Obstetrical Care

How to select the proper OB provider.

Millions of commuters exhibit daily acts of faith by boarding planes, trains and buses without knowing anything about the credentials or skill of the vehicle operators. Travelers can only hope that the regulatory agencies have properly scrutinized the operators to help ensure that the unsuspecting public will not be harmed. Thank goodness, when selecting a physician or midwife, pregnant women have access to more information and options than commuters. As you steer toward a healthy pregnancy and delivery, the most important decision you will make is the selection of a qualified healthcare provider and safe hospital. Choosing the proper provider is a defining moment of your pregnancy, not a minor detail.

Word-of-mouth referrals from friends are a great place to start while looking for obstetrical care, but then do your research. It is imperative that you check a healthcare professional’s credentials. Find out if the provider’s license is current or expired. Also obtain information on whether the provider ever received disciplinary action from the state medical board. Do not feel intimidated about checking a provider’s credentials; the public information can be obtained from your state board of medicine’s Web site.

Five types of healthcare professionals are trained to take care of pregnant women: obstetrician-gynecologists (ob-gyns), maternal-fetal-medicine-specialists (MFMs), family practice physicians, certified nurse-midwives (CNMs) and direct-entry midwives. The first three specialists have completed residency training programs. Ob-gyn physicians and MFMs are trained to perform cesarean sections in the event of emergencies, whereas most family practice physicians are not. MFMs have received additional fellowship training to manage high-risk pregnancies.

Certified nurse-midwives are nurses who have graduated from a nurse-midwifery program, have passed a national certification exam and usually have advanced degrees. They can attend normal and uncomplicated deliveries, provide prenatal care, attend to women during labor and births in hospitals or birthing centers and give postpartum care, including family planning services. Most states require CNMs to have a formal relationship with a physician who is usually but not necessarily an obstetrician-gynecologist. If you select a CNM as your healthcare provider, prior to your delivery, I strongly encourage you to meet the ob-gyn physician who is covering the CNM and check the physician’s credentials as well.

Direct-entry midwives are not nurses, but people who assist with home births outside of a hospital. If you are considering giving birth at home, understand that if you encounter a complication that requires hospitalization, a direct-entry-midwife does not have hospital privileges to facilitate your admission.

After you have verified a practitioner’s professional information, speak to the labor and delivery nursing staff at your local hospital. Most labor and delivery nurses are women and mothers who have personally witnessed every obstetrical emergency imaginable. Their opinions are invaluable. They have seen the doctors at their most vulnerable moments, particularly when they are under stress. They know which providers:

  • respond when they are paged.
  • make rounds on their patients by performing bedside evaluations of patients each day they are hospitalized.
  • are approachable.
  • are thorough.
  • respond to emergencies in a timely manner.
  • Interview both your prospective provider and his or her office staff to make certain that your goals are aligned. These are important questions to ask:
  • How many patients are scheduled per day? More than 30 patients scheduled in a day is a possible indication that you might not receive the time and attention you deserve.
  • What happens if you lose your insurance while pregnant? Will the practice accept state-funded programs such as Medicaid? You do not want to be in a position to look for a new care provider at the eleventh hour of your pregnancy.
  • Is your provider trained to handle unexpected birth complications such as shoulder dystocias, vaginal bleeding or fetal distress? If you have a family practitioner or CNM, how long will it take the ob-gyn to arrive if you need an emergency C-section?

Last but not least, trust your intuition. If something doesn’t feel right about your provider, don’t ignore the feeling. By following these suggestions, you can relax and enjoy your pregnancy with the confidence that you have obtained the best possible care for both you and your unborn child.