OB/GYNs who care for pregnant women must anticipate and mitigate the risks associated with childbirth through diagnostic testing, behavioral modification, and bodily awareness. As a patient, it is in your best interest to identify a provider that is aligned with your level of risk tolerance, while still maintaining the common goal of healthy mom, healthy baby. Since the Affordable Care Act allows for direct self-referral to an OB/GYN without needing to see a primary care provider first, among other benefits, you have the opportunity to evaluate individuals and practices for fit.
Given that the field of obstetrics is quite new to standardized quality of care measurements (which are due to be instituted around the country in January of 2014), here are some questions you might start with:
- Tell me about your basic statistics—what are your rates of cesarean section? Assisted vaginal delivery? Successful vaginal birth after cesarean?
- The last question will tell you how inclined the practice might be to do C-sections over allowing women to have a chance at a vaginal delivery when there is a slightly increased risk of complications.
- Are midwives integrated into your practice? Can I choose to seek care with a midwife for my prenatal care and delivery if I am low risk? How do you work together in the clinic and on the labor and delivery unit?
- Midwifery (by board-certified midwives with hospital privileges) has been shown to result in lower rates of intervention, more patient satisfaction, and less costly care for low-risk patients.
- Do you have a 24-hour advice line that I can call if something happens during my pregnancy?
- This can prevent unnecessary alarm, help patients decide when further evaluation is necessary, and assist them in avoiding the emergency room (no pregnant woman wants to be waiting for 8 hours).
- How are complications managed? Do you have a high-risk obstetrician within the practice? Where would I receive care for my delivery if I am high-risk?
- Linkage with high-risk providers is not only important in dealing with the unpredictable nature of childbirth, but can also provide information and assurances to low-risk providers that might otherwise order unnecessary tests or mismanage a complicated pregnancy.
- How are my medical records kept? Will they be readily available to the provider that cares for me during labor?
- The disjunction between prenatal care and labor/delivery can be very disruptive to patients and lead to unnecessary provisions like antibiotics and duplicate or nonessential tests during labor.
- How does your practice promote mother-infant bonding?
- Investigate their policies on immediate skin-to-skin with baby after delivery, having the baby stay in your room postpartum to encourage breastfeeding, and in-house breastfeeding support such as lactation consultation. These behaviors have all been shown to be physiologically beneficial for newborns.
There are many things to be consider when pregnant, but navigating the unknowns doesn’t have to be difficult. Take the time to choose a provider who will give you the best care for you and your future child.
Dr. Chitra Akileswaran is a Harvard-trained OB/GYN and advocate of affordable healthcare.
Patient consult photo courtesy of Shutterstock.