So you have decided you want to go with a private obstetrician (click here to look at my blog on all your options for where to have your baby). Just with everything, there are good obstetricians and not-so-good obstetricians, so how can you tell which one will support you best? If you have decided you want to go through the private hospital system then the next step is to figure out which obstetrician to go with. You can always head to Google reviews, but this method doesn’t necessarily find the right OB for you. Every woman has different needs, wants and will have a different experience. To help you figure it out, it might help to book an initial meeting with a couple and ask them these questions!
1. What are your beliefs and philosophies around birth?
This question to get a really good idea straight out on what your obstetrician is thinking, feeling and valuing in a birth. You can see if there is anything they say that sits comfortably or immediately jumps out as a concern to you. This is a very broad question to open up the conversation and if they aren’t used to being asked it, they may find it difficult to answer. Some may try to answer what they think you want to hear (so we need to check by asking more questions) and others will give you an honest answer straight out. From their answer you should be able to tell how much control and input they believe they should have in the process.
2. Is there anything you won’t let me do? Any procedures that must be followed when I am in labour?
This question will tell you any hospital policies that you will be expected to follow. According to Australian Law, you are allowed to deny consent for all procedures, however if they have a policy in place you will not be able to negotiate. There are no policies stating that a pregnant or labouring woman must do something. If your obstetrician is stating that they have a policy, then they may be referring to a guideline in place. A policy will have legal documentation along with it. A clinical guideline may be in place. These are based on research and opinion and a woman is able to decline following these guidelines if she wishes.
3. What do you recommend for pain relief in labour?
A great way of seeing if they have belief that a women is able to labour and birth without pain relief. If they value low intervention, natural birthing (which they may have indicated in question one) then this question should reflect that with suggestions about birth positions and relaxation techniques. If they jump to tell you about epidurals, have a think about if this is what you would like in labour as they are likely to offer it to you then too.
4. What is your caesarean rate and what would be your indicators to have one?
The national caesarean rate is up around 30% (click here for AIHW stats). It is important to note that this number includes planned and emergency caesareans. There is a higher rate of caesareans in private hospitals. If your obstetrician’s caesarean rate is much higher than the national average, it may indicate that they prefer to intervene in this way. Checking what they consider an indicator for a caesarean will show you how much control they want over the birth process. Breech babies, large babies and over-term babies do not have to be born by caesarean, though this is an option.
5. What is your episiotomy rate and what would you say is an indication to have one?
Obstetricians may feel that they need to perform an episiotomy to reduce the risk of perineal tearing. Unfortunately, this actually increases the risk of further tearing. Another common reason for an episiotomy is to allow for an instrumental birth (e.g. the use of forceps). A talented obstetrician will be able to perform an instrumental birth without the need for an episiotomy. Therefore if an instrumental birth is given as an indication, it may be worth considering if there is an obstetrician who feels they don’t need to.
6. Are there any factors about my history or pregnancy so far that you think could impact the birth?
They may not have all the information they need to answer this question, but if that’s the case they should say so! You might be able to get a sense of what your obstetrician is like in regards to their “fear” around birth. Do they seem relaxed when you ask? Or do they list everything that could possibly go wrong? You may have some indicators that do make you higher risk of some complications, but note how they react to these things and what their initial comments are. If they are already trying to plan your caesarean or your induction at 18 weeks and this is not what you want, then consider someone who is willing to monitor the situation and problem solve with you along the way.
7. What happens if you’re not available for my birth? Are you planning any holidays around my due date?
Everyone needs to take a holiday and even though they are unlikely to take on women who is due to give birth whilst they are away, babies decide to be birthed when they are ready and can’t always be planned around. Who will step in if they aren’t there? Do you get a choice who the second in-lie is? If they are planning a holiday in the week or two after your due date, will it be suggested you be induced early? How do the fees work if they aren’t available?
8. What post-natal care do you provide? Do you or midwives visit me at home or just in hospital?
Most private hospitals allow 3 days for a vaginal birth and 5-7 days for a caesarean. It is worth checking if there is the option to have your immediate post-natal care delivered at home. What if you decide that you really want to go home on day 2? Do you forgo this care or can alternative arrangements be made? What if something doesn’t feel quite right at day 8? Can you call on your obstetrician or a midwife on their team for assistance?
9. What scans and tests will you require me to have throughout my pregnancy?
Some scans and tests come with risk. For example, having an amniocentesis may be recommended for advanced maternal age or a family history of genetic conditions, but it has a 1 in 100-200 chance of miscarriage. It is good to discuss the expectation that you will have certain tests. You are always allowed to decline, but it may make you ineligible for that particular service and will need to find a different obstetrician who allows you to make that choice.
10. What is the cost of your services? Does this include extra things such as scans, epidurals or caesarean costs?
Even if you have private health insurance with maternity cover, it is highly likely that you will have extra costs to cover. For example, the private health doesn’t always cover the antenatal appointments or some extra scans. Make sure that you are covered for surgery and epidural costs in case you are required to have a caesarean as the cost of anaesthetics and surgery are very expensive – it’s not a surprise you want after!
Still not sure? Then get in touch and I’ll see if I can help point you in the right direction.