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The Informed Parent

The Pregnancy Consult

by Louis P. Theriot, M.D., F.A.A.P.
Published on May. 24, 1999

Mr. and Mrs. Jones have been married for 3 years and they are anxious to start their family. Mrs. Jones is eight months pregnant and with the exception of some morning sickness in the first trimester, things have gone rather smoothly. They have the names picked for the soon-to-be family member. The obstetrician knows the sex from an ultrasound, but the Jones’ wanted it to be a surprise. The nursery is all prepared with a fresh new coat of paint, a new crib and changing table.

Mrs. Jones pours over her To Do list and is pleased that almost everything is checked off. One final item on the list is the meeting with the prospective baby doctor that was recommended to her by her obstetrician. As they are getting into the car to meet the new doctor, she has to remind her husband why they are going to meet with him. "Gosh!", he pleads, "Our baby hasn’t even been born yet. What’s the big deal?"

Mr. Jones asks a legitimate question. What IS the value of the pregnancy consult before the baby is even born? If time allows and it is feasible, this visit is an important time for the parents to meet with the doctor in a comfortable, low-pressure setting without the pre-occupations with diaper bags, infant carriers and well-meaning family members who want to capture the baby’s "first visit" on film. It allows the parents to get a feel, or a true flavor of how the office operates. Many times when one walks into a brand new situation, he or she can tell if the chemistry is isn’t something that can be described in words, it is just a strong inner feeling. Ten out of ten friends may rave about a particular doctor or office, but after just spending a few minutes with that doctor, you can tell that it is not right for you. You MUST go with your feelings.

What should the Jones’ look for in the pregnancy consult? First of all, how far is the office from their home? What is the parking situation for the office---is it easily accessible? When they enter the office is there a waiting room for well children that is separate from the waiting room for sick children? How personable was the front office when she called to make the appointment?

After meeting the doctor and going over the usual pleasantries such as where he/she did their training, how long they have been with the group and whether or not they have children, it is time to settle in with more important matters.

The doctor should want to know about specific details about the pregnancy--who the obstetrician is, where Mrs. Jones will deliver her baby, and whether or not she plans to breast feed. It is also important to discuss if Mrs. Jones had any medical problems such as infections, bleeding, problems with blood sugars or blood pressure during the pregnancy. Was an ultrasound done at any time during the pregnancy and if so, was everything normal. Is Mrs. Jones taking prenatal vitamins and iron, or is she on any other medications? Does she feel the baby moving and has she experienced the fetus having the hiccups. This would be a good time for the Jones’ to ask if the doctor has any association with a lactation consultant should there be any problems with breast feeding. How committed is the doctor to work with them to establish successful breast feeding?

If the doctor doesn’t bring it up, the parents should discuss any questions they might have regarding circumcision if they have a boy. Somewhere in the "history gathering" pertinent family medical issues should be brought out such as allergies, asthma, diabetes or hereditary disorders.

Then the doctor should be asked about the workings of the medical practice. Does the doctor go to the hospital where the baby will be born? Will he or she be the one doing the exam on the baby when it is born? If it is a group practice, will one of the partners do the exam? If the baby has a medical problem requiring more intensive care, will the baby have to be transferred to a hospital that has a neonatal intensive care unit---and if so, who will take care of the baby then?

After the baby leaves the nursery and goes home with mom and dad, what is the schedule for well-baby visits, and what shots or immunizations can be expected? Will they have any problems making an appointment with their particular doctor, or will they have to see one of the partners? How difficult is it to get in to see the doctor that same day if the baby is sick? It is also important for them to find out how the office operates "after hours", when everyone has gone home. If they call at night or on weekends when the office is closed, will they be able to speak with a doctor from their group, or does the doctor "share" call with other groups? Are they expected to go to the emergency room or will the doctor "meet" them in the office.

Another area to discuss with the doctor is how the office handles routine calls during the day. Does the doctor return phone calls or is there someone who "triages" the calls. These are all important questions that should be addressed before being established as a patient in ANY medical practice because these are the things that invariably can lead to frustration and discontentment on the part of a patient...even if they "just love their doctor".

As the meeting is winding down, it would be a good time for the Jones’ to ask the doctor if he/she has any particular reading material that can be recommended to them. Are there any books that they should have as a reference?

After meeting with the doctor, it’s a good idea to meet with the office manager to discuss matters such as insurance and billing. What are the patients responsible for as far as submitting paperwork to the insurance companies? This would be a good time for the manager to give the prospective parents a tour of the medical office if it were practical.

As a pediatrician, I look forward to the pregnancy consult and take it very seriously. The soon-to-be parents are entrusting the care of their child, the most important thing in their lives, to the doctor. Hopefully this will be the start of a long and meaningful relationship. There will be times of joy and sorrow, happiness and frustration over the years. The pregnancy consult is a nice way to start such a relationship.

As they left the office, Mr. Jones held the car door open for his wife and helped her struggle into the car. In a kidding voice he said, "That was really informative and I feel good about the office. See, I TOLD you we should have made this appointment!". Mrs. Jones just rolled her eyes and said, "Yes dear".

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