Pregnant? Tips for Choosing Your Doctor - MetroFamily Magazine
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Pregnant? Tips for Choosing Your Doctor

by Stacey Allen

Reading Time: 5 minutes 

Whether you’re just thinking about having your first baby or you’re a seasoned mother with another one on the way, having a baby is a serious and life-altering process. The decision to have a baby is huge, and it’s immediately followed by another big choice: which physician will you choose to see your through your pregnancy and delivery? 

We had a chance to chat with Dr. Michelle Brunnabend, a new doctor in the obstetrics and gynecology field at the Women’s Health Center of Edmond with OU Medical Center, about tips for making the decision for new moms and for pregnant women who are interested in vaginal birth after cesarean, or VBAC. For first-time moms, she recommends starting by getting recommendations from friends and family.

“I would encourage women to select a physician who has similar philosophies as their own,” said Brunnabend, a graduate of A.T.Still University Medical School in Kirksville, Missouri. “This way, they are more likely to be happy with their care and have a mutually-desired outcome. They can best accomplish this by word-of-mouth through like-minded individuals and interviewing their physician at their initial visit.”

She suggests finding a physician who will support you in your delivery goals and plans. Once you have a list of recommendations from family and friends, start your homework by asking these vital questions:

  • Ask about the practitioner's approach to birth and if it matches your ideals. For example, some physicians don't allow doulas in the room. Also, there are different practices in regards to the level of intervention during labor and delivery. Be sure to ask if you can choose to have no interventions such as IV’s and ask about their standard practice when making the decision about when a cesarean birth is needed. You should ask what the doctor’s rate of cesarean births is. What does this doctor recommend if delivery gets complicated and why? What options do you and your doctor have if you’ve already had a c-section? (More on this below.)
  • Pain. It's scary, no matter who you have deliver your baby or where you choose to deliver it, to consider that pain is going to be a part of the birthing process. What's the OB's philosophy on epidurals and pain management? Can you choose what level of anesthesia you want or is it standard for this doctor to give epidurals all the time? If you don't want any pain management interventions, is the doctor okay with that?
  • At what facilities does he or she have privileges? Can I have my baby at the hospital I have in mind?
  • Is the doctor independent or part of a physician's group? And if so, does that impact who delivers the baby? (Many group practices have doctors who will not deliver on certain days of the week so it’s possible to end up with a doctor you don't know well.)
  • What is the philosophy of the doctor with their patients and their health through the pregnancy? What is his/her emphasis in terms of diet, exercise, vitamins, testing, etc.?

Regardless of your birth philosophies, asking the right questions should be able to guide you to the right doctor. 

While these are questions generally asked by women who are pregnant for the first time, women who have already had children may have different feelings going into pregnancy again. A hot topic among women who have had a cesarean section, or c-section, is whether or not it’s possible to have a VBAC, or vaginal birth after cesarean. A c-section is the most common surgical procedure in the country, with Oklahoma ranking the 12th highest state for rate of c-sections in the nation according to the Oklahoma Birth Network. 

Risks of the procedure for mothers include blood loss, infection and possible injury to nearby organs, in addition to mother-child bonding issues and delayed breast milk production. Risks for infants include possible preterm birth, breathing problems and a difficult time breastfeeding. While c-sections are sometimes important for safe deliver, vaginal birth after c-section is possible with the right physician. Dr. Brunnabend is one of the few physicians in the area who performs VBACs. Here are her thoughts on the topic:

Why can you perform VBACs and many of your colleagues cannot?

A majority of physicians in Oklahoma do not have malpractice insurance that enables them to encourage VBAC as a service they are able to provide. I am fortunate to be with a malpractice company that both supports and encourages VBAC as an option for my patients.

What are the advantages of VBACs? Why are they important to you?

VBACs have many advantages over a repeat cesarean delivery including decreased pain, shorter recovery time, lower chance of surgical complications and scar formation in the abdomen/pelvis, and lessened blood loss. VBACs also have risks associated with them which you should discuss with your physician so that these risks can be individualized to address your own situation. VBACs are important to me because it is important for women to be given all of their options for delivery and not just told that they can only have a repeat Cesarean delivery. This is an important part of what we call “informed consent” and giving women all of the risks, benefits and alternatives to all modes of delivery in an unbiased and informative fashion that will allow them to make the best decision for both herself and her babies.

I know it to be a relatively safe mode of delivery for some women who have had one and sometimes even two prior Cesarean deliveries and should be addressed and offered when appropriate. 

How common are VBACs and if a woman has already had a cesarean, what are the statistics on whether she can successfully have a baby vaginally after that?

After one previous cesarean delivery, the success rate of having a VBAC is approximately 60-70 percent and will differ based on the patient’s own history.

What are the criteria that you use to determine whether a woman could have a successful VBAC?

No. 1 is her willingness and desire to have a VBAC! After that, we would consider factors such as history of prior vaginal delivery, indication for first cesarean delivery, type of uterine incision of prior cesarean delivery(ies), history of major uterine surgery such as removal of fibroids, and number of prior cesarean deliveries to name a few of the major criteria.

About Michelle Brunnabend:

A graduate of A. T. Still University Medical School in Kirksville, Missouri, Brunnabend has attending privileges at both OU Medical locations but primarily practices at the OU Medical facility in Edmond. Always wanting to work in women’s health from early in her medical training, Brunnabend believes in the importance of “empowering and educating women with all their options.” She is pleased to provide VBACs for mothers not wishing to have multiple cesareans as well as all other women as they navigate their health and birthing options. 

“The city of Edmond has welcomed my family with open arms,” she said. “I am looking forward to giving back to this great community. My primary goal is partnering with the women of Edmond to ensure better outcomes.”

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