5 Things I Wish I’d Known When Choosing a High-Risk OB-GYN

November 7, 2014

High-Risk PregnancyThe year after my son was born at 26 weeks, my ob-gyn suggested I see a high-risk specialist to discuss the possibility of having another preemie. Here are five things I wish I’d known when I was choosing a high-risk obstetrician, or a maternal-fetal medicine specialist.

  1. Make sure your regular ob-gyn and your high-risk doctor communicate. A year passed between my initial consultation with a specialist and when I became pregnant. During that time, a large hospital system purchased my ob-gyn’s practice; my high-risk doctor had recently vacated that same hospital system. There was friction within the bureaucracy of the medical system that had nothing to do with me and my doctors. The better the working relationship between your high-risk doctor and your ob-gyn is, the better your care will be.
  1. Don’t let your doctors forget the little things. I was being followed for unexplained preterm labor. We talked about cerclages and cervical length, and I had weekly checks on my cervix. As it turns out, my cervix was fine, while the rest of me slid into a train wreck none of us saw coming. My high-risk doctor did not check my blood pressure or the protein in my urine. My regular ob-gyn appointments were only monthly, and after the hospital group purchased her practice, urine analysis was no longer customary at every appointment. So, no one noticed as the protein in my urine increased, and no one was watching my blood pressure climb. Preeclampsia probably would have happened anyway, but I might not have been in another state with near fatal high blood pressure had my monitoring been more thorough. My high-risk doctor was horrified to discover my ob-gyn had not been monitoring the protein in my urine, but if I had a redo, I would better advocate for myself and ask why some of my routine care was so minimal. The little things can turn out to be really important!
  1. Ask where your high-risk obstetrician has hospital privileges. I assumed the relationship I was building with my high-risk physician would extend into the delivery room if I had my daughter early. A stranger had delivered my son, and it was important to me that the birth experience be more positive the second time. My high-risk ob-gyn never volunteered that she was restricted from delivering at my hospital because of a contract with her previous employer, and I never asked. I assumed she would deliver me in an emergency, and I only discovered in the hospital that she was barred from visiting me. I had no relationship with either of her colleagues. I also discovered that the high-risk ob-gyns rarely delivered their patients because the on-call surgeon for the hospital did the emergency C-sections. But, in a twist of fate, my preeclampsia boiled over on a busy night, and one of the doctors in the high-risk practice performed my surgery. In hindsight, I wish I had asked more questions about the delivery procedures of the high-risk practice before I was in an emergency situation.
  1. Make sure you trust your doctor. In the area of high-risk pregnancies, so much is still unknown. After I’d had two incredibly rare deliveries, both without any explanation, I asked the doctor who delivered my daughter if he thought it would be safe to have a third baby. “Your case is rare,” he said. “But, I’ve known women like you to have inexplicable deliveries and then go on to a perfectly normal birth experience. We just don’t know.” You and your doctor will make many critical decisions without being able to see the big picture, and you’ll want to have confidence in the person in the corner with you.
  1. Seeing a high-risk doctor can bring such peace of mind. My second pregnancy was stressful because it was high-risk. I was terrified I would have a baby even earlier than 26 weeks. But, my weekly appointments became part of a routine that comforted me. I resolved not to worry between appointments so that I could enjoy my pregnancy, and I treasured the ultrasounds that allowed me to watch my daughter grow bigger and stronger week by week. Also, the process of sitting in the waiting room with women who had much more tenuous situations than mine helped keep me grounded. Rather than compare myself to people who seemed to skate through their pregnancies, I was able to keep my situation in perspective.

If you have any suggestions about choosing a high-risk ob-gyn, please share them in the comments.