10 Things Your OB-GYN May Not Tell You

When you’re pregnant, your ob-gyn may be the most important person in your life. But how can you pick the best doctor for you and the baby? Read on for the 10 questions expectant women should ask, but rarely do. Plus, get the answers to three reader questions. Some of the most important issues that could affect your pregnancy are ones you may never ask about. Your doctor is the key to most of them. After all, you’re on a magical 40-week journey with someone responsible for your baby's safe arrival. Although you don't expect your ob-gyn to walk on water, you do want to choose one who has your best interests at heart. Beyond the basics – Is your doctor board-certified? Does she or he accept your medical insurance? – here are 10 questions to ask when choosing an obstetrician: 1. How many patients are scheduled for appointments during a routine day? This is a loaded question and the answer may affect your quality of care and the waiting time for appointments. The more patients scheduled per day, the less likely your doctor will have time to address all your prenatal needs. It’s a red flag if he or she has more than 30 patients scheduled in one day or the office staff is reluctant to discuss the schedule. A physician with too many patients suggests potential financial difficulties in the practice or an unusual emphasis on making money. 2. Is the practice dedicated to obstetrics or are other services offered? In a growing trend, doctors are adding services, such as "medical spas," weight-loss services, retail vitamins and even liposuction. This might enhance his or her bank account but not your prenatal care. The fewer distractions your doctor has, the more time he or she can devote to managing your pregnancy properly. 3. How many hospitals does the physician have admitting privileges to? When it comes to hospital privileges for an obstetrician, less is more. It’s physically impossible for one person to be in two or more places at the same time. Yet this is what will happen if your doctor has two patients in labor at different hospitals or if he or she is performing surgery at one hospital and a patient is admitted in labor at another. If your physician is in a group practice, ask whether he or she has a "second" call system. If so, a partner will step in if your primary ob-gyn becomes busy with multiple deliveries or surgical emergencies. 4. Will you be referred to a high-risk pregnancy specialist if you develop complications? Maternal fetal medicine specialists (MFMs) are obstetrician-gynecologists who have trained for three extra years to manage complicated pregnancies (high blood pressure, diabetes, etc.). They normally don’t deliver babies but instead advise physicians on how to manage complications. MFMs are valuable resources when you need a second opinion, and your obstetrician should be open to their suggestions. 5. Will your doctor be available to deliver your baby? Don't assume that your provider will always be on hand to deliver your baby – vacations, emergencies and unforeseen occurrences can get in the way. Ask about "Plan B" and meet any "docs on call" before your delivery. That way, you can check their credentials and decide if you’re comfortable with them. 6. Will your physician continue to see you if you lose your insurance while pregnant? This may be an awkward subject to discuss, but it pays to find out in advance about your doctor’s policies on insurance and payment. These days, the loss of a job – and insurance benefits – threatens us all. You don’t want to discover mid-term that your physician doesn’t accept government-assisted insurance, such as Medicaid. Having this discussion before selecting an ob-gyn will prevent you from being blindsided if you become unemployed. 7. Does your doctor’s admitting hospital have a level-3 nursery? A level-3 nursery or neonatal intensive care unit (NICU) provides specialized care for extremely premature or critically ill newborns. We expect the best for all pregnancies, but emergencies can occur that require life-saving treatment for your baby. Nothing’s more comforting than being at the same hospital where your baby is treated and knowing that you won’t need an airlift to an unfamiliar facility for more than $20,000. 8. Does the hospital have 24-hour admitting obstetric coverage? When you’re in labor and admitted to a hospital, your doctor may not arrive immediately to give the nurses instructions about your hospital care. Teaching hospitals usually have physicians-in-training who will manage your care until the doctor arrives. Some hospitals now offer the services of a hospitalist. These are doctors hired by hospitals to manage patients. They can also admit patients who don’t have physicians. Hospitalists usually have the same credentials as your doctor, but you can’t always be certain of their skill or professional training. When more than one person is responsible for your care, understanding the lines and methods of communication is extremely important. Here are a few questions to ask: Is your doctor or the hospitalist responsible for admitting you if you go into labor? If the hospitalist is responsible, when will he or she advise your doctor that you've been admitted? If you have false labor and are discharged home, will the hospital staff inform your physician? 