Choosing a Health Care Provider For Your Prenatal Care

When searching for a health care provider to manage your pregnancy you want someone who is well-qualified, has clinical experience and has a good reputation among those who you trust the most. With this being said, there are still some additional (personal) factors that one should consider when selecting a provider for prenatal care. The prenatal care experience lasts close to one year (including postpartum follow-up) so you want to be sure the relationship you have with your prenatal care provider is well-suited.

Share The Same Philosophy As Your Prenatal Care Provider.

You should make sure you share the same philosophy about a few issues relating to prenatal care. You do not want to be in conflict with your prenatal care provider as you approach your delivery date. Often times there can be more than one management option for your prenatal care.  You and your provider must work together to decide what works best for you.  It is crucial to have a mutual understanding of the risks and benefits of a particular clinical approach.

Prenatal Care Provider With Your Best Interest At Heart.

The options available to you might be defined by the services offered within a particular clinical setting (hospital, birthing center etc.). Be sure your prenatal care provider's decisions regarding your care are not determined by what services are available when the services you want might be available at another health care facility.  You want to really be sure your prenatal care provider has your best interest at heart and will advocate for you when handling your prenatal care.

Prenatal Care Provider With Patient Loyalty.

If a provider is busy and has a loyal patient following, you should feel confident that your treatment will be based on what you desire. 

There are two main topics most often at the center of any discussion surrounding the choice of a prenatal care provider . It is crucial to address these topics right up front to secure a good relationship. You do not want to ever feel you were misunderstood or deceived about what your expectations were at the time of your delivery (assuming there were no unusual circumstances).

The topics I am referring to are: "natural" childbirth and pain management options. 

Whether you choose a midwife or an obstetrician as your primary provider the same holds true. In either case, providers can still vary tremendously regarding these topics. It is simply about being on the same page with your prenatal care provider at the start.

The definition of what natural childbirth is and what adequate pain management is, can differ depending on who you talk to and what resources you read. It is very easy to put these topics aside at first as there is so much excitement about the pregnancy and the fact that your delivery seems so far off in the future. My suggestion is to initially discuss these subjects thoroughly and do not gloss over them. 

I think pain control in labor is a crucial topic you should discuss with your prenatal care provider from the start. I can think of nothing more upsetting to a patient than to not be in control of her options for pain control particularly if she is not aware of what the options are.

This article is certainly not the place to define natural childbirth or discuss pain management during labor. I simply want to bring this important topic to your attention.

The last question to consider when choosing a prenatal care provider has to do with who is anticipated to be there for your delivery. As a result of the tremendous overhead (medical practice expenses) and lifestyle issues for practitioners, it is virtually impossible, in this day and age, to be assured that you will have your prenatal care provider at your delivery. As a result , it is important for you to be aware of your prenatal care provider's arrangement for on-call coverage. Cross-covering with other prenatal care providers at the same health care facility is not unusual and may be necessary depending on the size of the medical group you are seeing for your prenatal care. It is simply about having this discussion with your provider at the start. Discussing these issues is what maintains a trusting relationship with your prenatal care provider.  The timing of events surrounding labor and delivery is not always foreseeable and there is not a perfect solution every time. What is important and acceptable to most patients is that a reasonable effort is made to fulfill one's expectations.

By: Douglas Penta MD, OB/GYN (Platinum Author)

Avoid Long Waiting – How to Schedule Your Prenatal Care Office Visits

By: Douglas Penta MD OB/GYN  (Platinum Ezine Author)

This is the type of information I enjoy sharing with my readers. Advice that is intended to be practical and very applicable, to help you with the little things that can make a big difference.

When scheduling an OB/GYN office visit, it is helpful to first have an understanding of how a women’s health medical practice is managed on a daily basis.

In OB/GYN, there are many unpredictable factors that can impact how efficiently a practice will function from day to day. Unexpected events can disrupt even the most well thought out office schedule. Miscarriages, surgical emergencies and patients in labor are unpredictable events.

