Picking Your Pregnancy Healthcare Provider — PCP 058

What should you consider when picking an OB or midwife for your pregnancy. What are all the factors that might be problematic as you head towards your delivery?

Picking Your OB:

This episode was inspired by: Picking a Provider

Big thanks to our sponsor The Online Prenatal Class for Couples. This class starts in the third trimester and has ton of information to get you prepared for your delivery. Be sure to use the code mentioned in the episode!

Items Mentioned about picking an OB:

Find a doctor that matches you

My free birth plan printable

Questions to ask / things to consider

• Your Insurance
• What hospital you hope to deliver at
• Who will deliver you (who’s on for them at night)
• Who will answer your phone call after office hours
• Who will answer or deliver you on weekends?
• Who will see them in the office (and what are their credentials)
• Discuss any high risk issues you have
• Any special concerns you have about delivery (IV’s, home delivery and more)
• How easy it is to get appointments, and how likely they are to get delayed/moved
• Office staff customer service

Saying no in labor episode

What to ask your doctor at your first appointment

When you likely are “stuck” with a particular provider

Other things about picking a pregnancy provider that might interest you:

5 Tips for a C-section

What to consider before a VBAC.

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Producer: Drew Erickson

Check out my other pregnancy podcasts:

Check out all my podcasts:

Hilary Erickson 0:00
Hey guys, welcome back to the pulling curls podcast! today on episode 58. We are going to talk about picking your provider for your pregnancy. We’re going to talk about what are some questions you can ask when are you locked in to that doctor? And also probably some things you haven’t thought about that we only think about because we’re nurses and we see all the things so let’s untangle it.

Welcome to the polling curls podcast. I’m Hilary, your curly headed host on the podcast where we untangle everything from pregnancy, parenting and home routines. I want you to know that there are no right answers for every family and I find that simplifying my priorities is almost always the answer. It’s tangled just like my hair.

Okay, guys, before we get started, I wanted to remind you that I have a free birth plan that you guys can download. You can check it out. In the shownotes, and it might give you a few ideas to talk to your ob about at your next visit, so totally free. Check it out in the show notes.

This episode of The pulling curls podcast is sponsored by the online prenatal class for couples. It simplifies understanding labor so you can have a more relaxed pregnancy and birth taught by a highly experienced labor and delivery nurse and can be done wherever you are whenever you want. No more arranging busy schedules to fit in a prenatal class. Save 15% with a coupon code untangled You can find out more at pulling curls calm and the menu under courses or in this episode show notes.

Okay, guys, picking an OB is hard, right? I have so many friends who find that they thought it would be easy and then it’s more difficult than they thought. And I actually have a friend who’s about 32 weeks right now who’s really not happy with her practice, but she’s kind of changed at this point. So she has some other limiting factors. So and we all do so the number one is to check your insurance now insurances have just gotten real crazy.

I know that The insurance that they provide at work, which I’m not actually on very confusing, it only allows for a few physicians and most of our OBS are actually not on our insurance at the hospital. So all these nurses who’ve been to these OBS for so long can’t go to them anymore. So check your insurance, you’re gonna want to start with that list because you can end up paying thousands and thousands more for just a doctor that you somewhat prefer more and honestly guys, I do not think that that is worth it. So check your insurance.

And then I would definitely ask around ask on Facebook who people have gone to the problem is, is you’re probably early in pregnancy. So you don’t want to make like a big announcement. But if you’re considering pregnancy, I think it’s great to make an announcement on Facebook before you’re even pregnant. That way you can kind of have somebody picked out ahead of time.

Second thing is you’ll want to consider what hospital you plan to deliver at and then you’ll want to find out if your doctor that you’re looking at delivers at that hospital. This is mostly in like larger metro areas like I live in the Phoenix area and our physicians usually have privileges at one to two hospitals and so if you’re planning on delivering at a certain time Do you want to make sure that the doctors have privileges there?

So privileges are just like their rights to practice at a hospital and each hospital makes doctors go through a lengthy process in order to practice at the hospital. It’s kind of weird, but it’s not just like a restaurant where you can show up an order whatever you want from whatever doctor you want, the doctor has to have privileges at that hospital. So something to keep in mind if you have a particular hospital that you want to deliver. Most people pick their doctor and then just go to the one of the hospitals that they deliver.

