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Changing Your OB-GYN

Miriam Backes was in her sixth month of pregnancy before she began to feel uneasy about her obstetrician. Backes wanted a drug-free delivery, but her doctor specialized in high-risk births. While early on Backes had felt lucky to have a doctor who could handle tough births, as the weeks progressed, she was feeling increasingly mismatched.

"The doctor was doing ultrasound upon ultrasound and started talking about the baby being so big that I might have to be induced before my due date," says Backes, who lives in Lawrenceville, New Jersey. "The closer I got to delivering, the more medical the approach the doctor seemed to want."

So Backes changed doctors late in her sixth month. Even though her son Oscar was ultimately born by cesarean section, Backes has no regrets. "My labor went according to my wishes. It was allowed to progress slowly, without anyone's insisting on interventions."

Like Backes, many women unhappy with their obstetrical care face the tough decision of whether to switch doctors in the middle of pregnancy. When problems arise, is it better to find a new doctor? Or should you stay with your current physician to ensure continuity of care?

"There is no rule that says you need to switch by a certain number of weeks of gestation," says John E. White, MD, of Mount Auburn Ob/Gyn Associates, Inc., in Cincinnati, who will take patients anytime as long as he can meet them face-to-face at least once before their baby arrives. "If you have that "uh-oh!" feeling about the doctor, the office, the staff, or whatever, and you have a legitimate reason to switch, then you should."

Still, unrealistic expectations and preconceived notions have doomed plenty of doctor-patient relationships.

"There's an observation among ob-gyn circles that the patient who comes in with the longest list of demands is guaranteed to have the most complicated labor and delivery," says Sharon Phelan, MD, a professor at the University of New Mexico in Albuquerque. "And the women who come in with lots of demands are also often the ones I see doctor-shopping."

Dr. White and other experts suggest that women examine their reasons for wanting to change doctors and try to resolve problems first before seeking a new practice. Then, if you still need to switch, do it as early as possible to ensure your new doctor becomes familiar with you and your case.

"Most ob-gyns are uncomfortable with getting a new patient who is past 32 weeks, because even if you get the patient's records, you don't know the nuances," says Robin de Regt, MD, medical director of Women's and Children's Services at Evergreen Hospital in Kirkland, Washington. "That doctor-patient relationship is the art of medicine, enabling you to ask: 'What's changed with this patient?' If you don't know your patient, you can't answer that question."

After her experience, Backes also advises friends to try to settle on a doctor quickly.

"When I was looking for a new doctor, a lot of them were already booked," she says. "Changing so late in my pregnancy definitely limited my choices."

If you're thinking of switching doctors, tell your current physician why, experts urge.

"Many people want to avoid a confrontation, so they just have their records transferred with no explanation," says Susan Keane Baker, author of Managing Patient Expectations (Jossey-Bass). "That's like someone's breaking up with you without giving a reason. You should give the doctor a chance to make amends." Or at least do better in the future with other patients.

Here are the three main reasons you might have for making a change.

1. You're dissatisfied with your doctor's care. Lack of respect is a common complaint among many patients who switch doctors. "If your doctor makes you feel unimportant, that's a problem," says Keane Baker. Curt, unsympathetic office employees are also a turnoff, as are doctors who don't return telephone calls or promptly notify patients of test results.

Annemarie Mansour of Annapolis, Maryland, changed doctors as soon as she got pregnant with her third child. Mansour had suffered two previous miscarriages and didn't want to stay with the practice that had been overseeing her care. "They acted like their important patients were their pregnant patients," Mansour recalls. "When I miscarried and needed more attention, it wasn't there."

She chose a new doctor in a solo practice by seeking recommendations from other pregnant women. "The doctor sat down and talked with me. I didn't have to have my questions memorized and rattle them off before she rushed out the door," Mansour says. "And the office staff even knew who I was when I called."

2. You move to a new town -- or to a new healthcare plan. Sometimes the need to switch doctors is beyond your control. Pregnant women who relocate often find themselves scrambling to get a new physician. Health insurance changes -- fairly common even if you don't switch jobs -- can also send patients doctor-shopping. Finally, some ob-gyns grappling with skyrocketing malpractice insurance premiums are dropping their obstetrical practices to focus on lower-cost gynecological care, sending their patients out to other doctors.

Moving gave Paige Henry, a mother of three, a good excuse to leave a doctor in whom she had lost faith. When her second baby, Maura, arrived, she surprised everyone by coming out buttocks-first. Henry's obstetrician joked that her oversight of Maura's breech position was "a big oops" -- but that was a huge understatement, according to Henry.

Looking back, Henry blames the doctor's packed waiting room and hurried exams for the oversight. When she got pregnant with her third daughter, her family's move from New Jersey to Virginia gave her a happy excuse to switch during her 20th week.

3. Your pregnancy suddenly grows more complicated. That's what happened to me. In my 35th week, my midwife discovered that my baby was breech and my amniotic fluid was low. Suddenly I had checkups every other day. My midwife worked closely with an obstetrician, so they were both present for the visits, which included an unsuccessful attempt to turn my son in utero.

I wanted to try for a vaginal delivery anyway. But when my water broke a day before my due date and labor wasn't progressing, it became clear that a cesarean would be the safest way to deliver. Although the doctor did the surgery, my midwife was involved, and I loved that the new doctor tried so tenaciously to accommodate my wishes for a natural birth.

It helps to remember that all obstetricians want to give their patients a positive birth experience. "It doesn't really matter who delivers a patient's baby," Dr. White says. "What's important is a healthy mother and a healthy baby."

Dana DiFilippo is a writer in Lawrenceville, New Jersey, and mom to Zaki.