Granted there are always coverage arrangements in place to meet practice demands, but even with this being the case, there will always be occasions when the medical staff will be over-extended. When this happens, it is our hope, as providers, that patients will be understanding.

I am very sensitive to the total amount of time which can be lost by a prenatal patient during the course of her prenatal and postpartum care. Frequent visits can result in a significant amount of lost time from their daily schedules, including travel time, etc.

Providers dread running late for patients and even worse having to reschedule a patient, as this is not good for the relationship. Furthermore, it can often feel like a double standard to the patient, if the provider cannot see her. Patients wait for doctors… why shouldn’t doctors wait for patients?

The recommendations I am going to list below are extremely simple and intended to help minimize some of the inconveniences and frustrations associated with scheduling office visits:

• Book in advance.  Try to book as many appointments at one time as is possible/allowed so that you can get the times that you want. The intervals between appointments will be determined by the gestational age of your pregnancy.  Generally, appointments start about every 4 weeks, then become every 2 weeks, then every week as you approach your due date.
• Schedule early in the day.  You want to keep your appointments at the start of your provider’s work day. This will reduce the possibility of problems occurring that can set your provider behind. If you are scheduling an afternoon appointment, try to get a time immediately after lunch (at the start of the afternoon session). Most providers, who are running behind, will tend to use their lunch time as a buffer to catch up if their morning session runs late. Needless to say, this might mean giving up their allotted time for lunch but that is simply how schedules are kept on time in this setting.
• Call ahead.  Whenever possible, phone ahead to determine whether your provider is running on time. Most practices are glad to hear from you before you arrive so they can address a potential delay in the office schedule. When I am behind and am asked what to do about a patient who is inquiring, I much rather hear that the patient is on the phone and not sitting in the waiting room. I feel I have more flexibility, perhaps I can see the patient for the last appointment of the day or during a canceled appointment time that might have been called in earlier that day.
• Schedule when more than one doctor is in the office.  If there are choices to schedule your appointments, try to schedule on days when there are more than one provider in the office. As a result of surgical schedules, providers being on-call or just coming off call (at the hospital) there can be days with limited office coverage. This is no fault of anyone, it is simply part of the logistics of maintaining an office practice. If there is only one provider in the office (“your provider”) it can take just one urgent problem/emergency to disrupt a schedule for the rest of the day as there is no one else in the office to help catch up.

I hope these suggestions are helpful to you and also will help you have a better understanding of why there may be a wait for routine office visits.

Douglas Penta MD OB/GYN

Prenatal Care Blog

Low Back Pain During Pregnancy

Low Back Pain During Pregnancy by Douglas Penta MD

Low back pain during pregnancy is a common problem. There are a number of conditions that can cause this symptom and this article is by no means all inclusive.Perhaps the most common cause is simply the weight of the pregnancy particularly in the third trimester creating a strain on the back muscles and ligaments used to maintain your body stature. This is often seen more in women who have had one or more prior pregnancies as the supportive structures are loose and more likely to cause pressure on nerves innervating the lower back and pelvis. Assuming the pain is constant and has not been attributed to other problems (some of which are yet to be discussed), the use of belly bands or maternity support belts can be very effective in addressing the problem as they lift the weight of the pregnancy off of the lower pelvis and transmit the weight in such a way as to alleviate the strain on the back muscles and ligaments.

Another cause of low back pain during pregnancy, though less common, can be a symptom of a kidney infection. This can be seen most commonly after the first 15 to 20 weeks during which time the ureters leading to the bladder can be blocked by the uterus at the level of the pelvic brim. This blocks urinary flow to the bladder and can cause stasis of urine and increase the potential for a kidney infection (pyelonephritis). This is a problem that must be diagnosed and treated promptly as kidney infections can cause premature labor.Kidney stones is yet another problem that can cause low back pain and is determined by your primary care provider based on your symptoms, medical history and physical findings.Though all of the previously discussed causes of low back pain can be serious and cause significant discomfort the one cause of low back pain that is very important to recognize and not overlook is contractions. The low back pain relating to contractions is likely to have a regular, intermittent pattern unlike the other causes and is best evaluated by monitoring uterine activity with a uterine monitor for contractions. Causes for contractions prematurely can relate to dehydration, kidney infections, fibroids or have no defined cause. Regardless of the cause this is one cause of back pain that cannot be ignored.

