CPMs are uniquely qualified to attend homebirth. CPMs tend to embrace waterbirth as a healthy birth option and support their clients who are interested birthing in the water. CPMs have a strong working knowledge of gentle, natural healing modalities like herbs and homeopathy. CPMs act as guardians of the natural process of pregnancy and birth. They are trained to detect problems before they occur and to manage emergencies during birth. When they can’t prevent a pregnancy or birth complication, they refer their high-risk clients to a physician.

Direct-Entry Midwives are apprentice-trained non-nurse midwives and receive their training from more experienced midwives. DEMs are midwives who have not undergone the certification process that CPMs have. They may be highly skilled and well-trained, or they may be less experienced. Because the term direct entry midwife encompasses such a wide array of midwives with very different types of training and experience, it is up to the mom-to-be to ask many questions, check referrals and carefully assess the individual training and experience of a DEM.

Direct-entry midwives and even Certified Professional Midwives are sometimes referred to in the media and by physician groups as “lay midwives.” This term is essentially pejorative, and is not a professional classification of a certain type of midwife. Other kinds of midwives, such as traditional midwives, granny midwives, traditional birth attendants or independent midwives also are types of direct-entry midwives.

Licensed Midwives are usually CPMs or other direct entry midwives who have passed a licensure exam and have received a license to practice midwifery in their state. While many states do license CPMs and DEMs, several still have not enacted licensure legislation. The qualifications for the LM credential vary from state to state.

While many midwives are deeply committed to the Midwives Model of Care, some midwives practice with more of a medically-inspired model of care. Do your research. Ask lots of specific questions. Check out referrals. Most importantly, trust your instincts. Only you can decide which midwife best suits your needs.

Whatever your birth plan entails, if you would like to experience your birth as a healthy, natural, joyful life transition, a midwife is a great choice to support and care for you through your pregnancy and birth.


Copyright 2008 by Jacque Shannon-McNulty, all rights reserved, reprinted with permission

Jacque Shannon-McNulty is a doula, childbirth educator, mother of three and founder of Blissful Birth. She teaches childbirth classes and workshops and provides doula services in Chicago. http://www.blissfulbirth.com


Thank you, so much, Jacque, for sharing this very helpful info with us!   Much appreciated!!          :-D

  • We have a secret in our culture, and it's not that birth is painful. It's that women are strong.                                                                      ~Harm
  • Great spirits have always encountered violent opposition from mediocre minds.                                                                       ~Einstein
  • To know the way ahead, ask those coming back.  ~Chinese proverb

doulala
by on Oct. 12, 2009 at 6:56 PM

Since I am pasting my collection, lol!!




(midwives)  Woman's Way    and    Obstetric Way

 


 

Women's Way of BirthObstetric Way of Birth
Cultural definition of birth
  • Social event
  • Normal part of women's lives
  • Birth is work by the woman and her family and kin
  • The woman is a person passing through a major life transition
  • Potentially pathological process
  • Illness
  • Birth is work of doctors/nurses/midwives and other experts
  • The woman is a patient
The setting for birth
  • Home or other familiar surroundings
  • Informal system of care
  • In a woman's home or near
  • With other women of neighbourhood and family
  • Continuity of care
  • Woman free to change position and move about
  • Hospital, territory alien to the woman
  • Bureaucratic, hierarchical system of care
  • May be distant from woman's home
  • Woman is separated from those close to her
  • Discontinuity of care, e.g. shift changes/woman is moved from one room or one ward to another
  • Woman may not be free to change position and move about
Caregivers: the support they give and the conduct of labour
  • Older and more experienced women who are themselves mothers
  • See birth as holistic process
  • Shared decision-making between caregivers and woman giving birth
  • No class distinction between caregivers and woman giving birth
  • Equal relationship
  • Information shared
  • Personal caring - longer, more frequent, and in-depth prenatal visits
  • Often strong emotional support
  • Verbal and non-verbal encouragement
  • Familiar language and imagery used
  • Empathy
  • Cultural awareness because they are part of the same culture
  • Awareness of spiritual significance of birth
  • Believes in integrity of birth, uses technology if appropriate and proven
  • Young and older women who have often not themselves had babies, under direction of male obstetricians
  • Trained to focus on medical aspects of birth
  • Professional care that is authoritarian
  • Often class distinction between obstetricians and patients
  • Dominant-subordinate relationship
  • Information about health, disease, and degree of risk kept secret
  • Care depersonalized
  • Little emotional support
  • Lack of communication
  • Use of medical language
  • Threatening and often punitive behaviour, e.g. commanding, scolding, warning
  • Little cultural awareness of rituals, beliefs, social behaviour, values
  • Spiritual aspects of birth ignored or treated as embarrassing
  • Values technology, often without proof that it improves birth outcomes
Techniques used
  • Skills to preserve the physiological progress of labour
  • Usually intervention-free
  • Comfort skill, e.g. massage, hot and cold compresses, holding
  • Few resources to handle complicated obstructed labour
  • No skills to preserve the physiological progress of labour
  • Obstetric intervention
  • Drugs for pain relief
  • Skills and resources to handle complicated and obstructed labour, e.g. intravenous fluids, oxytocin stimulation, surgery

 

http://www.moondragon.org/articles/comparison.html




We've put birth in the same category with illness and disease and it's never belonged there. Birth is naturally safe, but we've allowed it to be taken over by the medical community.

~Carla Hartley, founder of Trust Birth and the Ancient Art Midwifery Institute

 

Treating normal labors as though they were complicated can become a self-fulfilling prophecy. ~Rooks

 

If you lay down, the baby will never come out! ~ Native American saying

doulala
by on Oct. 12, 2009 at 7:01 PM

And who ever you go with, keep researching & learning.   Learn about childbirth and your options.   (I have book, video, and class suggestions, too.)   You can learn about options, establish preferences and create a birth plan (to communicate it to staff in labor).   Making a plan helps to learn about options, and then discussing these choices with your OB/midwife helps to establish these preferences & communicate.   At the end, in labor, you can have a birth doula to help you work through your labor to be as happy & comfy as possible.


So whenever you want more info, let me know, I can share what I have.   :-)




  • Doulas mother the mother.    :-)
  • Every woman who wants a doula should have one!   :-)
  • If you don't know your options you don't have any.   ~Korte & Scaer
  • If a doula were a drug, it would be unethical not to use it. -John H. Kennell, MD
  • Women's strongest feelings [in terms of their birthings], positive and

    negative, focus on the way they were treated by their caregivers.   ~Annie Kennedy & Penny Simkin
sissychristi
by on Oct. 12, 2009 at 7:07 PM

I found the best care by not going to a doctor. When I wasn't happy with the doctors, I interviewed midwives instead. I have always gotten in right on time and they schedule the first visit for 2 hours to make sure you can talk. After that, the appointments are an hour-long so there is no rushing.

Before doing any procedure, they talk to you and find our how comfortable you are with the idea and answer any questions you have. They do not push exams on you that you don't want. Especially vaginal exams since they introduce bacteria into the vagina and are completely useless.

Midwives are highly trained and have more experience with normal births than doctors do. They are also equipped to order any lab work that a doctor can.

I hated every doctor I saw (8 total) but loved every midwife I intervewed (6) and had a hard time choosing just one.

sissychristi
by on Oct. 12, 2009 at 7:13 PM

Oh, and I also had cervical cancer. My midwife said there is no risk. She told me that occasionally if there is any scar tissue on the cervix it might not dilate as quickly, but applying primrose oil to the cervix a couple weeks before the due date will soften the scarring and eliminate the potential problem, as rare as it may be.

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