9. If you choose a family practice physician or certified midwife to deliver your baby, when will they inform the ob-gyn if a suspicious fetal tracing (a check of the baby’s heart rate) appears? Ideally, they should communicate with the obstetrician at the earliest sign of trouble. The fetal monitor, if interpreted properly, can be a good indicator of the baby’s health. An obstetrician should be notified before major problems develop. 10. If you need to be induced, will your doctor be able to secure a hospital bed? The "squeaky wheel gets the grease" holds true even in a hospital. Your doctor must not only be an excellent clinician but also your greatest advocate. Often hospitals are short-staffed, beds are at a premium and physicians are discouraged from admitting patients for labor inductions. But if you have a high-risk condition, such as diabetes or high blood pressure, sending you home would be a bad idea, even if your baby appears to be normal at the moment. A high-risk condition always requires special attention and you may need to deliver your baby early, at 38 or 39 weeks. You want a physician who has the power or influence to make the hospital say yes – even when they want to say no. Congratulations on your journey toward a healthy pregnancy and delivery. By asking the right questions, you’ll find the right ob-gyn for you and your baby. Ask the Doctor Have more questions about your pregnancy? Dr. Burke-Galloway is here to help. Read on for a sneak peak of her responses to reader questions about infertility, chicken pox and more. Dear Dr. Burke-Galloway, My daughter has been trying to conceive and has had three intrauterine inseminations, but still no luck. Could this be from her thyroid condition? She is seeing a fertility specialist who says that shouldn’t be a problem. What would you recommend? - Donna B. Dear Donna, Although the cause of 15% of all infertility problems is unknown, it’s always easier to treat a problem if we know why it occurs. Hypothyroidism can produce menstrual irregularities, which suggests no ovulation. A reproductive endocrinologist (a fertility specialist) is usually familiar with the management of thyroid conditions. Has your daughter had tests to determine whether she’s ovulating? Has her husband been tested for a low sperm count? Are they receiving intrauterine inseminations because of a male infertility problem and, if so, what is the underlying cause? The answers to these questions might determine possible issues. I think your daughter has taken the proper step by seeing an infertility specialist. But because the topic of infertility is so vast, without more information about the reason for the use of intrauterine insemination, it is difficult to offer further advice. Have a question for Dr. Burke-Galloway yourself? Email her here . Be sure to include your first name and last initial. Plus, meet Dr. Burke-Galloway . Dear Dr. Burke-Galloway, What happens if a pregnant woman is exposed to chicken pox if she hasn’t had it before? Or, if the mother had chicken pox in childhood, what happens if she is exposed to it again? - Shelby M. Dear Shelby, The most common complication of chicken pox or varicella-zoster virus in pregnant women is pneumonia. If a pregnant woman is exposed to chicken pox but hasn’t had it before, she should contact her obstetrician or family physician immediately. The vaccine for the varicella-zoster virus isn’t recommended during pregnancy. But the patient should be closely monitored for signs and symptoms of pneumonia, then treated with an antiviral called acyclovir if necessary. If a mother had the chickenpox in childhood, she’ll probably have antibodies that could protect her against the infection. The chances of her contracting the disease again are very small. Have a question for Dr. Burke-Galloway yourself? Email her here. Be sure to include your first name and last initial. Plus, meet Dr. Burke-Galloway. Dear Dr. Burke-Galloway, I had a liver transplant back in 1998. What, if anything, needs to be done for me to have a baby? - Suzanne H. Dear Suzanne, First, let me congratulate you on a successful liver transplant. Although I’m not certain why you had a liver transplant, 90% of them are done because of hepatitis. The recommendation is for a patient with a liver transplant to wait at least two years before attempting to conceive. You’re well beyond that. You should obtain pre-conceptual counseling from a Maternal Fetal Medicine specialist (a high-risk obstetrician) to discuss special needs or requirements before you attempt to conceive. Good luck. Have a question for Dr. Burke-Galloway yourself? Email her here. Be sure to include your first name and last initial. Plus, meet Dr. Burke-Galloway, and get your own copy of The Smart Mother's Guide to a Better Pregnancy. Are You Ready for Your New Baby? Your belly is bulging and your due date is fast approaching. Your bag is packed, the baby’s room is done, and you have a name picked out. But are you really ready for your new baby?