By Casey Newman
Whether you’re pregnant or thinking of becoming pregnant, choosing a maternity care provider is one of the most important decisions you can make. The right — or wrong — provider can have a large impact on your pregnancy, labor and birth and even your postpartum period.
Sure, an OB/GYN or midwife might have a pleasant, clean office, and staff may have good bedside manner, but beyond the superficial appearances and experiences, what should you consider when choosing a provider?
Asking these questions (and the answers you get) can help you choose the best provider for you.
What’s Your C-Section Rate?
In 2017, nearly a third of births in the United States were via c-section. But whether you have a c-section, however, has little to do with you or your baby’s medical needs and more to do with where and with whom you give birth. The majority of c-sections are unnecessary, often performed because a provider has grown impatient with the labor process, a woman has had a previous cesarean, or she has an often misdiagnosed “large” baby.
Ask your intended provider what his or her c-section rate is. They should know.
Red flag: They don’t know their rates. Similarly, it’s a red flag if they respond that their rate is consistent with the national average. (Remember, the national average isn’t good.)
So, what’s the answer you’re looking for? Your provider should know their rate and it should be, in total, under 25% with their primary rate under 15%.
“If a doctor tells you that he doesn’t know his Cesarean rate, you can assume that it’s bad. He may legitimately not know his numbers, but his lack of concern about perhaps the most important indicator of quality for his profession shows his lack of concern for his patients and his patients’ outcomes,” writes Dr. Howard Herrell.
If you’re seeing multiple providers within a practice or will have a laborist or attending OB at your labor and delivery, you’ll want to know the c-section rate of the entire group or hospital you’re considering.
What If My Baby is Not Head-Down at Term?
About 1 in 25 babies aren’t head-down at term. This is known as a breech presentation and is often a fast track to a c-section. However, there are ways a provider can help turn a breech baby before delivery (there are also some providers who will vaginally deliver a breech baby, but this is becoming rarer).
Ask your provider when they check to see if the baby is head-down. (Many don’t check until 36 or 37 weeks.) If your baby is not head down, a good provider should suggest an external cephalic version (ECV). ECV is evidence-based and works about two-thirds of the time.
Red flag: If your provider just recommends a c-section without attempting an ECV.
What’s Your Episiotomy Rate?
Like c-sections, rates for episiotomy vary widely from hospital to hospital and provider to provider. And, like c-section, episiotomies are rarely necessary and can cause complications like infection, pain, extended healing time and future issues with incontinence.
Red flag: If your provider notes that they usually perform episiotomies because they heal nicer than tears.
How do You Deliver Twins?
Having a twin pregnancy is often a fast track to the OR, however, both you and your babies do better if they’re born vaginally. A healthy twin pregnancy with the first baby head down should not mean an automatic c-section.
Red flag: If you’re pregnant with twins and your provider automatically puts you into a high-risk category and recommends a cesarean.
Other Things to Keep in Mind
Kindness/Pleasantness is not an indication of a good doctor: Your doctor can be kind or pleasant, but not practice evidence-based care. They can be kind and still disregard your wishes. They can be kind and still cause trauma. Kindness does not equal quality.
The use of ultrasound to predict baby size: Some providers may give you an ultrasound around 36 weeks to gauge the size and position of the baby, and depending on the results, schedule you for a c-section, but ultrasound is notoriously wrong in predicting baby size. (I was told I would have an 8 pound baby via 36 week ultrasound. She was 6 pounds.)
Their language: Does your provider use phrases like “I can’t let you…” or “You’re not allowed…” or do they use supportive phrases like, “We encourage you to…” or “We support you in…” Believe it or not, your provider’s choice of language is a big indicator of how you will be treated in labor and delivery — whether as an autonomous human or a child incapable of making their own decisions.
Whether they listen: Similar to their choice of language, a good provider will listen to you without interrupting. If you can’t get your questions answered or you’re spoken down to when you voice concerns, run.
Casey Newman is a mother of two from Green who depends on wine to get her through bathtime and bedtime. She is a maternal and women’s health advocate who volunteers with several birth and maternal rights organizations and has spoken to Congress members about issues affecting moms.