Unfortunately in America we seem to have bought into the idea that the most important things about choosing a care provider are if they are on our insurance plan, how close they are to our home or work, and if we like the waiting room decor.  Okay…I might be exaggerating a bit on the last point…but really…the things we take into account really aren’t often important.

I admit…I’ve been guilty of the same kind of decision making.  In choosing my first OB, I just stuck with the GYN I’d seen for about 4 years prior to pregnancy.  I had chosen the practice based on recommendations from friends that they were a “Christian” practice.  I would later learn that just because the care providers shared the same religious faith with me, it did not mean they shared the same philosophy about birth.

There is a LOT of variation in practice philosophy amongst care providers, since, as my father used to say, doctors practice medicine. Its part science, but also part ideology, where entrenched beliefs often are contradicted by medical research.  Just looking at the Christian birth care providers I’m familiar with, there are some that:

  • will cut episiotomies without consent, even though research shows they are usually unnecessary,
  • state outright that they do not trust vaginal birth and much prefer planned cesareans,
  • will allow women a lot of latitude in how a hospital birth is carried out–asking her every step of the way if she wants option A, B, or C and avoiding cesarean whenever possible,
  • will attend homebirths with a woman who has had 2 prior cesareans.

During my first pregnancy I started realizing that the practice I was using was a philosophical mismatch with me, but I didn’t switch.  Why?  Because I felt too busy perhaps?  All I can say is please don’t follow my example!  It is only through the grace of God that my inaction did not result in my having a cesarean. Had any of the doctors from my chosen practice been on call when I went into labor, my birth would have been very different.  Care provider choice does matter.

So how do you go about choosing the right care provider for you? The first step is knowing what your options are.

In the Lehigh Valley we have 5 hospitals that provide birth services:

For the most part, a hospital birth in the Lehigh Valley will be with an obstetrician. There are large practices, and smaller practices. With small practices you can generally develop a closer relationship with your care provider(s), but you should be sure you understand how your provider handles being on call for births, so that you know what happens when your chosen provider is not available. Lehigh Valley Health Network has a large number of offices each staffed with a few obstetricians, but at the current time, all of the doctors form a pool to take call for births, resulting in a situation where most women who go into labor spontaneously will not have met the doctor who is on call for their birth.

It should also be noted that Lehigh Valley Health Network and the St. Luke’s hospitals are all “teaching hospitals,” so typically residents will be overseeing much of your care in labor. You can usually decline care from a resident, but your ability to do this often depends on the availability of your chosen doctor. You may also be asked if you are okay with student doctors and/or student nurses observing your care. You may decline to have students present without this impacting on how care is delivered to you.

There are a limited number of family physicians who attend hospital births, and one obstetrician practice at LVHN has midwives on staff that do a few births each year, however the odds of birthing with a midwife are very low. Women may choose to travel to Pocono Medical Center, Reading Hospital, or Morristown Hospital to birth with midwives.

A variety of midwives provide home birth services:

For women who desire a birth center environment with Certified Nurse Midwives, they will find that they need to travel a bit to access this option:

Choosing between these options will involve a mix of understanding your personal philosophy about birth and needs based on your risk level, and understanding which option is best for you given your insurance and financial situation. Some women shy away from home birth or birth center birth because of lack of insurance coverage, only to find that using these options can be less expensive than using care providers that are covered by insurance.

Many women will ask in various local mom groups for recommendations for care providers, and this can be a great thing to do. But the result is often just a list of women saying “I used Dr. Smith and loved her!” That’s not enough to go on. What did the woman love about Dr. Smith? Is that a feature that you are looking for? So make your questions a bit different. Instead just of asking for names of doctors, ask “who was your birth care provider, and what did you like and dislike about her?” This can give you a bit more of a window into the care providers’ styles. In more in-depth conversations you might also ask what routine prenatal appointments include, how long wait times are for appointments, what is the care provider’s policy on attending vaginal birth after cesarean (an important question even for first time moms to ask!), and what protocols does the care provider follow during the birth?

If you are considering a home birth in the Lehigh Valley, you will have to be more proactive about evaluating your chosen care provider. Consider using the PA Midwives’ Alliance guide Know Your Local Midwife to help you decide what questions are important for you to ask.

I recommend that women interview at least three care providers before choosing one. I also recommend touring 2-3 birth places (and perhaps ask the nurses what care providers they see provide the style of care you are looking for).  I have to admit, I didn’t interview my care provider in my first pregnancy. I distinctly recall how unprepared I felt to make choices about maternity care early in my first pregnancy; and given that, I probably would not have made a good choice even if I had interviewed several different care providers. For this reason, I strongly encourage women to take a healthy pregnancy class early in pregnancy that covers care provider options (as my 2 week Healthy Pregnancy class does). I also encourage women that you can switch care providers at any point in pregnancy when you realize a different care provider would be a better choice–I have even had clients who switched care providers in labor!

Even with my second pregnancy I only interviewed one care provider–the one who had been the on-call doctor when my first was born.  It wasn’t until my 5th birth that I actually interviewed 4 different care providers (and kind of half-way interviewed a 5th over the phone), and chose one.

She wasn’t covered by my insurance.  And yet she probably cost me less than either of the “in network” providers I interviewed would have cost considering that I would have had a $300 deductible and 20% co-pay for the in network providers who were both hospital based.

She was the furthest away from my house.  Of course after signing up with her I found out she would do home visits for a small fee, and so my appointments literally took only 30-60 minutes of my time, and ALL of that was face time with the midwife, unlike the 2-ish hours I often spent on appointments during my first pregnancy between driving (just 10 minutes from work!), waiting in the waiting room, having vitals taken by nurse, waiting in the exam room some more…then seeing the OB for 5-10 minutes.  Even when I did drive to her office for two visits, I still only devoted a bit less than 2 hours to each visit, and saw my midwife for 30-ish minutes.

In the end, each woman’s choice of maternity care provider will be made based on a unique set of criteria. Making the decision thoughtfully will help you to be most satisfied with your care.