Though there are other less common causes of low back pain during pregnancy the conditions mentioned above are the most common.

To best avoid low back pain during pregnancy, lift heavy items with caution and maintain posture as best you can. Keep well hydrated at all times particularly during the hot weather as dehydration occurs often during pregnancy if one does not make a conscious effort to drink eight to ten glasses of water a day. Prenatal visits are designed to pick up signs of bladder infection as prenatal care patients have their urine checked at each visit.If there are no serious medical problems detected leading to the onset of low back pain during pregnancy and the symptom is determined to be due to the weight of the pregnancy, perhaps the absolute best thing you can do to prevent or alleviate low back pain and ligament pressure is to use a maternity belt. I have seen patients experience a tremendous amount of relief with maternity belts. It used to be that such belts were hard to find but with the resources available online this is no longer a problem.

I hope this article has been informative about some (not all) causes of low back pain during pregnancy. Again this is only for educational purposes and any questions or concerns relating to this problem must be addressed by your primary care clinician.

For more information about pregnancy and your prenatal care please visit:
http://womenshealthandfitnessblog.com
This article is for educational purposes only and is not a replacement for the care you receive from your primary care clinician. Only your personal health care provider can manage your medical problems as he/she has the necessary history and physical information required to address your particular problem. This article does not include all causes of low back pain during pregnancy.

Article Source: http://EzineArticles.com/?expert=Douglas_Penta_M.D.

Article Source: http://EzineArticles.com/8342715

Gestational Diabetes By Douglas Penta MD

There is a distinct difference between adult onset diabetes and juvenile diabetes.

Pregnancy-related diabetes, better known as gestational diabetes, is also important to understand should this condition arise during your pregnancy. I hope this article will clear up any questions regarding the distinction between these various types of diabetes mellitus. Unlike many medical conditions that are not fully understood, diabetes is well understood and regardless of what type you are dealing with, the goal is the same: to maintain an overall normal range of blood sugar levels to prevent organ damage associated with uncontrolled diabetes, including heart disease, renal disease etc..

Juvenile diabetes is perhaps the easiest to understand as it relates to a lack of insulin production by cells in the pancreas and is thought to be a result of genetically predisposing factors and viral-mediated in certain cases.

Adult onset (AODM), is very different in terms of its cause as it is not related to a lack of insulin production, but instead, to the ability of insulin receptors to respond to the insulin. AODM is controlled well with life style changes and in many instances such changes alone can resolve the problem ( changes include weight loss and changes in diet and exercise). I have actually seen many overweight patients with AODM, lose weight such that the condition no longer required treatment with medication.

Finally, as an OB/GYN physician I must mention the diabetic condition I have dealt with most often during my career and that is gestational diabetes (diabetes relating to pregnancy). It is routinely screened for during pregnancy and is most like AODM as it is a lack of response of receptors to the insulin that is present and not a deficiency of insulin.

I have had many patients on very large doses of insulin for gestational diabetes to maintain normal ranges of blood sugar. The insulin receptors are not sensitive enough to normal levels of insulin and thus the need for additional insulin supplementation. Women with gestational diabetes are thoroughly educated about how to maintain normal blood sugar levels and it is a task that takes a great deal of education/instruction.

Gestational diabetes can be indicative of a predisposition to diabetes later in life and thus it is important to follow-up one’s blood sugar after delivery and be conscious of this possibility later in life. In the majority of cases the diabetic condition associated with pregnancy resolves immediately after delivery of the placenta.

I hope this information is helpful. It is not intended to diagnose, treat, cure or prevent any condition; however, the more one understands the cause of a particular condition the more proactive one can be about the management.

Douglas Penta MD

Article Source