Finding the Right Prenatal Care
2. What tests do you advise? What if they show that something might be wrong with the baby?
Ask your provider to explain each option, including what it tests for, how accurate it is, at which stage of the pregnancy it's performed, and what the risks are. Ideally, he'll give you all the details you need to make an informed decision, and not pressure you into having -- or not having -- a particular test. If you're over 35, for instance, he'll probably bring up amniocentesis, which involves extracting fetal cells from the amniotic fluid and examining them for signs of genetic abnormalities, such as Down syndrome or spina bifida. If you've decided not to have the test, however, it makes a big psychological difference to have a practitioner who'll support your choice.
In the unlikely event that a test shows something might be wrong, you'll want a doctor or midwife who'll support your decision about whether to continue the pregnancy. When Ellen Vaugh's (not her real name) amniocentesis indicated that her baby had Down syndrome, she knew she wanted to keep it. "But when I told my obstetrician, he practically recoiled in horror. I could tell he thought I was making a huge mistake, which made an already traumatic situation all the more unsettling. I stayed with him through my pregnancy, but I wish I hadn't because I didn't feel as comfortable with him after that," she says. To avoid unnecessary tension, ask up front about your options, then listen carefully to the response. If you're brushed off with a line like, "Let's not worry about that now," the doctor may not be a good fit for you.
3. At what point do you recommend a C-Section?
In some situations -- your baby is in distress or in a breech position, for instance -- surgery is unavoidable. But doctors vary as to how long they typically allow a woman to push in the delivery room before they perform a cesarean: Some will let you try for up to four or five hours, while others have a limit of an hour or two, so ask your provider to explain his policy. You can also inquire about his cesarean rate (the national average is roughly 32 percent), but remember that doctors who handle a large number of high-risk pregnancies will, understandably, have higher numbers than those who don't.
If you're strongly committed to a vaginal birth, ask your provider about what he does to avoid surgery. Possibilities include everything from administering oxytocin, a medication that speeds up labor, to allowing you to squat while pushing. If you've had a cesarean section and would like to try a vaginal birth after cesarean (VBAC), ask the doctor if you're a good candidate (women who've had a vertical incision aren't, for example), and his policy about VBACs. Many doctors strongly encourage a VBAC, preferring to stay away from surgery unless necessary; others are fine with letting a patient elect to have a repeat cesarean.