Finding the Right Prenatal Care
6. How much weight should I gain?
The American College of Obstetricians and Gynecologists recommends gaining 25 to 35 pounds (35 to 45 for twins) if your weight is considered normal at the beginning of the pregnancy. Some providers strongly encourage expectant women to stay within those guidelines; others think it's fine to gain 40 -- or even 50 -- pounds. If you don't want to be nagged about adding extra baggage (or conversely, prefer someone who will keep you in line if you start gaining too much), ask what range your doctor suggests. "If he says something like, 'Absolutely no more than 35 pounds,' you have your answer," says Williams.
You should also bring up any specific concerns -- if you are overweight or a vegetarian, for instance, or if you have a history of eating disorders. "A woman with particular needs should look for a provider who's willing to work with her," says Williams. That can mean anything from making concrete suggestions about portions or substitutions in your diet to referring you to a nutritionist. If your doctor responds to your questions with vague or incomplete answers, such as, "Just try not to eat too much junk," you probably won't get the extra guidance you may really want.
7. How much control can I have over childbirth?
Keep in mind that for the majority of the time you're in labor, you'll be in the hands of nurses and at the mercy of hospital rules. But since you probably have some idea of how you want your delivery to proceed, try to find a practitioner who's in sync with your philosophy and willing to override hospital policy when possible -- letting you walk during labor if you want, rather than hooking you up to a fetal monitor, or forgoing an IV if you don't need fluids or pain medication. Jennifer Drawbridge, of Guilford, CT, chose a nurse-midwife who supported her decision not to have an IV. "When the hospital staff tried to force one on me," she says, "my midwife was able to dissuade them."
Another issue to consider: the provider's stance on episiotomies (when a cut is made to provide a larger opening for the baby's head). ACOG does not recommend the procedure be performed routinely—only in certain cases, such as when the baby is in distress (and needs a quick delivery) or when it may help prevent severe tearing in the mother. Still, some doctors still perform them regularly, since they feel that they cause less damage and are easier to repair than a tear; others try to steer clear of them whenever possible, thinking that they cause more bleeding and postnatal pain than tearing will.
When asking about any decisions concerning your pregnancy and delivery, keep an open mind. And remember that the final call about some issues is best made in the delivery room with the baby's -- and your -- well-being in mind.