Although pregnancy can be a joyful and exciting time in each woman's life, it is only the beginning of a life-long journey for mom, dad, and the new addition to your family. Choosing the right obstetrician for you and your baby is one of the most important decisions you will have to make at the start of this journey.

When choosing an obstetrician, patients often ask their gynecologist or primary care physician to recommend someone. Most, however, will simply ask their friends or relatives for a recommendation.

But how do you know that you are getting a doctor who meets or exceeds your needs?

When choosing your obstetrician, you may want to think about asking the following questions. You may want to visit several obstetricians and interview them before making a final decision. But be warned, although these questions will enable you to find a good match, many obstetricians feel uncomfortable about answering most of them. In the end, however, the obstetrician who answers these questions to your satisfaction will almost certainly be a very good match for you.

1. How many babies have you delivered this year and how many do you deliver per month?
2. Will you be the person that I see each time I come for a visit?
3. At what facilities do you have privileges?
4. How many babies do you deliver vaginally and by Cesarean section?
5. Do you allow your patients to delivery vaginally after a previous Cesarean section (VBAC)?
6. Who are the physicians who cover for you when you are not available or on vacation? When will I probably meet them?
7. Do you use or recommend induction of labor in order to deliver your patients? What is your complication rate with induction of labor?
8. Do you routinely use medication to control labor pain? Do you recommend the epidural? Or do you encourage your patients to deliver by natural child birth methods?
9. How do I reach you if I have an emergency? Do you use an answering service or a nurse to screen non-emergency calls?
10. How many family members or friends am I allowed to bring to my appointments or to the hospital when I deliver? Am I allowed to film my delivery?
11. How much experience do you have with treating high-risk or complicated pregnancies? If I develop a problem during my pregnancy, will you continue to be my doctor or will you refer me to another doctor?
12. If I choose you as my doctor, what is the expected cost if I deliver vaginally or by C/S?

1. How many babies have you delivered this year and how many do you deliver per month?
   • Although there is no specific number which is right regarding this question, you should consider finding an obstetrician who dedicates the majority of their practice to obstetrics.
   • In El Paso, the average number of deliveries in a practice is approximately 15 per month or 180 deliveries per year.
   • Physicians averaging a higher number of deliveries per month will more than likely have a greater exposure to high-risk situations and will have a greater level of experience with difficult pregnancies, unusual labor situations and complicated deliveries.
   • Dr. Novoa is one of the most experienced OB/GYN doctors in El Paso. His focus is on high risk vaginal deliveries, specializing in the delivery of teen pregnancies, twin vaginal deliveries, and VBAC (Vaginal Birth of Cesarean Section). He delivers more than 50 patients per month (600 per year) with a 95% vaginal delivery rate.

2. Will you be the person that I see each time I come for a visit?
   • Many practices use physician extenders, such as a mid-wife, nurse practitioner, or physician assistant, to assist the doctor. Although these providers are highly qualified and provide excellent care, you may want to be examined by only your doctor at each appointment.
   • You should be given the choice of seeing your physician, another physician, or a physician extender.

3. At what facilities do you have privileges?
   • Most physicians limit the number of hospitals where they deliver.
   • It is important for you to find a physician who not only delivers at the hospital of your choice, but also has privileges at the closest hospital to your home.
   • In an emergency, you should go the closest hospital. If your physician does not have delivery privileges at this hospital, you will be treated by a physician who you do not know.
   • Dr. Novoa has privileges at Providence, Sierra, Las Palmas and Del Sol. He is also able to provide emergency coverage for other doctors at Providence, Sierra and Las Palmas within 5 minutes of notification.

4. How many babies do you deliver vaginally and by Cesarean section?
   • This is a very sensitive subject with most obstetricians.
   • Healthy People 2010, a branch of the US Department of Health and Human Services, recommends that the rate of primary (first time) Cesarean Section be 15% or less. It also recommends that the rate of repeat Cesarean section be 63% or less.
   • Currently, the rate of Cesarean section in the U.S. is higher than 25% and is continuing to increase each year. This means that 1 out of 4 patients are being delivered by Cesarean section. As a comparison, during the 1970's, the rate of Cesarean section was only 5%.
   • Despite this dramatic increase in the rate of Cesarean section, there has not been a significant increase in the benefits to the newborns delivered in this manner.
   • Therefore, if your obstetrician has a higher than average rate of Cesarean section, you have a higher risk of being delivered by Cesarean section.
   • Dr. Novoa specializes in vaginal birth and has a 5% primary C/S rate. This represents one of the lowest in the United States despite having delivered over 5000 babies.

5. Do you allow your patients to delivery vaginally after a previous Cesarean section (VBAC)?
   • The World Health Organization (WHO) and the U.S Department of Health & Human Services (Healthy People 2010) encourages patients to attempt a vaginal delivery after previous Cesarean section if the patient has only had one previous Cesarean section and there are no other contraindications.
   • Most doctors do not offer this service. Worse, some doctors not only discourage this form of delivery but refuse to refer their patients to obstetricians willing to deliver a patient in this way.
   • Few doctors in El Paso offer VBAC. Among those that do perform VBAC, they average only a few per month. Dr. Novoa performs more than 50 per year with a 90% rate of vaginal delivery.

