Doctor Who?

In many Twin Cities clinics, continuity of prenatal care is a thing of the past.

It bothers some women more than others that their labor physician is based on luck-of-the-draw. For her second pregnancy, Paulette Mattson saw one obstetrician prenatally but didn't know who would be on call for her delivery at Fairview-University Medical Center in Minneapolis. "Here I had spent all this time, prenatally, with one physician, and he wasn't even going to be there to see the end result," she says. "But when the time came, I really didn't care. I just wanted somebody who had a medical background to get the baby out!"

For Paulette, having a prior relationship with the doctor who delivers her child isn't as important as his or her bedside manner. With Paulette's first pregnancy, the obstetrician she saw prenatally was also there for the delivery, but only "for the last half-hour, the last hurrah," she says. Moreover, he was "kind of a cold person. I know doctors are busy, but right after Sarah was born he rushed off to do another operation. Sure, it was nice to know that he was going to be there, but what counts is whether he is compassionate," she says.

Nancy Nelson, R.N., supervisor of operations at Park Nicollet Meadowbrook Clinic in St. Louis Park, feels it would be to the patient's advantage to see the same person from prenatal care through delivery. "You form a stronger relationship. The trust aspect is increased." But, she adds, many women who elect to see a physician (as opposed to a nurse midwife) for maternity care "come with the idea, 'Just get me through the pregnancy and I don't care who does the delivery.' The women rely more on themselves to get through the labor process."

Bridget is a good example of that philosophy. "Before I went into labor, it bothered me that I didn't know what physician would be there," she says. "But during labor--maybe because of the drugs--I didn't care as long as my husband was there. That gave me the most comfort. The doctors were just in and out. It was my labor, and I felt I wanted to handle it myself," she says.

Because of the discontinuity in physician seen for prenatal care and for labor/delivery, some clinics ask women to rotate through the physician group and see them all prenatally. This way, the woman will have at least met the physician who is on call for her delivery. However, she may meet a physician during prenatal care whom she really dislikes, and feel anxious about encountering that physician during labor.

Johanna Bomster had her first baby in April at Abbott Northwestern Hospital in Minneapolis. She had been encouraged to see all five physicians practicing at Women's Health Consultants in Minneapolis during her prenatal care. There were two doctors in the group that she hoped not to see in the hospital birthing room. "One was very brisk and abrupt, and another I just didn't connect with," Johanna says. Although it was not possible to request that these doctors not attend her delivery, "I was really fortunate," she says. "I had seen the physician who delivered my baby for five of my prenatal visits, including the last two. And I liked her. In my childbirth preparation classes, all the woman were saying, 'I hope I get so-and-so for the birth.' But we all knew it would be whoever was on call."

At some clinics, a patient can ask that a certain doctor not attend her birth. "A woman may have encountered a physician before in an emergency situation and she will tell us that under no circumstances will she allow that physician to touch her. Or she may have had an undesirable circumstance with a first pregnancy and she can request not to see that physician again. We always have a back-up physician on call for situations like that," says Nancy Nelson of Park Nicollet.

Women who are really uncomfortable with the idea of seeing a strange doctor in the delivery room can better their odds at some clinics. The HealthEast obstetricians try to deliver their own patients during the daytime, whereas at night usually the person on call does deliveries. "It's at least a fifty-percent chance that a woman will be delivered by her own doctor," says HealthEast's Laura France, M.D. "And I tend to try to deliver my own patients at night as well, because I am the only female in this group and my patients often come to me for that reason. Or if I have a particular patient that I know wouldn't do well with another person, I will cover for that as well."

HealthPartners is aiming to be able to assure patients that one of the providers they see prenatally also does the delivery, "but we don't have that just yet," says John Yeh, M.D., head of OB-GYN. "There are circumstances in which a physician will come in for a particular patient's delivery. There may be a special medical problem or a special understanding," he says. But, in general, a HealthPartners patient has about a one in ten chance of seeing her doctor at the delivery.

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