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How to Choose the Right OB for You · Flourish- A Prisma Health Podcast

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Cheryl Martin (Host): Bringing a baby into the world is an unforgettable
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time for a mother, and pregnancy comes with many birthing choices.
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So, being well-informed before your decisions is key.
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Here to discuss some of those options is Dr.
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Matt Scalise, an obstetrician and gynecologist with Prisma Health.
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This is Flourish, a podcast from Prisma Health.
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I'm Cheryl Martin.
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Dr.
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Scalise, great to have you on to discuss an important topic for expectant mothers.
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Dr. Matt Scalise:
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Thank you so much for having me, Cheryl.
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It's a pleasure
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Host: So before we talk about options, why don't you share a
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little bit about your journey as to why you chose to be an OB-GYN?
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Dr. Matt Scalise:
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Thank you so much.
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I think that's such a crucial question.
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I get asked that a lot, particularly as a male provider.
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But I became an OB-GYN, because it's one of those few specialties where you
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get to be a part of some of the most important moments in a person's life.
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There is just something so special about taking care of patients through
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pregnancy and delivery, being there for the excitement, the anxiety,
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the unexpected turns, and ultimately helping bring a baby safely into the
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world, and that really never gets old.
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But I also love that OB-GYN is not just about delivering babies.
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You get to care for patients across so many different stages of life,
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adolescence, contraception, fertility, pregnancy, postpartum, menopause,
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surgery, everything in between.
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And that mix of relationships and procedures, where one day you're
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counseling someone through a really personal decision, and the next you're
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delivering a baby, and then managing an emergency, and then doing surgery.
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It's just an emotional, technical, unpredictable, and very human
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specialty that was so amazing.
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Host: Well, I can tell that you are passionate about your job and that
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you love it, that it's a calling.
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So, what does a woman need to keep in mind when choosing an obstetrician?
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Dr. Matt Scalise:
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Yeah.
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Before we jump in, I just should probably acknowledge the obvious, and of course, I
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am a man, so my personal labor experience is extremely limited, and by which
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I mean it's completely nonexistent.
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I've never had a contraction.
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I've never felt a baby kick in my belly, and I've never had someone tell me
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to just breathe while I was actively questioning all of my life decisions.
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But that absolutely shapes my perspective.
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You know, what I can offer is the perspective of an OB who
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has cared for lots of patients through labor and delivery.
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I'm really happy to chat about the different nuances of obstetric care.
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And I always want one thing to be clear: Birth is not something
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that providers should control.
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It's something we should help support, guide, and make as safe as possible.
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And so, getting into your question about what do women need to keep in
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mind when choosing an OB provider, think of the OB provider as like
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choosing your birth team captain.
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You want someone who makes you feel heard, safe, informed, but also
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someone that's going to help push you to do something you didn't think
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your body was going to be able to do.
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You want to have a cheerleader, but you also want to have someone that's
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going to be open and honest with you.
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And there's three additional things.
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I really want people to consider, and I wrote this down.
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And the first, communication style matters.
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So, you need to feel comfortable asking questions like, "Why are we doing this?"
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Or, "What are my options?"
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Pregnancy comes with a lot of different decisions, and you want a provider who
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can explain things clearly without making you feel silly or dumb for asking them.
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And number two, ask about your provider's philosophy of care.
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Some patients want a very low intervention experience, while others want an epidural
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as soon as they hit the parking lot.
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Now, none of those things are bad or anything in between is wrong, but
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the key is finding a provider that supports your goals but is also honest
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if medical circumstances would change.
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Now, the third thing is thinking about the whole system and not just one person.
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And what I mean by that is that the reality of modern OB practice is that
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it's shifted from smaller private practice groups to a larger group model.
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So as a result, you often are considered a patient of the practice
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rather than a specific physician.
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And so, a good question to ask may be, you know, who covers after hours
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or on the weekends, or who delivers you if your provider is not on call?
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What hospital do they deliver at?
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What resources are available in terms of anesthesia, nursery
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versus NICU, blood bank even?
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Now, I don't think patients need to be necessarily asking about the minutiae
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of pregnancy care at that stage, but having a basic understanding of how the
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practice works and what capabilities the hospital has is very important.
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The bottom line is choosing someone who respects your birth preferences, but also
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needs to be prepared for birth realities.
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Host: What I love is you don't mind the questions, you actually welcome them.
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Dr. Matt Scalise:
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Absolutely.
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I think any time your provider is giving you any flak for asking questions
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or taking ownership of your personal health, that's certainly a red flag.
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Host: So, what is a birth plan?
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And what should you consider when creating a birth plan?
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Dr. Matt Scalise:
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a birth plan is basically a written guide to your preferences for labor, delivery,
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and the immediate postpartum period.
