Selecting a Pediatrician
Denise Bolds, MSW CD(DONA) August 31, 2017
A pediatrician is a medical doctor specializing in children and their diseases. The pediatrician is one of the most important components of successful parenting. Newborns, infants, children, adolescents and teens with their parents interact with the pediatrician very closely, providing, education, advocacy and resources as well as medical knowledge. The pediatrician has a contribution to how parents parent their children and how children grow up embracing the value of their health.
New parents may have never encountered a pediatrician as an adult. They either fondly remember their pediatrician or forgot them. Many parent-to-be get referrals of pediatricians from family and friends. First, make sure the pediatrician is board certified and accepts you/your partner/spouse’s health coverage. Try to have one close to home if possible.
As new parents, you have the right to interview pediatricians and pediatric practices. Here’s some suggested questions to use when interviewing pediatric provider prospects:
1. How large is the practice? Do you want the pediatrician to be of the same gender as your newborn? This can be helpful when your newborn becomes an adolescent.
2. What is the on-call procedure for this practice?
3. Is this pediatric provider immunization friendly? Are they willing to spread out immunizations for your baby?
4. Is the practice open to working with new parents? You will have questions - many of them. Can this practice work with you both or find your queries bothersome?
5. What is the waiting room procedure like? Will your newborn be in the same waiting room as a sick child? Can you & your newborn be put directly in an exam room or wait in the lobby/car until it’s your turn and you are called on your call phone to come in?
6. Is there a well waiting room and a sick waiting room or just one for everyone?
7. Where does the pediatrician have hospital admitting privileges? Is your health insurance accepted there?
8. Is this pediatric practice breastfeeding friendly? Do they have an IBCLC (breastfeeding expert) on staff?
9. Can they recognize a lip tie or tongue tie? This is helpful if you are having challenges in breastfeeding.
10. Are there any fees for forms or copies from this practice?
11. Is this pediatric practice diverse? Do they have same-sex, interracial families they support?
12. What are the office hours? Any late night or Saturday appointments?
Remember! Pediatricians get reviews too! Check them out on line!
I remain deeply grateful to Dr. Peter Gergely of Gergely Pediatrics, Garrison NY for over 20 years of excellent care for my son and empowering me as a single parent!
There’s a satirical storybook sold on Amazon on this subject. It’s a very serious subject: parenthood and sleep. As a certified birth doula and an experienced single mother, I can relate to this subject from both professional and personal levels.
Human beings need sleep. When a pregnant woman sleeps, her body relaxes; allowing for the amazing science of the body to preform functions that benefit her and her unborn baby.
Sleep rejuvenates the body and uses less energy to do so. It is scientifically based; the human body’s temperature decreases during sleep. A woman in the pushing stage of labor falls into a deep, resting sleep in between contractions allowing her body to rest before pushing again. This is the true essence of a ‘power nap’.
After the birth, the new mom’s adrenaline is still going strong. A few hours later, she will feel the exhaustion of her labor. With the support of her partner, labor and delivery staff and her doula, she can get some rest… maybe.
If the mother has a Caesarean- section or any other complications from the birth such as excessive bleeding, she will continue to be closely monitored by the labor and delivery staff every 15-30 minutes for her blood pressure, temperature and to check her uterus. Once stable, the new mother will be monitored less frequently. Many women say they cannot sleep in the hospital after the birth no matter how the medical staff implores her to rest. This can be the result of the environment (bed, lighting, noise, room co-sharing) or policy (frequent vitals checks).
Once the parents go home with the new baby, there is a transition of assimilation to the environment for the baby who just spent the last ten months in the mother’s uterus. The new mother also adjusts to her hormones reverting back to non-pregnant, normal self. This will include hot flashes, restlessness, hair loss, etc.
The new mom is also adjusting to breast/bottle feedings, counting wet/poop diapers, bowel movement, stitches, moving around and more. Family and friends come to visit, everyone is excited to see the new baby. Everyone has a gazillion questions and photos. It’s smart for the new parents to ask for cooked meals from the visitors; it’s a great help. The mother needs something else: sleep.
Sleep deprivation is used as a training tool from the military to medical school. Sleep deprivation is defined as a condition of not having enough sleep; this lack of sleep affects organ function and cognition. It is also known to cause clumsiness and poor judgment. Having a lack of sleep can cause high blood pressure, weight gain/loss and heart disease. Lack of sleep in addition to giving birth places the mother’s body in a no-win situation. Many fatal accidents involving infants are the result of parents not having enough sleep.
Sleep deprivation and the new mother equals a higher incidence of postpartum depression in the new mother.
Mothers are usually hesitant to disclose their fatigue; society projects the “suck it up” and “the rite of passage for the mother” attitude. Many new mothers are reluctant to admit to sleep deprivation for fear of being labeled as ‘weak’ or ‘complaining’ this social expectation can kill. Every year there are fatalities of infants where the exhausted parent fall asleep holding them.
