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What an exciting time for you and your family! Your anticipation probably began even before you had a positive pregnancy test. You will be making a number of decisions at this time, in- cluding where to have your baby for the safest, best birth experience possible. When reviewing your obstetric care op-
tions, you will want to consider the type and philosophy of the practice and the hospital services, how high-risk pregnancies would be handled should you need that level of care, and the kind of lactation and postpartum support available to you.
Type of Practice
The obstetric practice can include a solo- physician practice, a group-physician practice and a collaborative practice with midwives. The days of the solo obstetrician delivering all of the babies have become limited for many reasons, including safety (too many competing demands) and fatigue. As a result, most physi- cians have some kind of coverage arrange- ments. You should feel comfortable inquiring about them, along with the handoff of patient information and concerns. In addition, you may want to ask if the practice has a physician in the hospital at all times to cover the laboring patients. In smaller practices or rural settings, this may not be a reasonable expec- tation. Some patients choose mid- wifery care and may never meet a physician. If you are interested in having a midwife, you should ask about coverage and how emergencies are handled.
Hospital Setting Sometimes patients base their decision about delivery on the type of hospital. You may want
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to consider the distance from home or work, patient accommodations, family friendliness — even food service and the décor. It is recommended that you scratch beyond the surface and inquire about other issues as well. What to investigate: additional obstetric support services. • Is there an anesthesiologist in the hospital at all times, or does one need to drive to the hospital if a laboring patient requests an epidural, or if a patient has an emergency? • If your baby were to have unexpected prob- lems at birth, what are the arrangements with the pediatricians? • Can the hospital handle high-risk situations, or would you and/or your baby need to be transferred to another hospital if a complica- tion arose? If a transfer were necessary, where would you go? • What types of support are available to you after delivery regarding breastfeeding and post- partum education? It is important to become educated about
the birthing process. Take advantage of the many ways to get information, including word of mouth, pregnancy/parenting websites and childbirth education classes. Remember that most deliveries are low risk and can occur in just about any hospital setting. However, when the situation deviates from what is expected, you need to know about the care you and your baby will receive, based on the decisions made while choos- ing an obstetric provider and a hospital for maternity care.
Susan Mann, MD, was a practicing physician at Harvard Vanguard Medical Associates for 25 years until transitioning to her own practice. She has participated in the delivery of more than 4,000 babies.
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