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But I like to think of this more of like a birth wish list because
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birth is not always something we can fully "quote-unquote" plan.
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Babies are wonderful, but man, they are terrible at reading the itinerary.
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So, a good birth plan should cover stuff like labor preferences, number one.
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And that means, in terms of movement, position changes, what kind of music
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or lighting do you want, who is in the room or not in the room, in-laws
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included, whether you want a doula, IV preferences, monitoring preferences.
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The next thing would be pain management.
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So, you know, kind of mentioned briefly, unmedicated labor versus using adjunctive
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pain medications such as nitrous oxide versus epidural or just saying,
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"Listen, I'll decide when I get there."
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Another thing to put in your birth plan is delivery preference, meaning, "What
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kind of pushing positions do I want?
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Do I want a mirror, delayed cord clamping, skin-to-skin?
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Who cuts the cord?"
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And lastly, newborn preferences.
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Breastfeeding versus formula, really capitalizing on that golden hour.
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Newborn medications and vaccinations they prefer, and then talking about
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circumcisions if it's applicable.
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But the most important thing is to keep that birth plan,
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that birth wish list, flexible.
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A birth plan should never feel like a contract with your
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medical team, in my opinion.
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It's more of a conversation starter.
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I feel like there's so much stuff out there on social media that's
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definitely added to the colorful flavor of many birth plans.
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And sometimes, while some things on social media are rooted in
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truth, it may not be as clinically applicable to that particular patient.
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And so, patients sometimes there can be an adversarial dialogue that happens
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between the provider and the patient if what they've heard maybe doesn't coincide
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with that provider's recommendation.
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So again, having that open and honest discussion is so important so that
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we can come together to find a good birth plan that fits within what
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you want to do, how you envision that birth, but also it's safe.
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My ultimate goal is a healthy mom and a healthy baby.
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And as long as we can agree on that, I think we're in good shape.
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Host: That's great.
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Now, you know there are a lot of options these days.
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So, one question is, why should you choose a hospital for your baby's birth
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versus a birthing center or home birth?
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Dr. Matt Scalise:
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People sometimes think choosing a hospital means giving up a
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calm or natural birth experience.
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Now, that's honestly the furthest thing from the truth.
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A hospital can still support a very personal, low intervention birth, and
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especially at Parkridge where I work at.
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But it also, most importantly, gives you immediate access to emergency
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resources if it's necessary.
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The biggest advantage of a hospital is that if things change
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quickly, help is right there.
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Labor can be a beautifully normal, labor course hours and hours.
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And then, suddenly require immediate intervention for bleeding, fetal
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heart rate concerns, or shoulder dystocia, severe blood pressure
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issues, infection, so on and so forth.
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I recently had a patient with a very uncomplicated term delivery, but
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their baby had trouble breathing as soon as baby came out with delivery.
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And we suspect this is due to some type of something called a meconium aspiration.
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And meconium is baby poop, and sometimes babies, when they're in
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some distress in the womb, they poop and that's called meconium.
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And if they aspirate that, they breathe that into their lungs, it can cause a
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lot of irritation and makes it harder for those babies to move oxygen more
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easily, which can be really concerning when you're trying to comfort baby.
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Baby's not breathing as well as we want, still a little blue perhaps.
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And in that particular circumstance, we're able to really quickly and
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seamlessly identify that being an issue.
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We're able to transfer that baby to our nursery to get some additional respiratory
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support, and that baby was back in the room with mom just a few hours later.
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What I lose sleep over is thinking about those moms out there with home
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births having something like this, despite being uncomplicated and
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low risk, but not having that right staff or that training or equipment
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to intervene when something happens.
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So, I say all this not to scare patients.
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I really think that scare tactics have been used way too often
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to over-medicalize pregnancy.
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But it's also true that a planned home birth is associated with a higher
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risk of perinatal death, neonatal seizures, and comparatively speaking
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to hospital births, even though that overall risk is very, very low.
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Now, it's also important to know that certain things like fetal malpresentation,
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you know, like a breech presentation or, basically, if baby's not head down,
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if you've got multiple pregnancies, twin, triplets, et cetera, or a prior
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C-section, those would be definite contraindications to a planned home birth.
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Now, that doesn't mean that every patient needs to have a highly medicalized birth.
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It means that the safest place to have, again, a "natural birth" is
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often a place where the medical backup is immediately available.
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The hospital is not there to take over your birth.
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It's there to be ready if birth decides to take a turn.
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Host: I'm glad you mentioned natural childbirth.
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So, how can you have a natural childbirth in a hospital?
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Dr. Matt Scalise:
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You can absolutely have a natural childbirth in a hospital.
