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Things to Consider When Choosing a Healthcare Provider
Joel Bernstien, MD posted:
Decisions, decisions, decisions...Who's going to deliver your baby? Where are you going to deliver? Which hospital? Do you want to be at a hospital at all?

You may not be pregnant yet. But these are all important questions to consider as you determine which health care provider to partner with for your pregnancy journey.

Many women have already established care with an OB/GYN for annual exams and other gynecology visits. So you may be settled on choosing from within that practice or group. But it's important to examine the major factors involved in picking an obstetrical health care provider.

What Is The Make-up of The Practice?
I can think of several different practice models and there are certainly advantages and disadvantages to all of them. The traditional OB/GYN group practice will be made up of more than one doctor -- and sometimes midwives -- who share in a call-pool for deliveries. That means that there's a chance you will not be delivered by your regular doctor, but by someone else in the group. In many traditional group practices, like the one I am in, doctors encourage the patients to see all the providers during their prenatal care. That way, when it is time for delivery, you won't be forced into an uncomfortable situation of meeting the provider for the first time.

There are also solo practices, where one doctor is available for all his or her patients' deliveries. Nonetheless, some solo practitioners are in a shared call-pool with other solo or small group practices. Thus, you may get a delivery provider that you have not met before.

A newer practice model is one in which the providers in the practice no longer do the deliveries themselves; but rather, they depend on a group of doctors who work at the hospital exclusively. These delivery doctors are called hospitalists or laborists.

Some practices are run by family medicine doctors. These are usually in more rural areas, but not always. Family medicine doctors that do obstetrics are usually very well trained and often do extra OB training during or after their residencies. These doctors will take care of you and then the baby after it is born.

Lastly, nurse midwifery practices are becoming very popular. A certified nurse midwife is a licensed nurse who has undergone special training to care for obstetrical patients. They usually care only for the low risk pregnancies and may refer you to an obstetrician if necessary. Some midwives deliver in a hospital and work alongside obstetricians. An advantage of this system is that you can get the experience of a low intervention process with the security of an obstetrician and/or a pediatrician nearby if they are needed. Some midwives deliver at a birthing center separate from a hospital, or offer homebirths.

Where Should You Go to Deliver Your Baby?
As I mentioned, you can deliver at a hospital, a birthing center, or at home. I am very biased in my opinion of delivering at a hospital. But many of my patients are not low risk. The reported advantages of a non-hospital delivery are lower intervention and decreased cesarean rates. The disadvantage would be that if an emergency occurred with your care or the care of your newborn baby, the necessary resources may not be immediately available.

Most women choose to deliver at a hospital. If you have an OB/GYN doctor you trust and like already, I would encourage you to continue your care with him or her. Your doctor will already have a designated hospital for delivering your baby. If you do not have a practice picked out and want to select a hospital first, then find a provider that delivers there and look into what kind of care is available at that hospital, including:
- Anesthesia: Is there an anesthesiologist in house that can provide care for emergencies or put in an epidural in if you desire?
- Pediatrics: At what gestational age can your hospital deliver? Many hospitals have a restriction on their ability to care for babies born preterm. If you were to be at risk of a preterm delivery, you would be transferred to another hospital with new doctors for your care.
- Emergency services: Very rarely pregnancy and delivery can lead to emergency and life threatening situations. Many hospitals have the intensive care units, doctors, operating rooms and blood banks available for the most serious of situations.

Lastly is the location of your hospital or delivery location. I doubt you want to drive 2 hours in active labor to get to a hospital if there is an equally good hospital closer by.

Be sure you're comfortable with the provider(s) and the location of your delivery. If you want a good jump start in your search, ask your friends who have had babies for a referral. They may have a great practice or hospital nearby that you can consider using for yourself.

What other qualities do you feel are important in selecting a health care provider for your upcoming pregnancy? If you've already decided or have started researching, what are some helpful tips you can give the community for making these decisions?
s2bmama responded:
have a question will a tampon put in right after sex an my knees to my chest hurt my hance of conceiving?
3country love3
Heather922 responded:
Thank you for the information! This answers a couple questions I've had about choosing an ob/gyn as I don't one at this point.
Joel Bernstien, MD replied to s2bmama's response:
I'm not quite sure about that particular circumstance. I don't think it will help however. No medical evidence exists that I know of to substantiate any post-coital rituals. Sperm can be found in the cervix and uterus within seconds of ejaculation.

Hope this helps!

-- Dr. B

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