Your Pregnancy Matters
Choosing an Ob/Gyn: Questions to ask the provider and hospital
August 11, 2020
Choosing your Ob/Gyn is one of the first big decisions you'll make when you find out you're expecting. Research shows that nearly three-fourths of patients are more concerned about choosing the perfect Ob/Gyn than choosing their delivery hospital.
Having a baby changes your whole world and you want to go through this experience with an Ob/Gyn, certified nurse-midwife (CNM), or family medicine doctor who you like and trust. But both decisions – provider and delivery hospital – must go hand-in-hand, and there's much more to consider than personal preference.
For example, many private practice Ob/Gyns deliver at specific hospitals on a rotating schedule. And not all hospitals offer the same services and coverage. So, balancing your provider and hospital preferences may require careful consideration.
There are a lot of unknowns with pregnancy, from gestational diabetes and preeclampsia to twins, preemies, and more. While you may want a certain prenatal care and birth experience, you need to know you and your baby can get any type of care you need.
As you begin the prenatal care journey, make a list of providers and hospitals your friends and family recommend. Then, ask the following questions to help you decide which provider and hospital is the best choice.
Questions to ask your potential Ob/Gyn
What is their general philosophy?
Each doctor and practice is different, and each holds a unique philosophy regarding patient care and support. When searching for an Ob/Gyn, you'll want someone who can manage your medical care and who respects your cultural needs and personal preferences.
Ask questions like these to get a sense of whether their practice can provide the birth experience you envision:
- Do they support non-medicated deliveries?
- How many ultrasounds will they perform?
- Is their bedside manner as kind – or authoritative – as you'd prefer?
Related reading: Why cultural awareness matters in pregnancy care
Do they take your insurance?
Many Ob/Gyn providers are affiliated with multiple hospitals and deliver at different locations based on patient needs and preferences. However, even if you choose an Ob/Gyn that accepts your insurance, not all the hospitals at which they deliver will necessarily be in-network with your insurance. You may have to pay more to deliver with a specific provider or at a specific hospital.
Before you choose your Ob/Gyn and hospital, contact your insurance company to make sure your policy covers services for both.
Where does your Ob/Gyn deliver?
Depending on where you live, the closest hospital might be an hour or more away. But if your chosen Ob/Gyn doesn't deliver there, you might be looking at a longer trip to deliver with your doctor. Talk with your Ob/Gyn about where they deliver and whether it might be safe for you to travel on the big day.
Will a different doctor deliver your baby?
Many Ob/Gyn practices follow a rotation or on-call system for deliveries. So while you may see one doctor throughout prenatal care, a different doctor may attend your delivery.
If you're concerned about having a different doctor at delivery, ask your Ob/Gyn if you can meet some of their colleagues during your prenatal care. Some Ob/Gyn practices already do this as a standard of care.
To feel even more prepared, you might also ask about other providers who may attend your appointments. In some practices, providers such as nurse practitioners, certified nurse-midwives, or physician assistants see patients for prenatal or postpartum care.
What to ask when choosing a delivery hospital
Does it offer your preferred pain management method?
Well before you are in the throes of labor, talk about pain management options with your Ob/Gyn. Not all hospitals offer the same things.
For example, UT Southwestern's William P. Clements Jr. University Hospital offers nitrous oxide (laughing gas) to take the edge off labor pain. This service has been temporarily discontinued because of COVID-19 but will return after the pandemic is under control. This is a good option for mothers who want a natural birth experience.
Other pain relief options to ask about include:
- Aromatherapy or essential oils
- Birthing balls
- Comfort items from home
- Doula support
- IV pain medications
- Tubs or showers
- VR goggles
Can it manage risks related to chronic health conditions?
Underlying health concerns such as pre-existing diabetes, maternal heart disease, and lupus must be closely monitored throughout pregnancy as well as during the labor and delivery process. Patients with these conditions are more at risk for complications, including preterm birth, high or low birth weight, or stillbirth.
Proper care for underlying health issues may require the assistance of other subspecialists. However, not all hospitals have subspecialists available, which may present a problem for high-risk patients. Find out whether your potential hospital cares for patients with complex pregnancies and how they can manage your care in the event of an emergency.
Related reading: How women can manage gestational diabetes with a healthy diet
What if I need an emergency C-section?
No one likes to think about a less than perfect birth, but it’s important to plan for the possibility. To perform emergent C-sections, a hospital must have access to 24/7 in-house anesthesia. This is not a concern at a large academic medical center like UT Southwestern. However, at small or rural centers, you might have to be transferred if an emergency occurs or there may be in a delay in care while waiting for the appropriate medical providers to respond.
Also ask about the possibility of assisted delivery, such as the use of forceps or vacuum extraction. These procedures can reduce the need for a C-section, but some providers don't feel comfortable doing them.
Can the hospital care for my baby if I deliver preterm? Does the hospital allow VBAC deliveries?
Some hospitals do not offer neonatal intensive care unit (NICU) services, so preemies and twins who need extra support will be transferred to another hospital.
When I had my youngest child at 33 weeks, I was fortunate to deliver here at Clements University Hospital, which has a NICU in the same building. Read my story.
Also, not all hospitals allow vaginal birth after cesarean section (VBAC). Although rare, a trial of vaginal birth after cesarean can lead to complications such as uterine rupture, which not all hospitals are equipped to manage. While 60% to 80% of patients who attempt VBAC will not need a C-section, some Ob/Gyns will not take on the risk.
What happens if the baby is breech?
Often, a C-section is recommended for breech babies – when the baby’s bottom, not their head, is positioned near the birth canal. A C-section is generally considered safer than vaginal delivery for breech babies.
However, some hospitals offer the option to try external cephalic version (ECV) – attempting to turn the baby’s head down a few weeks before delivery. ECV is successful about half the time, according to the American College of Obstetricians and Gynecologists. Talk with your doctor to see if ECV is a safe option for you.
Does the hospital allow vaginal delivery of twins?
If you are healthy and neither baby is breech, you might consider vaginal delivery. However, research shows that approximately 44% of planned vaginal twin deliveries result in a C-section.
Having both heads down occurs in just 40% of twin pregnancies. While some hospitals may allow delivery of one baby vaginally and one by C-section, most will recommend having both by cesarean.
As noted above, to do a C-section the hospital must offer 24/7 anesthesia. If you're expecting twins or more, plan to deliver at a hospital that is comfortable with your preferences but can also meet your babies' needs. You’ll also need to find a provider who is comfortable managing your birth preferences.
When you're choosing an Ob/Gyn, you'll need to think about some potentially upsetting situations. However, it's better to get the assurance beforehand that your provider and hospital are equipped to take care of you and your baby if something unexpected happens.
Discussing potential concerns before they happen makes for a smoother, less stressful experience for everyone. While you might have to compromise with a few of your "wants," asking the right questions will lead you to the provider and hospital that can help you achieve your goal: a happy, healthy mom and baby.