QuestionDear Dr. Rapaport:
I am in my 7th week and have yet to select an obstetrician, nurse midwife, or midwife. This is my first pregnancy and there are many options to chose from. My fiance's cousin is a midwife who does home births. As this is my first, and not knowing what to expect, I don't feel comfortable with the idea of home birth, but at the same time, I am apprehensive about chosing an Obstetrician with all of the different styles out there.
You will have to forgive me, as I have been reading a lot since learning of my pregnancy. I always thought that episiotomies were the way to go from listening to mothers talk about their tearing, but I am learning that if the birth is done right and naturally, a woman should not have major tearing during delivery. I also want to avoid being induced, having an epidural, being confined to a propped up position on a bed during my delivery, and cesarean section. I would like my delivery to be as natural and gentle an entrance as possible into the world for my baby, but at the same time have medical assistance there to ensure that we are both safe and healthy.
Other than an insurance book of providers in my network (I live in New Haven, CT), I have nothing to go on to make my selection. One thing is for certain, I do not want to go with an OB from a large practice as I want more personal care.
I am nervous about putting off my selection much longer as I have anxieties about my pregnancy being safe/normal and not being ectopic or in my fallopian tubes or something. As an OB, I was wondering what your opinions are on these issues, and I was wondering if you could make some recommendations or places to get information on my options in my area.
Thank you,
K
AnswerI would suggest that you avoid home delivery, especially for your first delivery. If there is a problem (breech, placenta previa, abruption of the placenta) and you try to deliver at home, it can be wrought with disaster. Nowadays, most obstetricians offer very natural deliveries. I do not routinely cut episiotomies because it has been found that it is easier to repair a "natural" tear then to cut one and then repair it. We do not induce a patient unless it is beneficial for the baby (Diabetes, hypertension, preecclampsia, post dates, etc). We do not perform cesarean section unless it is absolutely indicated (failure to progress in labor, Herpes virus, contracted pelvis, breech presentation, placenta previa, fetal distress). We also allow any position you would like during labor and delivery. We allow doulas or midwives at the delivery (although we frown on home births). Most hospitals and practices have certified nurse midwives on the staff. I would avoid very large groups of doctors. Solo practitioners are good because you always will get the same doctor and you will have only one person to ask questions of. HOweveer, sometimes a three or four man (or woman) group is good in case someone is on vacation. We all want the baby to have a natural entrance to the world. You should see a practitioner by the eighth week of pregnancy. Ask what their practices during labor are and tell them your preferences. It is not uncommon for patients to develop9 a "birth plan" and to submit it to the doctor to see if it meets with the doctor's approval. YOu can then always choose another practice. If you are not having any pain or bleeding now, it is doubtful that you are having an tubal pregnaancy. There are many wonderful obstetricians and midwives in the New Haven area, especially in Yale. I practice in Rockland county, New York and we provide very natural care to our patients. If you have any more specific questions or would like any advise on any other aspect of the pregnancy, please do not hesitate to ask me. Good Luck.