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Hospital birth does not automatically mean epidural, Pitocin, lying flat on your back
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and bright lights with med students and strangers looking at very intimate parts.
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For many low-risk patients, hospitals like Parkridge, where I work at,
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support movements during labor, wireless monitoring or intermittent
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monitoring when it's appropriate.
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We've got birthing balls, peanut balls, squatting bars.
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There's hydrotherapy and showers.
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We've got doulas and support folks, low lighting, music, aromatherapy,
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delayed cord clamping, all sorts of things that would historically
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be associated with, again, quote unquote, "natural childbirth."
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But the key here is just communication.
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We want you to tell your team, "I'm hoping for an unmedicated birth.
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I'd like support with movement, positioning.
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I want coping techniques."
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That lets your nurses, your provider, your support team help protect that goal.
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And also, just to be clear, getting an epidural does not mean you failed.
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Needing Pitocin at any point in labor does not mean that you
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failed and your body can't do it.
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And even having a C-section doesn't mean that there's something wrong.
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The goal is not to win a toughness contest.
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You don't get a special certificate if you've had an unmedicated birth.
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The goal is to feel informed, respected, and safe.
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Host: What is midwifery care and when is that a good option?
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Dr. Matt Scalise:
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Midwives or midwifery care, these folks are just experts in normal
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low-risk pregnancy and birth.
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Now, their care model often emphasizes education, prevention, emotional
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support, physiologic labor, kind of helping patients avoid unnecessary
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intervention when it's safe to do so.
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Now, OB-GYN physicians, obstetricians, gynecologists, they're trained in
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both normal and high-risk pregnancies.
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And I would say they're also surgeons.
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So, that means that they manage complications, that can arise
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in pregnancy, such as severe hypertension/preeclampsia, heavy
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bleeding, abnormal kind of heart tracings requiring either operative
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vaginal deliveries or C-sections.
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So, I don't like framing it as like, you know, midwives versus doctors.
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And the best systems, which is what we have and what I'm really
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proud of at Parkridge, is that it's a very collaborative approach.
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Midwives are excellent at supporting normal labor, and our OBs are there for
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higher risk situations or when birth needs medical or surgical intervention.
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And a kind of simple way to say it is that mid-midwives specialize in
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supporting normal birth, while OB-GYNs are trained to manage both normal birth and
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complications, and especially when surgery or higher level of medical care is needed.
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So that's kind of my philosophy
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Host: And what is a water birth and when is that a good choice?
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Dr. Matt Scalise:
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A water birth usually refers to laboring and sometimes
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delivering in a tub of warm water.
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It's very popular because warm water can help with relaxation, pain control,
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mobility, and that feeling of being kind of less on display during labor.
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But it's an important distinction between laboring in water and
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delivering underwater, which those are not really the exact same thing.
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So, for appropriate low-risk patients, water immersion during the first stage
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of labor up until about six centimeters can be a really helpful comfort tool.
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But delivery underwater is more controversial and depends heavily
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on particular hospital policies.
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And so, definitely inquire about water birth options depending
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on where you wanted to deliver.
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But also, provider comfort factors into that, patient risk factors,
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and just having emergency readiness on hand is also important.
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So, some hospitals allow laboring in water but ask patients to get
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out of the tub for delivery, while others have more formal water birth
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programs with specific criteria.
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So, water labor may be a good option for someone who is full-term, low
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risk, they've got a reassuring fetal status, there's no infection concerns,
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there's no need for continuous interventions and then, importantly, a
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facility and staff that's trained and clearly follows some safety protocols.
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Water can be a great tool in labor, but like every tool in birth, it
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works best when we use it for the right patient and in the right setting
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and with the right safety plan.
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Host: Anything else you'd like to mention about birthing options?
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Dr. Matt Scalise:
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When we talk about birthing options, the goal here should not be to make one
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type of birth sound superior to another.
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The goal is to help patients understand their options and choose a setting and
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team that really match their values while keeping safety at the center.
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A great birth experience is not defined by whether it was unmedicated or
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medicated, vaginal versus cesarean,
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midwife or physician-led.
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A great birth experience is one where the patient can say, "I understand
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and understood what was happening.
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I felt respected, I felt safe, and my team was prepared."
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Host: Dr.
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Matt Scalise, thank you for your time and sharing your
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expertise on birthing options.
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A birth team captain and cheerleader.
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Some great advice.
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Thank you.
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Dr. Matt Scalise:
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Thanks, Cheryl.
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It was a pleasure
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Host: For more information, visit prismahealth.org/podcast.
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Now, if you found this podcast helpful, please share it on your social media
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and check out our podcast library for other topics of interest to you.
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This is Flourish, a podcast from Prisma Health.
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Thanks for listening.