When her first baby was born, Laura Goyer, of Vienna, Virginia, had an obstetrician she loved. He patiently responded to all of her questions, and if he didn't know the answer, he seemed eager to learn something new. "Once, he sent me eleven articles that he'd read and summarized for me," she recalls. "I really felt I could trust him."
She wasn't as lucky the second time around. Before becoming pregnant again, Goyer had changed insurance companies, and her doctor wasn't in the new plan. Though the group of five physicians she chose came highly recommended, a nurse's comment led her to believe that the doctors might not respect her belief in natural childbirth. She briefly considered switching to another practice but decided to talk to the doctors about her concerns instead. "Eventually, I developed a very good relationship with two of them-including the one who delivered my baby," she says. "But if I hadn't been proactive, I doubt things would have ended as well."
Having a doctor you feel comfortable with is always important. But, as Goyer learned, establishing a partnership is particularly critical during pregnancy and childbirth. If you're generally healthy, these months may mark the first time you've had such intense, ongoing contact with a medical professional. And that contact comes at a point in your life when you may be feeling anxious, unsure, excitable, and overwhelmed.
The key to ensuring a good experience lies in establishing a rapport with your doctor early on. In fact, experts say that miscommunication is at the root of almost all doctor-patient conflicts.
From the start, you should discuss the kind of birth experience you hope to have, suggests Nancy Levine, M.D., associate professor of family medicine at the State University of New York at Stony Brook.
"It's important for a woman to feel that she's contributing to the care she's receiving," says Janet Lobatz, a certified nurse-midwife and a founder of The Maternity Center, in Bethesda, Maryland. "The biggest problem is either the doctor not hearing what the patient is saying or the patient not being explicit enough." A study done at the University of Chicago Medical Center suggests that a major reason patients with "bad outcomes" sued their doctors was how their doctors had talked to them.
Unfortunately, because of managed care, doctors and patients may not have as much time during prenatal visits to get to know each other, notes Barbara Korsch, M.D., professor of pediatrics at the University of Southern California School of Medicine, and author of The Intelligent Patient's Guide to the Doctor-Patient Relationship (Oxford University Press). And if you alternate between several doctors in a group practice or HMO, there may be even less of an opportunity to build a trusting relationship over time.
Your expectations, however, need to be realistic. It's certainly reasonable to assume that your doctor will respectfully listen to your questions and concerns, says Dr. Levine. Your doctor should be easily accessible in emergencies, willing to return your phone calls within the hour if there's a serious problem, and prompt in letting you know about test results.
It's unreasonable, however, to think that a busy doctor will behave like your mother, therapist, or best friend. And although you may decide to write a birth plan, it's impractical to expect that you'll be able to control every detail of your pregnancy and delivery -- complications can foil even the best-laid plans.
Thanks in part to the Internet, which has made medical information more accessible, women are becoming better educated about pregnancy and want to be more involved in their care, notes Barry Egener, M.D., medical director of the Northwest Center for Physician-Patient Communication, in Lake Oswego, Oregon. Conflicts sometimes arise, though, when patients bring on-line material about alternative therapies -- such as herbal treatments for morning sickness -- that haven't been proven safe or effective for pregnant women, says Yvonne S. Thornton, M.D., director of the Perinatal Diagnostic Testing Center at Morristown Memorial Hospital, in New Jersey. You can certainly ask if your doctor has heard of a particular remedy and if she thinks it's worthwhile trying, but remember that not every treatment is appropriate for every patient.