As a side note, just because your doctor doesn’t have privileges like at a hospital that you’re preferring doesn’t mean that they’re a bad doctor. It really is a lengthy process. Plus, they then have to do rounds at all of those different hospitals. So most doctors, the limit I’ve really seen is three and that is really stretching them thin. So just something to keep in mind. Okay, so once we have those two narrowed down, you’re gonna want to ask kind of some more technical questions.

So who answers the phone when they’re not in the office? Do they have an answering service? Do they answer calls? 24 hours a day, most OBS have some dogs slash nurse and usually the nurse is the gateway to the doctor that you can talk to 24 hours a day. That doesn’t mean that they’re going to call you right back but you should be able to get in touch with one of them you know any time of day because obviously you’re pregnant 24 hours a day if you have a problem, you should really be able to get in touch with you.

Also you’ll want to know if there’s like 40 doctors in the group that answer those phone calls because if it’s some faceless name, then service just might not be what you’re hoping for. And then the same thing is who takes their calls on the weekends. You can’t expect your ob to be on every weekend. That’s just not how healthcare is happening anymore.

I know back in the day these OBS were on 24 seven 365 days a year maybe they take a week off for vacation but OBS just aren’t practicing like that and think about your own life would you really want to be on would you want your husband on 24 hours a day seven days a week or your wife You know what I’m saying? So they really just are not on like they used to be but how often are they taking weekend call?

How often are on a phone call at night? How big of a practice are they splitting things with now even if your doctor is alone in their practice, they most likely They split their call time with different practices, we do have one or two do most of their own deliveries, which is awesome. But most practices I’m seeing really go to a different model. That all being said, You will be surprised at how little you actually see your doctor while you’re in the hospital.

You mostly see nurses like me, we call them at the very end, sometimes they’ll come and break your water but really you don’t see your ob that much in the hospital. So if you love their office staff and you love the care that you’re getting at each prenatal appointment, and probably what care you’ll get after the baby then that is probably more important than if they’ll deliver your baby at the hospital. FYI, one other thing is sometimes you’d see the OB at your first appointment and then after that you’re going to see either a nurse practitioner or physician’s assistant. Now I have some bias against physician’s assistants in labor and delivery.

They are not actually allowed to deliver babies most of them have never delivered a baby they’ve never been in labor and delivery. So they really sometimes when they call me I’m like I just shake my head. They just don’t know all that much about delivering babies so nurse practitioners generally do because all nurses have a labor and delivery rotation.

During nursing school so nurse practitioners cannot deliver a baby physician’s assistants cannot deliver baby as far as I know maybe there’s some states that they can but certified nurse midwives can deliver a baby in the hospital doctors OBS can deliver babies in the hospital as well. Oh and family practice can deliver babies in the hospital as well but just ask them how often you’re going to see an OB how often you’ll see a PA or an NP and honestly, there’s great ones of pas and NPS as well.

Just you know, if you’re constantly seeing a new face every time you go into the office, that can be frustrating for a lot of people something to keep in mind. Okay, if you have any high risk issues if you’ve had any problems with previous pregnancies including VBAC, you’re going to want to bring that up very early in your office visits, see how they’re going to do it. Some practices still really don’t be back. Most people even though a cog really recommends it.

That is their choice. Just like you can make choices they can make choices. So you want to find those things out early on in pregnancy don’t so definitely ask the questions that you have. If you have any like endometriosis, or fibroids or stuff like that, bring that up early on so you can see how they’ll deal with it and also just how they educate you and if you feel comfortable with how they’re doing that you guys might want to check out my episode called saying no, it’s with my friend Mandy, we talk all about how to say no and labor and how doctors should be talking with you. And they should be talking you in a very educating mode during all of your pregnancy.

So something to keep in mind. Also, if you have any other special concerns, like you definitely do not want an IV, you 100% want to be back. If you’re planning to use a doula or go natural, or if you’re planning a home birth, and you’re just seeing them on the download. You want to be honest with them throughout your pregnancy, you want to be honest with what you’re hoping to expect at delivery so that neither of you is caught off guard. I know I have a lot of patients who come in and they’re like, they want to refuse the IV and I’m like, that’s great. Have you talked with your doctor about this? And they’re like, no, why would I do that?

and I’m like, well, because they’re the one that ordered it, I don’t order anything and then the OB gets very frustrated that they haven’t talked about it the whole time and the patient wants to be induced but they don’t want an IV it’s all just you know, you just want to be educated but you also really need to give the doctor the facts from your site as well. Okay, so when you have your first appointment, I was asking the OBS at work if they do like interview appointments and…

They all were kind of like no they really just don’t have time because those would be considered unpaid appointments so they really just don’t have time to spend like a half an hour with you totally dressed at that appointment the your first appointment should be that type of interview now I have been to some ob offices where the first appointment is really just weighing you getting your urine doing a blood draw checking out your insurance, you don’t even see the OB so that is frustrating I’m sure because then you can’t really make those choices but those labs are going to be done with any physician you know, at any practice and you can always take those to your next practice with you I would go ahead and make an appointment at whatever physician seems to be the best give that a try.

