8 Things to Consider When Looking for a New OB
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Finding a new obstetrician when you get pregnant is the first big decision you’ll need to make during parenthood, and it can feel overwhelming – especially in a major metropolitan area where there are a ton of practices to choose from. Typically an OB won’t take you on as a new patient until you are pregnant, and it’s a good idea to call as soon as you can to schedule your first appointment, because some practices can book up far in advance. Before you start googling or calling around, there are a few things you should consider to help narrow down your search:
1. Hospital Birth vs. Birthing Center or Home Birth
Whether you want to go the traditional route with a hospital birth or would prefer to try for a birthing center or home birth is the first decision you will need to make, since it will determine what type of medical professional you start looking for. It’s probably the biggest decision you’ll need to make around your birth, and there are big risks and benefits you’ll need to consider, so you should do your diligent research around the options and possible outcomes or complications.
If you decide on a hospital birth, you’ll look for an obstetrician (OB). If you want to try for a birthing center or home birth, you’ll look for a midwife. I am a hospital birth kind of person, so I never even considered a midwife and am not the most equipped person to go into too much detail around it or answer any questions; but my understanding is that even if you have arranged to deliver at a birthing center or at home, certain complications during your pregnancy may rule that out as a possibility or heavily suggest that you should deliver at a hospital instead. Your midwife should be well-equipped to
2. Group Practice vs. Solo Practitioner
Some OBs run their own practices in which they are the solo practitioner. This means you’ll see that doctor for pretty much every visit and that he or she will be the one who delivers you, unless he/she is away on vacation or out sick when you go into labor.
Other practices are group practices, meaning that several OBs work at the practice and any of them could deliver you. They typically try to rotate you through all of the doctors during your pregnancy, so you at least meet each one and won’t see a total stranger in the delivery room. Some group practices have you choose a primary whom you’ll see during your first and possibly second trimester, and then they rotate you during the third; and others have you start rotating from the first visit.
I chose a group practice for both of my pregnancies, because I felt more comfortable knowing that I could always be seen by an OB last-minute if necessary, and that there would always be a doctor from the practice on call whenever I went into labor. I did not feel the need to get to know one doctor very well throughout my pregnancy and to have that doctor specifically deliver me (and I also didn’t want to have my heart set on a single doctor delivering me, in case he/she ended up not being available on the day).
Typically, doctors at the same practice will share similar philosophies on labor & delivery practices (see section below for examples), but they may differ in certain areas, so it’s a good idea to ask any questions important to you when interviewing a doctor or practice.
3. Hospital Affiliation
There are many factors to consider when selecting a hospital, and you should try to think through which may be important to you. This list probably doesn’t cover all of them, but here are some to start with:
Proximity – This is often one of the biggest factors for people, since many would like to deliver as close to their home as possible (especially in a major city like New York or Los Angeles, where traffic can be unpredictable and add on a lot of time). I chose the closest hospital possible, which was a half-mile away from our apartment, and it came in handy both times. During my first pregnancy, my water broke before my due date but I wasn’t dilated at all yet, and we were sent straight to the hospital from my OB’s office to make sure we could get a room and start induction meds as quickly as possible. My husband had to leave to get our stuff and make arrangements for our dog, so it was helpful that we were close by. During my second pregnancy, I loved having my husband and parents be able to easily walk over with my daughter for her to meet her baby brother in the hospital. And since I felt almost completely fine after my second delivery, my husband & I walked home with the baby in a stroller after our stay, and it was so nice not to have to deal with driving/parking and a car seat (especially since there was practically a mini hurricane on our way home and I felt safer with our Cadillac of a stroller than I would have in the car with a newborn!
Shared vs. Private Rooms – This is another biggie for people in a crowded city like NYC where you aren’t guaranteed a private room for your stay. Some hospitals are starting to add more private rooms, so the chances are greater that you’ll be able to get one; and others still have slim chances, so it’s likely that you may have to share. Hospitals also charge wildly different prices for private rooms – we paid $595 for one night during my first delivery for a private room (which we almost passed on but ended up being worth every penny), and I’ve heard of prices upward of $1,000 at other hospitals. Some hospitals also have rules about shared rooms, such as not allowing spouses/partners to stay over; and since you can’t guarantee you’ll be able to get a private room at some hospitals, this is a possibility that you should consider ahead of time.
Level of Care – You’d hope that the level of care at each hospital with an L&D ward would be about the same, but it’s always good to hear that the hospital you’re considering has exceptional doctors and nurses on staff. It was also important to me that if I paged a nurse, they’d be able to come quickly to help me, since the first time I was a nervous new mom, and the second time, I stayed alone both nights so my husband could be with our daughter.
Philosophies – Hospitals may differ in certain philosophies around monitoring during labor, breastfeeding vs. supplementing with formula, room sharing with baby, first bath for baby, etc. It’s a good idea to think through whether you have strong opinions on any of these things, and whether any philosophies the hospital takes a stance on are in line with your own.
