Choosing Your OB or Midwife

Female Doctor

Choosing the doctor or midwife who will provide your obstetrics care is an important decision that can impact your birth experience to a greater extent than many women realize.  About two-thirds of expecting mothers decide to receive their OB care from a different physician or midwife than the one they were seeing for well-woman and gynecology visits.   Some of these women just don’t “click” with their existing OB or midwife.   Others find when they begin to talk about the birth process with their existing OB/Gyn that he or she has different practices or philosophies related to birth than the ones they have. Also keep in mind that many midwives practice in the hospital, so you can often choose a midwife even if you want to deliver in the hospital setting.

Whether you are inclined to continue your care with your existing physician or not, it’s important to think through the decision and how your choice aligns with your hopes and philosophy around your own birth experience.  It’s often worthwhile to put in the time to research and “interview” a few doctors or midwives before you choose one.   Here are three questions to ask when interviewing a doctor or midwife for the job of caring for you during your pregnancy and birth:

Does his/her philosophy about birth align with yours?  If you are at the beginning of pregnancy, you may not have a strong sense yet of the kind of birth you want.  But you probably have some ideas about the ways in which you like to manage your health based on other experiences in your life.  Ask yourself some of the following questions:  Do you tend to prefer to defer decisions to your doctors or do you like to do research on your own? Do you incorporate natural approaches to managing your health, such as watching your diet, exercising, or using alternative health such as acupuncture?   You can ask each doctor or midwife about their approach in these broad areas.  For example, how strict are their protocols – do they allow flexibility in them based on your preferences or are they rigid?   Do they use medical interventions as a first resort during pregnancy and birth or do they tend to recommend and/or exhaust natural methods first?

What is his/her Cesarean rate?  C-sections are a medical miracle and save the lives of millions of babies each year.   But according to the World Health Organization, about half of the C-sections in the U.S. are unnecessary and should not be performed because they introduce additional risks that come with any major surgery.   The World Health Organization recommends a C-section rate of between 10-15%.  The average U.S. obstetrician has a rate of about 30%.  Finding a doctor or midwife with a rate closer to the recommended level can mean the difference between a natural vaginal birth and a C-section.

What is his/her epidural rate?  If you are thinking of trying an unmediated birth, it’s a good idea to ask the doctor or midwife what his/her rates of epidurals are.  If the epidural rate is high (such as 70-90%), there may be concern that the provider is either not very supportive of natural birth or does not have a lot of experience supporting women in natural pain management.

 

 

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