6. Who are the physicians who cover for you when you are not available or on vacation? When will I probably meet them?
   • Almost all obstetricians have "on call" or week-end coverage agreements with other obstetricians. Most obstetricians try to work in a 3-5 person call group. This means that your doctor will only be on weekend call 1 out of every 3-5 weekends.
   • It also means that there is a good chance that another doctor will be the one to deliver you if you go into labor on a weekend.
   • It is unlikely that you will be able to interview all the physicians in your doctor's call group. However, if you do have an opportunity to interview these doctors, remember to ask them the same questions you ask your doctor regarding their practices.
   • Dr. Novoa does not routinely work in a call group. He prides himself on offering 24/7 coverage. Despite delivering more than 600 babies per year, he delivers more than 95% of his own patients.

7. Do you use or recommend induction of labor in order to deliver your patients? What is your complication rate with induction of labor?
   • Induction of labor is defined as artificially causing labor to begin. Some methods include the artificial rupture of membranes, the intravenous use of Pitocin medicine; and the oral, vaginal or rectal use of misoprostol (Cytotec).
   • Elective induction of labor (not medically indicated) has become very popular. Unfortunately, many obstetricians do not explain that an elective induction of labor can increase your risk of Cesarean section by up to 40%.
   • Your doctor should clearly explain the risks verses the benefits of induction, and should be willing to state how many patients are induced and how many end up being delivered by Cesarean section.
   • Dr. Novoa offers elective induction to most patients after 38 weeks. Of those that desire elective induction, approximately 95% will deliver vaginally. This means that the rate of vaginal delivery for those patients desiring an elective induction are similar to those desiring a unassisted natural vaginal delivery, which is also 95%.

8. Do you routinely use medication to control labor pain? Do you recommend the epidural? Or do you encourage your patients to deliver by natural child birth methods?
   • A majority of obstetricians recommend the use of both intravenous narcotic medication and the epidural for the management of labor pain. In the past, it was thought that these methods of pain control increased the risk of complications; however, recent studies have not shown this to be the case.
   • More than 90% of pregnant patients choose to deliver with the assistance of pain medication and/or the epidural.
   • If you choose to try to deliver your baby naturally, you should discuss this subject with your doctor at your first appointment.
   • Dr. Novoa uses two drugs to assist in contractions, which are pitocin and cytotec. He also offers an epidural upon request.

9. How do I reach you if I have an emergency? Do you use an answering service or a nurse to screen non-emergency calls?
   • Call the doctor's office and find out what their policy is on this.
   • Some physicians return all non-urgent calls at a certain time each day, while others reserve a special line for messages or have nurses answer questions and act as a go-between for other information.
   • Find out how quickly you're likely to hear back if you call with a routine question or an urgent matter.
   • Your doctor should give you a list of the hours of operation of their office. These hours should be convenient to your schedule.
   • In case of emergency, you should be able to contact your obstetrician with only a minimal delay in time.
   • Your doctor should give you specific instructions of what they consider an emergency and where to go in case you have one.
   • Although you may want to deliver at a specific hospital, you should consider the possibility of having to deliver at more than one hospital in case of an emergency.
   • Remember to ask your doctor if they have privileges at any hospitals close to your home.
   • Dr. Novoa can be contacted by cellular telephone after office hours. His emergency number is 915.731.0472.

10. How many family members or friends am I allowed to bring to my appointments or to the hospital when I deliver? Am I allowed to film my delivery?
    • Try to find an obstetrician who allows you to bring at least one family member to your appointments.
    • Many obstetricians will allow at least two people in the delivery room with the patient.
    • Make sure to find out if your doctor will allow you to film your delivery.
    • If you are restricted from filming all of the delivery, you may be able to film parts of the labor and delivery.
    • Even if your doctor agrees to allow you to film, your hospital may not allow you to film at all. Check with both your doctor and your hospital concerning their policies on filming your delivery.

11. How much experience do you have with treating high-risk or complicated pregnancies? If I develop a problem during my pregnancy, will you continue to be my doctor or will you refer me to another doctor?
    • Some obstetricians prefer to treat only low-risk or uncomplicated pregnancies and will immediately refer a patient with a chronic illness, such as high blood pressure, epilepsy, heart disease, or diabetes to another obstetrician or a perinatologist (a high-risk obstetric specialist).
    • You should ask your doctor how much experience they have treating high-risk patients. Those who feel comfortable working with high-risk pregnancies will not transfer care to another obstetrician, although they will probably coordinate care with a perinatologist.
    • Dr. Novoa accepts high risk patients although he routinely works with perinatologists in the management of complicated pregnancies. However, he will be the doctor assigned to deliver your baby.

After asking the aforementioned questions, you should also be able to get a feeling for the "bedside manner" of your obstetrician. Is your obstetrician forthcoming with explanations and up-to-date in their thinking? Do they seem interested in you as a person or are you just another number? Do they seem like someone who will respect your wishes?

In the end, you should find a healthcare provider who communicates well with you and with whom you feel comfortable. Picking the right doctor for you and your baby is just one of the many decisions you will need to make during this exciting journey of new life.