Selecting the right obstetrician

The difficult decision of choosing a doctor is all the harder when it means selecting an obstetrician, because this special kind of doctor must treat two patients simultaneously. But the sum is more than the mere addition of the parts, because there is a third entity, the pregnancy itself, which is that symbiotic relationship between mother and child. This third entity has it's own type of respiratory system, circulatory system, and nutritional exchange. For that brief time which is the duration of gestation there is a different anatomy altogether which is the combined mother/child. An obstetrician, to relate properly to an expectant mother (and father), must be able to relate to all three--the mother, the child, and the pregnancy relationship between the two. For there are diseases of just the mother, diseases of just the fetus, and very strange medical complications in the mother and fetus together.

A lot of this is book knowledge for sure, but there has to be another talent of insight, because the mother-to-be's thinking is altered as well. Ovarian, pituitary, thyroid, and adrenal hormones jive together with hopes and dreams to create woman as another thinking and emotional species altogether, a dynamic metabolism honed over the span of evolution to produce a miracle nine months later.

Taste isn't the only thing revamped. Emotional and behavioral aspects of her personality underscore a maternal instinct that comes from deep inside our primitive brains. So how does that affect the selection of the doctor who will mastermind the prenatal care?

Expecting The Best

That doctor better be perfect. At least in the expectant couple's eyes. Everyone realizes that perfection is an unattainable ideal. But different couples have different priorities as to what constitutes an "acceptable" level of perfection. Some want the hand-holding type who will do all the worrying for them, taking them through the prenatal course in a mystic cloud of vague pronouncements of well-being. Some want the opposite, a Carl Sagan who will explain the millions and millions of details, pointing out all of the risks and benefits of every option pregnancy has to entertain. Still others want a pal, somewhere in between the first two types, but with enough empathy to agonize with the parents over every decision. All of these types have successful practices because they attract adequate numbers of patients who seek them out because of their specific mindsets. But all obstetricians hope to blend the three types perfectly so that the care is knowledgeable, caring, and endearing.

But there is also another type of obstetrician. This is the one who has an agenda. This one is inflexible in his or her attitude about Lamaze or epidurals, participation by the father or breast-feeding by the mother, automatic episiotomies or refusal to do them. There is one way to do things and if a patient disagrees, she is propagandized until she leaves the practice. Luckily, this type is rare, because such a practice doesn't get a lot of business. People nowadays don't see the sense in the enforcement of arbitrary rules that won't affect the health of the mother or baby. And they're right, because there is no sense in arbitrary rules--especially in today's consumer market where people have a choice of hospitals.

Being an obstetrician and also the father of four children, I've had ample opportunity to consider all of the intricacies of what's important in an obstetrician-patient relationship. A lot of my training in this insight comes from patients switching to me for reasons I remember and fine-tune out of my practice:

I called my doctor for three days and he never returned my call. This is a frequent complaint that drives patients to seek another doctor. Either this doctor's too busy or the protocol on handling patient calls is too sloppy.

There are several doctors in the practice, and they all tell me different things. Having several doctors in a practice enhances their skills, because they all sharpen each other. But then again, ten different doctors will have eleven different opinions (you can quote me on that), so a patient must be willing to forgive minor variations on matters that are relatively inconsequential. However, if one doctor tells you it would be dangerous for a pregnancy to continue and another says it will be dangerous to deliver, there could be a problem here.

I asked my doctor about this and she just blew me off. Patients should give the doctor the benefit of the doubt. Never should a patient leave the office without all of her questions answered. Stop the doctor, who may have just misunderstood you, and tell him or her that you still have a question. I sometimes have a patient who might apologize to me for having too many questions, admitting guiltily that she may be taking too much of my time. The truth is that, yes, I am busy--but with her! Once I'm in the exam room or consultation room, she's the most important person in my practice, no matter how long it takes. And she should feel that way too.

Strangely enough, the medical world and patients' reasons for selecting doctors have changed in a very short time. I no longer see people switching doctors because they feel some are "knife-happy" or too greedy. They seem to switch for failures in the doctor-patient relationship; such a relationship should be professional, but always personable as well. This isn't taught in medical school. A lot of it is innate, but there is a lot learned about human nature in the first years of unsupervised private practice, too.

A pregnant woman wants the best for her unborn child, and she will usually know after a first visit whether a certain obstetrician's for her. Besides our board exams, we OB doctors must also pass the maternal instinct.