Choosing an Obstetrician

A lot has been written about the process of choosing an obstetrician. It nearly always overcomplicates the decisions you must make and bombards you with lists and questions that seem to require you to have a medical degree yourself or aspirations of acquiring one. In our experience there are only a few simple steps and issues you need to think about:

1. Public or private? - In Australia we are blessed with some great public hospitals. Often doctors who work in private practice will also do some sessions in public hospitals either to keep themselves up to date, connect with other colleagues, to teach a new generation of doctors or simply because they believe the public system should be supported. If you are happy with your local public hospital which also has maternity services this is certainly an option. The benefits of choosing to have a private obstetrician include: you can choose the hospital your baby will be delivered at and the environment in which you and your baby will be cared for after birth, you can choose the obstetrician who will be at the birth, the qualifications and the experience of the obstetrician will often be superior (as you will not get a trainee doctor), and your own obstetrician will be available to see you at a mutually convenient time before the birth for regular check ups and in case you have any concerns.

2. Finding an obstetrician - there are approximately 130 obstetricians in Victoria (Australia) at June 2008. There are various ways of finding an obstetrician. Perhaps you have used one before that you like and trust, your mother or your friends may have had a good experience, your GP or gynaecologist may recommend one, you can search the RANZCOG list, or you may have even seen glowing comments on an internet forum. While you can be assured that every obstetrician will have a base level of competence finding an obstetrician is a personal decision - there is no guarantee that another's recommendations will be suitable for your circumstances. You may prefer an older doctor, you may prefer one that also practices in a public hospital, you may prefer a female one, or you may prefer one that specialises with certain issues. It is all well and good to know of several obstetricians but are they available to help you? With increasing birth rates and demand for obstetric services many obstetricians may not be able to see you. The best idea is to think about finding an obstetrician early in your pregnancy. This will also enable you to get informed answers to the questions that you have now you have found out you are pregnant.

3. Skills and experience - fortunately this is an easy one to check. All people entitled to call themselves obstetricians in Australia must be accredited by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). "The primary role of the RANZCOG is to train and accredit doctors throughout Australia and New Zealand in the specialities of obstetrics and gynaecology so that they are capable - professionally and psychologically - of providing the highest quality health care for women" Source: RANZCOG website To be a member of RANZCOG usually takes at least 13 years from the point a person begins to study as a doctor, and at least 7 from the point they are fully qualified. The process involves the person completing basic medical training at a university and teaching hospital (usually 6 years) which entitles them to be called a doctor, pass the exam to enter the field of obstetrics and gynaecology (usually another 6 years). There is also an ongoing training and professional development process that must be met to maintain accreditation. To check your obstetrician is registered (and has not been struck off because of unprofessional conduct) you can check via the Medical Board. By the time a typical obstetrician enters private practice they will have helped over 1000 babies into the world using a variety of methods.

4. Convenience - Perhaps being close for consultations and check-ups (eg close to your work, close to home or a close relative) or close to the hospital in which you will have your baby is important to you? Having an obstetrician's practice close to the hospital they deliver at is actually quite important – it reduces the time that the doctor is in transit and the chance that when you need them most they will be available quickly. Most obstetricians will position their practice close to a major maternity hospital. You can always search the Yellow Pages or Google Maps to see which obstetricians are located near you or the hospital you wish to attend.

5. The Hospital - If all goes as normal you can expect to be in hospital for 4-7 days around the birth (only 1-2 days in the public system, after a normal delivery). Most of this time you will spend in your own room getting to know your child and how to feed and care for him or her, letting your body deal with no longer being pregnant and seeing well wishers. If it is important for you to have your baby at a particular hospital you may want to check which obstetricians practice at that hospital as this will reduce your choice. Sometimes there is a compelling reason why a particular hospital should be preferred over another (eg if there is one that is close to your home or has a great reputation). If you live near the city there are usually a range of suitable institutions. In Melbourne we are lucky to have the new Women's Hospital open close to the city. You can usually check online with the hospital to see who delivers at that hospital eg Frances Perry House (the private hospital co-located with the Women's hospital). You may wish to select a doctor who only delivers at that one hospital. The advantage of this is that your doctor is less likely to be in transit between delivering a baby at another hospital or even in the middle of a birth at another location when you need them - or worse stuck in traffic. It takes time to change, travel, re-scrub to see you.

6. Accessibility and method of practice - Some obstetricians practice on their own, although recently there has been a move to shared practices where two or more obstetricians share responsibility for patients after hours - particularly where the obstetricians have their own young families. It is simply not physically possible for someone to provide 365 24/7 care on their own. At some point your obstetrician needs to sleep, see their family and live their life. It is worthwhile understanding what arrangements the obstetrician puts in place when they are not available – for example another obstetrician might be employed to do this or another obstetrician in the same practice may assist. It is always possible your obstetrician may not be available particularly if you have an unscheduled arrival. So if you get the chance it is worth meeting them so you will not get a stranger at the birth. You may even get two obstetricians you know at the birth if you have need a caesarean as the assistant may also be from the same practice.

7. Confidence talking to your obstetrician - This consideration is unlikely to come into play often. However it is important that you have confidence in your obstetrician, their judgment and advice, and you do not feel awkward with them. You should feel comfortable raising issues about your body (including your private parts), your state of mind and your preferences and expectations regarding the birth. Having a baby is one of the most stressful (and rewarding!) events in your life and the last thing you need is feeling you are not being supported or they are weird in an unpleasant way. If you do find yourself in this situation, try to discuss it with the obstetrician (or if it relates to their behaviour and mannerism and you feel you can't raise it directly with them with their medical receptionist or practice manager). If the issue remains unresolved perhaps it is better to see another obstetrician in the practice or elsewhere.

These considerations should help you choose the right obstetrician for you. If you later feel you have made a mistake with your choice, raise the issue directly with the doctor and see if the issue is a misunderstanding or can be resolved. If not, there are other choices available.