[epl0822]

My DH and I are having a minor disagreement on where to deliver our next (hypothetical) baby. I went public last time and, due to various reasons, I now want to go private. DH has been doing some research and quickly discovered giving birth at a private hospital with private OB has a much, much higher rate of intervention. He is worried for me about having an unnecessary c-section. Neither of us have any medical background so if an OB said "you should get a CS because there will be XYZ risks to you/your baby...." then I can't imagine us feeling very confident about disagreeing and going against medical advice.

We've moved into a new area and the few friends who gave birth around here have all gone public. I don't know who to ask to recommend a good OB who strongly supports natural births. And if I ring up and ask, of course they will say they support a natural birth.

So my questions...
(1) when you were contemplating private vs public, did the higher intervention statistics put you off going private?
(2) how do you choose a good OB? Are there any specific questions I need to ask?

[lsolaBella]

I asked online for personal recommendations, experiences with particular OBs.

I also found a blog of someone who used my OB too.

I also did lots if reading about my PG and any potential complications. I knew my bubs was breech so from 30 wks started to research breech bubs. My bubs was one of the few who didn't turn. So when at 37wks my OB recommended cs for XYZ reasons, that concurred with what I had read.

[whale-woman]

Part of the reason private obs have higher intervention rates is people who WANT more interventions know they can ask for them and get them. Other private obs are used by high risk people, or people with bad experiences in earlier deliveries not to mention older and wealthier women might be more likely to go privately, all factors which might increase the intervention rate. I wouldn't use public as I wanted a c/s which my private ob will provide. There is nothing inherently wrong with interventions, it's about what style of management you want. A private ob will give you different options than the public system and ultimately you can refuse intervention if you want.

ETA I was recommended my awesome ob by a friend I trust. Book in early if you go privately as the good ones book up fast. (as I suspect do the good birthing centres etc.)

The other thing to consider, since you say you have no medical background, is whether you should be so biased against interventions. Interventions can be lifesaving so it is possible (though a lot of EB will disagree with this) that a care provider chosen for a low intervention rate might be a bad choice. If you wanted to avoid íntervention at all costs fair enough, but I think good, competent care is much more important and a care provider that takes the time to understand your attitude to risk (as all delivery options have risks and benefits) and work with you to get the best outcome for you and your bub. A good private ob will take the time to do this.

This post has been edited by whale-woman: 14/01/2013, 06:00 PM

[futureself]

(1) when you were contemplating private vs public, did the higher intervention statistics put you off going private?

No, because I understand the many factors that surround statistics and numbers written in isolation are essentially meaningless. For example: older woman are more likely to go private and older women have more complications therefore require more medical assistance to give birth safely. Another example is woman who need/want an 'elective' caesarean go private so they have the power to choose. Both these scenarios push a certain Private hospitals rates of intervention like epidural or caesarians way up but as you can see, don't necessarily apply to you.

(2) how do you choose a good OB? Are there any specific questions I need to ask?

How long do you 'allow' me to go overdue before talking intervention?
What is your experience with breech vaginal delivery?
What circumstances do you recommend induction?
How many caesareans did you perform, or average % last year? Is this due to you 'speciality' i.e If take on high risk mothers, are experienced with twins, etc

Ask on here for recommendations for OBs in a particular area. We can PM recs, just not post publicly.

[Girlo]

You might like to think about whether they are close to retirement if you want more than one more. I took a recommendation and was v v happy with my OB, but depending on when we start TTC for number 2, he may have retired!!

[epl0822]

The other thing to consider, since you say you have no medical background, is whether you should be so biased against interventions. Interventions can be lifesaving so it is possible (though a lot of EB will disagree with this) that a care provider chosen for a low intervention rate might be a bad choice. If you wanted to avoid íntervention at all costs fair enough, but I think good, competent care is much more important and a care provider that takes the time to understand your attitude to risk (as all delivery options have risks and benefits) and work with you to get the best outcome for you and your bub. A good private ob will take the time to do this.

