should you switch obs?

Feeling anxious or ignored? It may be time to dump your doc. Plus, how to improve your relationship if you can'’t.

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When she was seven months pregnant with her second child, Trish Jorquiera moved to a different state. Forced to quickly choose a new obstetrician, she found the receptionists hostile, the waits unreasonable and the doctor barely civil. “I tried to imagine I was in the delivery room and that doctor walked in,” Jorquiera says. “I wouldn’t have felt I was in the right hands.” When she tried to switch to a different OB, however, the new doctor initially refused to take her as a patient because she was so far along. Luckily, he relented after Jorquiera explained her concerns about her physician, discussed her problem-free first delivery and offered to fax her medical records for his review. “Feeling comfortable with your care provider eliminates some of the anxiety associated with pregnancy and becoming a parent,” says Jill Powell, M.D., an assistant professor of obstetrics, gynecology and women’s health at Saint Louis University School of Medicine. But you don’t want to rush into a decision to switch either, and perhaps end up unhappier than before.

Put your doctor to the test Consider these factors when deciding whether to stick with the physician you’ve got or jump ship. Trust and confidence. Bedside manner counts. But if push comes to shove, you want someone who is competent, not just warm and fuzzy, says Anne E. Garrett, founder of The Preeclampsia Foundation in Bellevue, Wash. “I had a doctor who was outright rude, but she saved my life—and perhaps my baby’s—when I started showing signs of preeclampsia [a dangerous high-blood-pressure condition]. The goal is a healthy baby and a healthy mom,” Garrett adds. “Everything else is a perk.” Bottom line: Follow your instincts. Red flags Your doctor fails to order routine tests, shows irritation if you ask for a second opinion, or seems unaware of new research or advances you’ve learned about. (To check a doctor’s disciplinary record, see “Find It on the Web,” below.) Communication. Dwindling appointment times leave little opportunity for chitchat. Still, a good obstetrician will listen to all your concerns without rushing you out the door. “It’s important that you get their undivided attention while they’re with you,” Powell says. The stakes can be high if you don’t have the chance to discuss your symptoms or health history. Red flags Your doctor dismisses or ignores your questions and concerns; you don’t feel comfortable discussing your medical history or lifestyle because you feel “judged.”

Flexibility. If, while pregnant, you begin to feel that a hospital birth is too clinical for you, discuss your ideal delivery—including pain management and alternative laboring positions—with your obstetrician before switching to a midwife or birthing center. “Just because physicians have to be cautious about medical issues doesn’t mean they can’t strive to meet a patient’s expectations,” says Stephanie L. Nicholas, M.D., clinical associate professor at Magee-Womens Hospital of University of Pittsburgh Medical Center. Red flags Your doctor discourages natural childbirth techniques, like walking during labor or epidural-free deliveries, won’t even discuss using a doula, or changes the subject when you mention your birth plan. Or, the hospital where your doctor delivers doesn’t offer options you want, such as allowing the baby to room in with you.

Sticking with your OB Whether you love or hate your obstetrician, the following strategies can help improve your relationship. Come prepared. Bring a list of questions, but don’t pull it out at the end of the appointment. “Go in and make it clear right away that you have questions,” Garrett says. “The doctor will tend to take them more seriously.” Still concerned afterward? Ask to follow up by e-mail or to speak with a nurse. Describe your ideal delivery. “Discussing expectations is one of the keys to a good relationship with your care provider,” Powell says. Ideally, you should talk about each part of your birth plan. To learn your doctor’s expectations, ask her to describe a typical labor and delivery. Share your concerns. Are long waits, cancellations, unreturned calls or rude office staff driving you crazy? Your doctor may be unaware of such problems, Powell says, so speak up. Don’t allow yourself to be intimidated or ignored by staff members. Provide as much information as possible. “Don’t say, ‘My stomach hurts,’” Garrett advises. Instead, point to the painful area and use descriptive words such as “throbbing” or “shooting.” Do your homework. A lot of first-time moms don’t read the “bad news” parts of the pregnancy books, Garrett says. “Knowing about bad things doesn’t make them happen. But it might save your life or that of your baby.” If your reconciliation attempts fail and you do decide to change OBs, try to do it sooner rather than later; some physicians won’t take patients late in their pregnancies, and it might take you longer than you expect to find a doctor you like (see “Where Have All the OBs Gone?” below). Plus, why delay achieving peace of mind? Once Trish Jorquiera saw her new doctor, the difference was immediate. “It was like night and day,” she says. Unlike her previous doctor, the new one listened to her medical history and addressed her concerns point by point. “I felt I had an ally,” Jorquiera says.

Where have all the OBs gone? Even if you’d like to ditch your doc, it may be hard to find a new one, so do your research first. The following 2004 figures from the American College of Obstetricians and Gynecologists (ACOG) are some points to ponder: >> Because of rising malpractice claims and medical liability insurance rates, several states are in danger of having too few physicians available to deliver babies. They are Florida, Georgia, Mississippi, Nevada, New Jersey, New York, Ohio, Oregon, Pennsylvania, Texas, Virginia, Washington, West Virginia and Wyoming, as well as the District of Columbia. Plus, a crisis is brewing in Alabama, Arizona, Connecticut, Illinois, Kentucky, Maryland, Missouri and Utah. >> One in seven ACOG Fellows no longer practices obstetrics because of the risk of liability claims. >> The number of medical students entering the OB-GYN specialty in the United States has declined for the third year in a row.

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