Labor Options – I am someone who was happy to go with whatever the doctors recommended to ensure a safe delivery for me and my baby, so I’m not super familiar with the alternative options provided during labor, but some things I have heard of are: whether you have to stay in bed after getting an epidural or can get a “walking epidural” and move around; whether there’s a shower or bath tub you’re allowed to use during your labor; whether the hospital provides a yoga ball or birthing peanut for your use; whether you’re allowed to labor and/or deliver in non-traditional positions (e.g., other than on your back); and whether you’ll need to be monitored at all times during your labor or can opt for intermittent monitoring. If these things are important to you, then they’re worth looking into ahead of time so you’re not surprised or disappointed.
LCs and Classes – Some hospitals have in-house lactation consultants (LCs) who can give you 1:1 help during your stay, which is very helpful. And some also have classes you can take during your stay, like breastfeeding and newborn care. Some even have continuing classes or meetups you can take advantage of after your stay – like a breastfeeding support group or new mom meetup.
Perks and Food – Extra perks like a hospital gift and good food is probably not a big enough draw to choose one hospital over another or reject a hospital with otherwise amazing care; but it was certainly nice to receive a toiletries bag upon arrival in my room, great hot food delivered to me for every meal (including bone broth and ice cream!), a good on-site cafe for my partner, and a parting gift for the baby or a cute outfit or muslin blanket for the baby. My hospital didn’t have as nice of a gift as some others did, but this was not an important factor for me, so I didn’t feel bad that I missed the expensive perfume another friend received at a different hospital (let’s face it: I have barely even worn perfume since giving birth the first time over 4 years ago!).
One other thing to keep in mind is that there is no such thing as a perfect hospital that provides a flawless experience every time for every person. I had a wonderful experience at NYU Langone in New York City, where I gave birth twice, and I have also heard some horrible stories from people who delivered there. This could be because it was just an off day (as can happen at the best hospitals or to the best people), or because something one person cares about and finds fault in is something that another person does not care about or even notice, or because someone just had a very one-off bad experience due to a particular situation that most people would never encounter. So I would try not to get bogged down in every single review or every single detail, and instead to look at the big picture and to choose based on factors that are the most important to you or on trusted friends’ recommendations.
4. Philosophies and Preferences
In addition to the hospital’s philosophies, individual OBs and group practices also have their own philosophies and preferences. These may include views around pain medications vs. natural births, fetal heart rate monitoring during labor, the use of a doula, the use of induction medications, interventions during labor & delivery, birthing instruments such as a vacuum or forceps, episiotomies, handling of breech babies or VBACs, decisions around C-sections, etc. If you have certain preferences or hopes/wishes for your labor and birth, it’s a good idea to interview a few OB practices before selecting one. See below for a list of suggested questions that you can download and print out, and add any others that are important to you.
5. High-Risk Pregnancy
If you are of a certain age (I refuse to say “geriatric” [insert eye roll]), or if you have certain health concerns, you may be considered to have a high-risk pregnancy and will need to be seen at a practice that specializes in this area (sometimes it’s called “Maternal Fetal Medicine” or “MFM”). If you’re unsure whether your pregnancy would be considered high-risk, this is something to ask about when you start calling OB practices to schedule your first appointment.
6. Location
You will go to your OB’s office a LOT, especially if you are over 35 or have any particular health concerns such as gestational diabetes. Monitoring frequently increases in the 3rd trimester and even more so during the final month, so you should make sure that it’s not a giant pain to get to the doctor’s office. For my first pregnancy, I had to take the subway in NYC – it was a quick trip, but not ideal always to have to rely on public transportation. For my second pregnancy, I was able to walk to my OB’s office, which I much preferred. I could always take a cab or cross-town bus if I needed to, but it was nice to get the exercise and the fresh air.
7. Ultrasound Capabilities
Another thing that was important to me in choosing an OB was that I be able to get basic ultrasounds done at the same office and at the same time as my doctor appointments. For the big ultrasounds like nuchal, 16-week scan and 20-week scan, you will typically have to go to a specialized facility. But for all of the other ultrasounds that happen throughout your pregnancy – especially if you’re over 35 and especially during the final month of monitoring to make sure that your baby’s size and your fluid levels are both looking good – it was much more convenient to be able to go to a single location.
8. In-Network
Finally, you’ll want to make sure that both your doctor and the hospital they’re affiliated with are in-network with your insurance. OB visits are numerous with exams, ultrasounds, lab tests and vaccinations, and hospital bills are EXPENSIVE. My hospital bills for labor & delivery plus my two-night stay in a shared room in NYC came to more than $25,000 (!!!!!), so that is not something you want to get stuck paying out-of-pocket.
Once you’ve narrowed down your OB choices, you can simply select a practice and call to make sure they have availability for your due date, or you can interview a few practices. Mom Crew has put together a list of printable OB Interview Questions to evaluate practices and choose the one that feels right for your family.. Feel free to add some of your own questions too, depending on what’s important to you.