8 Things Mamas on Bedrest Should Consider When Choosing an OB

November 11th, 2010

A few of the more recent posts have been quite heavy and if you are a mama on bed rest, you may be wondering,

“What does the argument between midwives and obstetricians have to do with me? There is no way that I’m having a home birth or a midwife given my complications. Besides,  I just want my baby-by whatever means necessary!”

It is the “Whatever means necessary” that is the key phrase in this statement. While no one would fault a mama on bed rest for these feeling, it is important that mamas realize that they must play an active role in the care and birth of their babies. It’s great if mama trusts her obstetrician, that is the way it should be. But mamas should still be fully aware of the treatments planned for herself and her baby. Additionally, if mama has any specific requests, she should make those requests known and they should be honored-even if they cannot be granted- because it is important that mama understand why she can or cannot have certain procedures and to be fully informed at all times.

It may seem that Mamas on Bedrest & Beyond is anti-obstetrician. Nothing could be further from the truth. It’s as I often tell my children,

“I love you but sometimes I don’t like what you do.”

Such is the case with me right now with obstetricians. I have utmost respect for them and what they do. But the war their professional organization is waging with midwives is horrendous and at the end of it all, mamas and babies may pay the price, especially those mamas with limited access to health care. That is my greatest concern.

In the blog post , “High Risk, On Bed Rest, You Still Have Delivery Options”, we provided mamas on bed rest with a list of 7 questions that she should pose to her obstetrician prior to delivery, ranging from how the OB decides to induce to types of and requirements for anesthesia. As stated in that post, a woman may end up following all, some or none of her obstetricians recommendations, but she can only make decisions about her care if she is fully informed about her options and the risks and benefits of each treatment proposed.

But what if the requests are not really of a medical nature? What if mama has requests that just make her feel more comfortable and secure? Again, if you have open communication with your obstetrician, it should be easy for you to request comfort measures such a a birth doula, having hypnosis recordings available and using them or having family members present without feeling intimidated or belittled.

So what types of things should a mama on bed rest consider when choosing a provider? Below are  8  characteristics every mama should consider when choosing her health care provider. At this point in pregnancy, many mamas on bed rest may feel locked in, like they cannot change. But if you find that you are unable to communicate with you provider, that he or she does not inform you of treatments and results, that they are making decisions which make you uncomfortable and won’t explain their rationale for those decisions, you have the right-no an obligation-to your self and to your baby to address these issues and have them resolved to your satisfaction. And while it may seem difficult, if you are truly uncomfortable with the care that you are receiving or with your provider, you do have the right to change providers, even late in a pregnancy.

But before you go making radical change, here are the 8 characteristics you should consider when choosing your health care provider:

  1. Education and training. Is you obstetrician trained to handle a high risk pregnancy? There are many good obstetricians who are great at uncomplicated pregnancies, but not so great at handling complicated pregnancies. Obstetrics is often called “the specialty of the unknown” because things can change very quickly. Your obstetrician needs to be able to handle these unexpected events or transfer your care quickly to a physician who can address your needs.
  2. Affiliation and Referral. If they are not as skilled handling your situation, who are their associates with whom they confer or refer in cases such as yours? Is your obstetrician associated with a maternal-fetal medicine specialist with whom he/she can confer? Are they willing to call that specialist in on your case, early, or will they try to “handle the situation” themselves? Make sure your obstetrician can put his or her ego aside and exercise their best judgment on your behalf.
  3. Hospital privileges and Affiliations. In what hospital(s) is your physician allowed to practice? What type of hospital is that? (Small community hospital vs. tertiary care center?) If you are transferred to a higher level facility, will your obstetrician be able to take care of you or will you then be attended by the hospital staff? What type of relationship does your obstetrician have with that staff?
  4. Type of Hospital. It’s important to know the level of care your intended delivery hospital is able to provide. Is it a small community hospital? This is often great when it comes to personal care, but this type of hospital and staff may not be equipped to deal with a complicated delivery. What types of nurseries do they have? If your baby is born prematurely, will this hospital be able to care for your child or will your child be transferred to another facility? This is a huge question because as a mama of a preemie, I had fits having my baby just 8 floors away from me. I couldn’t have imagined her being in another facility, perhaps hours away.
  5. What is their practice philosophy? Is your obstetrician a “by the book” person or are they able to be flexible? Will they balk if you decide to have a loved one film your birth? Will they balk if you have your husband and mother in the delivery room? How will they react if you refuse an epidural or an episiotomy? What is their induction and cesarean section rate? Finding out these practice habits before you are ready to deliver will alleviate any potential misunderstandings.
  6. How is their office staff? This is huge because you are likely going to spend more time with the nurses and office staff than with your obstetrician. If  they don’t promptly return your calls, are rude during office visits, don’t relay your messages to your obstetrician, then your OB needs to know so that She/He can make adjustments and you can decide if this is the practice for you.
  7. What’s their personality type? Is your obstetrician someone with whom you can communicate easily? Do they offer the chance to ask questions or do they come and go like the wind? How do they respond to your questions? Are they open to questions or insulted that you dare question their judgment? How do they respond if you have a difference of opinion or even refuse their recommendation?
  8. Do you like your obstetrician? This may seem like a no-brainer, and some would argue that this should be first, but I have heard many women put up with obstetricians that they could not stand because “She/He’s the best in his field” or “My neighbor said she/he is just wonderful.” But what do you think? We all have our little quirks. Make sure that your quirks combine with those of your obstetrician and don’t repel like oil and vinegar.

Remember, obstetricians are human just like the rest of us and may make mistakes. But if you have a good relationship with your obstetrician, open communication and they are willing to seek the counsel of other (perhaps even a midwife if the situation warrants)  it’ll be one of the most valuable relationships of your life.

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