Many new parents experience insomnia from anxiety; there is fear present that something may happen or go wrong with the baby if parents go to sleep. Post Partum Maternal Anxiety is real. This is anxiety that something like SIDS will happen to the newborn if left unattended. The new mother experiencing this anxiety will watch her newborn constantly, be reluctant to put the baby down, and more. Sleep deprivation, the lack of sleep/rest places the body into ‘overtime’ with major organs such as the heart and brain suffering the most. Mothers will often forgo sleep to complete chores, tend to pets, other children in the home and of course be the perfect hostess to the constant flow of visitors. Many moms simply cannot go to sleep unless someone is up watching the newborn. This new mom may also have trouble sleeping if she hears her baby crying even with the other parent taking care of the baby.
There’s a solution.
For the first 45 days after birth, limit the amount and duration of visitors to the new mom/baby. Delegate household chores and responsibilities in advance to those who are willing and reliable. Hire a postpartum doula to support the family with sleep solutions for newborn care while providing security to the family (especially Mom) the baby is well cared for while they sleep. Teaching new parents about newborns safely sleeping on their back, in a clear crib/bassinet and no co-sleeping. It’s vital to acknowledge Post Partum Maternal Anxiety by working with the new mom in her sanctuary (home) building trust, comfort and reasonable goals as a new mother. Fathers and partners can also experience Post Partum Parental Anxiety. Successful motherhood is not just the birth registry, the shower or the birth; success continues with postpartum support that provides security for the family to enjoy the miracle of life.
Denise Bolds, MSW CD(DONA)
January 9, 2017
Here’s A Scenario:
A pregnant woman is faithful to her obstetrician care she currently receives. This mother-to-be has an awesome relationship with her prenatal provider: the medical professional is aligned with this woman’s beliefs and approaches to birth. The obstetrician recommends the prenatal woman to take a tour of the local hospital labor and delivery unit where the obstetrician has privileges; the mother-to-be will give birth at this facility.
After taking the tour of the labor and delivery unit, the pregnant woman is distraught; she cries all the way home in her car. The hospital tour she just participated in is the complete anthesis of her obstetrician’s care and service. The pregnant woman also finds out after doing research the hospital the obstetrician has privileges in is not baby friendly; it also has a high cesarean-section rate.
The pregnant woman is now faced with a dilemma; she’s 27 weeks into her pregnancy; she must accept her current provider and facility or start over with a new provider and facility as well as building a relationship from scratch. She goes to her obstetrician’s office and requests her medical records to be sent to a new provider… The current obstetrician only sends appointment dates. The pregnant woman calls her doula for guidance on how to navigate this scenario efficiently and correctly.
As a certified birth doula, I have several of my clients face this very same issue every year. It is immediately assumed that if the OB provider works well, the hospital will fall in the same line as well. This is a huge fallacy and a stressor for pregnant women.
Can Get There From Here…
Every woman who becomes pregnant has choices. It is the diligence that is often neglected. The obstetrician maybe completely likable and even wonderful; however, the institution where he/she has privileges to deliver at is also vital. What does privilege mean? Medical practitioners have to be approved by a hospital before treating patients there: there is a credentialing check that takes place as well as malpractice coverage, and of course insurances accepted. It is a lengthy process. In the sanity of business, obstetricians usually support births at a local hospital where they provide prenatal care. It’s like an accord (agreement/understanding) between medical groups and practitioners not to encroach upon one another. It is territorial; most times the doctor has no say or influence in the hospital they attend births at.
Baby friendly is a designation a hospital’s labor and delivery unit applies for: it is a lengthy process that involves policy change and training of staff. A baby friendly hospital supports rooming-in of mother and baby, no formula, breastfeeding support and the labor policies allows the laboring mother more flexibility.
It is imperative the mother-to-be is aware of the polices and practices of both the prenatal provider as well as the institution she will birth at; same approach applies for midwives who support births at hospitals. If the pregnant woman utilizes an OB/GYN group for her prenatal care, there is a strong possibility she will not have her OB she likes when she goes into labor as the OB staff does take call on rotation.
Keep in mind having a c-section is major abdominal surgery with increased risks, interventions and recovery than a natural vaginal birth with little interventions. A birth doula who is skilled can provide education support in this area as the pregnant woman makes her decisions with her partner. Having a birth preference is also a tool of empowerment. (more on that in another blog)
Know Your Rights!
A patient has the right to change providers. A patient has the right to request their medical records and have access to them. All that is required is a signed release giving the office permission to release records and it is up to the pregnant woman to collaborate the prenatal care team she wants. It takes some diligence…
Always know the cesarean section rate of any hospital and practitioner. There are several ways to research this on the internet:
Do take the time to research c-section rates. Also, make sure you contact your insurance provider to inform them of your change in prenatal providers. You do have the right to make that change. No pregnant woman should have to face giving birth with a provider or facility that they are uncomfortable with or uncertain of. This stress will have an impact on the woman’s labor and birth.
Building A Supportive Team.
A supportive team for the pregnant woman is more vital than her birth registry and the size of her baby shower combined. Having a birth doula that supports and understands the pregnant woman and her partner’s beliefs and wishes is also part of the team. The doula also has resources and considerations that the parents-to-be may not have ever considered. It is also vital to have your prenatal practitioner and institution where the birth will take place also be a part of the team. Having a supportive team positively impacts the birth and bonding of the baby and parents. It also provides respect for the doula to provide education and resources while respecting the policies of birth professionals/institution. The pregnant woman is never to feel trapped and voiceless. There’s nothing more beautiful than witnessing a pregnant woman’s confidence in her birth.