I'm not "biased" against interventions, I simply don't want to have one unnecessarily if an OB is overly cautious. I am not trying to avoid interventions at all costs, just want to minimise the chances of having them done unless necessary.

I am aware of the other statistical factors regarding the higher intervention rates in private hospitals.

[07gbam]

Your question highlights one of the many problems and misconceptions ( no pun intended) surrounding modern obstetric care in the private sector.

We should not assume intervening in birth is a negative thing. Especially not because a nameless, faceless natural birth proponent has successfully planted the seeds of discontent and mistrust among inexperienced mothers-to-be. Nor at the very least because intervention is what has brought maternal and infant mortality to an all time low in the first world.
Intervention is not without risks but despite what some will try to convince you, is not done to make anyone's life easier other than that of you and your precious baby.They will come up with all sorts of seemingly convincing arguments, mostly emotive and based on ideology. Few have ever taken full responsibility for a labouring mother and those who have will almost always have someone else to hand over to and go on to blame when things don't go as planned.
Obstetric intervention is a victim of it's own success, and like most things, becomes taken for granted and misrepresented in some sectors, turning it into a battle between women's perceived control over their bodies, and that of a male dominated profession hell bent on depriving you of what nature drove you to do. Ask your Ob what he/she did when their child was due, and if they will share their personal story with you , you will quickly see that no doctor takes unnecessary risks with their own child let alone that belonging to another family. There is no such thing as 'unnecessary caution' in medicine, and especially not in obstetric practice when anything unnecessary and in fact that IS necessary comes with a risk. Ask yourself whether the risks of letting nature taking it's course are more acceptable to you than the risks inherent in modern obstetrics with it's aim to anticipate risk and intervene when the risks outweigh letting nature do it's own thing. When the time comes to welcome your baby into the world you invited him/her into, you may feel driven to take whatever advice is given to you as mothers are inclined to do. There is no such thing as excessive caution when it comes to your precious baby. I felt I actually wanted my Ob to be 'overly cautious' about my baby.
The natural birth proponents are all about informing women that doctors 'unnecessarily intervene' without perhaps understanding that absolute risk is often impossible to assess , and that doctors act to avert disaster based on what they know is most likely to happen in a situation and not on what is certain not to happen. The birth process is unpredictable, there is no such thing as a low risk woman, and unless we come to understand that, birth in the first world will continue to be a battle ground between women who want 'control' over what is essentially a complicated and risky process, and those who wish to have someone 'look after' them during the birth.

[lsolaBella]

As PP said modern obstetric intervention is why my first child and I are still alive (and also why I am still here with my third), it is why my SIL and her children are here, it is also why my sister and her baby are here (emergency premmie cs due to HELLP eclampsia).

We are very happy with that. My SIL wanted a water birth, that was not to be.

[SeaPrincess]

(1) when you were contemplating private vs public, did the higher intervention statistics put you off going private? No. I went private primarily for continuity of care and secondarily for my choice of hospital. I was lucky in that both of the private hospitals that I delivered in are well-supported by a team of midwives and both of my OBs were very much in favour of natural birth if possible. The OB who delivered my first and 3rd babies normally works out of a low-risk hospital, but is also able to deliver at the main public hospital where high-risk pregnancies are referred, so I would have had that as well. I never asked, but I suspect that was also the case with my other OB, since the 2 hospitals were neighbours.

(2) how do you choose a good OB? Are there any specific questions I need to ask? One of my OBs was recommended by a friend - she was a bit ahead of me and having twins. He was happy to deliver twins naturally and is also pro-VBAC. My first baby was induced for medical reasons, but he still arrived at 3.30am, so it certainly wasn't for convenience (although when I was induced for #3, he didn't make that mistake again!) My other OB was in another state, where at the time, the choice of private specialist was extremely limited.

[premmie_29weeks]

07gbam that's the best post I've read on eb on this topic bravo!

I'm in Sydney's eastern suburbs and gave birth twice with an ob at prince of Wales private. Pm if that's anywhere near you and ill give you my obs details. He was wonderful, and I was lucky that neither birth presented any challenges. One was vb with epi and one all natural unexpectedly.