You know, take those first few appointments honestly, up till at least 25 weeks you have a vast ability to be able to change your provider once you hit 25 weeks and especially as you head into 30 weeks other providers are going to be very hesitant to take you they are taking on the risk of your pregnancy and if you did or did not get good prenatal care before that. Now that being said if you were like moving and your ob you know if you have a reason of why you Have to go to a new ob they’re much more open to that versus someone who just wants to change at 30 weeks.

I don’t know if that’s because they’re concerned, they’re not going to get paid as well. I don’t know what it is. But that’s something to keep in mind that really once you hit 30 weeks, you’re kind of locked into that ob unless you have extenuating circumstances like moving, etc. Now, while you are at those appointments, ask them lots of questions you can ask them their frequency of C sections, I asked the doctors if they knew what their c section frequency is, and they were like, I don’t know, which is interesting because our hospital does know I’ve seen the statistics of who does the most c sections and they I’ve also seen their PCI dummy rates so those are not 100% accurate because sometimes they’re not charted right because it’s just taken from our charting but they didn’t know their actual rates.

However, when you’re discussing stuff like this, you’re wanting to make sure that they’re not like condescending and rude while you’re asking those types of things. They might say I don’t know the actual rate but I’m really hesitant to do an A PCR to me unless I find that the baby’s life is in danger. I probably only do XYZ number of PCR dummies a year you know, I only do five And that will give you an idea that

yes, and in fact a PC armies are sometimes necessary and important. So you want a doctor that skilled enough to do them in the right cases, not just oh, I never do a PC enemies, that would be a danger sign because sometimes they really aren’t necessary. I never do see sections also a danger sign because they are necessary sometimes. So if you mostly want to look at their teaching attitude as you’re talking about questions like this, so those are my suggestions.

Other things you want to consider is how easy it is to get an appointment. You know how frequently your appointments are pushed back, stuff like that. Now if you have an OB that’s just kind of delivering on their own, you’re going to be aware that their appointments get pushed back somewhat frequently, depending on how their office is scheduled because they will randomly get called in for delivery during the day of course your appointment is going to get moved around.

If you’re at a larger practice where you see more providers, especially nurse practitioners and physician’s assistants who are not going out to deliver frequently then your your appointments are going to be more on time and that might be important to you if you’re busy and you’ve got work and stuff like that and having appointments moved around can be really problematic, you’re probably gonna want to look at a practice that that physician is just in the office that day even with doctors, sometimes they’re just in the office or they’re just on call but some providers are doing both, you know, on their own.

So that’s just something to think about. Every person is going to have to decide what’s important for them. You know, if you’re a stay at home mom and it’s easy for you to move appointments around then that wouldn’t be as big of a concern as well. One other thing to think about is how nice the office staff is.

I know a lot of people just dread their appointments and if you’re feeling that way because the office staff is rude and condescending, first I will talk with your physician about it if you feel like they are just out of touch you know the office app is just super rude I would definitely talk with a doctor about it but also if you hate it, then stop going to them pick a different one just be keep in mind you are not locked into a doctor once you pick them.

However, there may be some insurance things that you have to deal with. You might have to pay for that first appointment separately. If you switched positions, you could definitely call your insurance to find out how that works. But don’t feel like if you don’t like your doctor that you just have to stick it out with them because you’re going to end up you know, possibly delivery with That person making life or death decisions for you and you really want to be able to trust them. So those are my tips for picking an OB.

If you guys have other tips for picking an OB or things that did or did not work for you, I would love to hear it in the comments in the show notes. Be sure and check it out. This is Episode 58.

You can find it pullingcurls.com\podcasts and I would love to hear what you guys think so definitely pick a provider that aligns with you, you really can make a difference. Thanks so much for joining us today. I hope we help smooth out a few of the snarls in your life. We dropped an episode every Monday and we always appreciate it when you guys share and review. Until next time, we hope you have a tangle free day!