Throughout pregnancy, at the end of each prenatal appointment, most doctors conclude with the usual: “Do you have any questions for me?” Many times patients sit there thinking they are supposed to have a question, but can’t come up with anything. Others may be concerned that their questions will sound naïve or trivial. Not wanting to risk sounding foolish or feeling that they are wasting their physician’s time, they ask nothing. None of this is correct. Doctors want to hear their patients’ concerns and help guide them through their pregnancies.
There are many questions patients can and should be asking throughout their pregnancies to help understand what physical changes are occurring, how pregnancy will affect their daily lives, and important delivery issues.
The first trimester brings a whole host of challenges that impact normal life functioning. While a small percentage of women will experience severe nausea and vomiting that needs aggressive treatment for hyperemesis gravidarum, many women experience milder symptoms of nausea as well as heartburn. Because these symptoms are so common, many believe they are simply part of pregnancy and there is nothing to be done to change them. However, nothing could be farther from the truth. Asking your doctor what treatments are available to help with nausea and vomiting as soon as you start feeling symptoms, rather than waiting until you are vomiting many times a day – which can lead to dehydration – can make it much easier to treat and avoid needing multiple medications or hospitalization. If you are experiencing heartburn, that needs to be treated differently than nausea, so please be sure to ask if you need other diet/lifestyle modifications or medications.
Another issue that comes along with nausea in the first trimester is headaches. One of the most common causes of headaches in early pregnancy is stopping or significantly reducing caffeine intake. You do not necessarily need to drastically change your coffee or tea habits, so always ask your doctor how much coffee or tea you can drink if that is your regular routine.
While the first trimester has its own issues to be addressed, some pregnancies have unique issues that should be discussed with your doctor at the outset of the pregnancy, even though they pertain to later. For some pregnancies the delivery can be a particular issue, and sometimes patients and their providers may not be on the same page. Two relatively common examples are women with a prior Cesarean delivery who are interested in having a normal delivery or women who are carrying multiples. Many women assume that in both situations a normal delivery should be possible, but their doctors may not feel that way. Many physician groups, and many hospitals, will insist on Cesarean delivery for a woman who has had a prior Cesarean or for someone carrying twins. If these questions are not asked early in the pregnancy, it can set the stage for an unpleasant interaction later when delivery planning is necessary. Please recognize that as doctors our primary concern is your comfort, so asking is helpful to us as well.
Another inquiry one should make early on is which physician might be there for delivery. Some doctors, or groups, are always on call for their own patients, while others may cross cover with other groups. Some practices have deliveries done by hospital-employed doctors. While there are advantages and disadvantages to all these models, you will want to know early on what to expect so that you are not surprised later.
Two questions that tend to pertain more to the second and third trimesters are regarding exercise and travel. In most pregnancies, both are fine with some limitation or modification. However, some pregnancy complications will put limits on both. It is worth asking the question. You may be pleasantly surprised to know that in the majority of pregnancies, you will actually be able to do more than you might anticipate.
The third trimester, like the first, leads to very common symptoms related to the growing pregnancy that many women do not ask about, assuming that they are normal and nothing can be done. Two common symptoms are back pain and pelvic pain. These can also lead to difficulty sleeping due to discomfort. Most of the time, these problems are related and can be helped with simple treatments like propping well with pillows while sleeping and thinking about body mechanics while moving around. Diagnosing these problems is usually straightforward and solutions can be easy. In some cases, pain can be so significant that physical therapy may be needed. Most of the time back and pelvic pain resolve after delivery, but if they don’t, be sure to ask if your condition should be treated with physical therapy.
As your pregnancy is getting near the end, it is important to ask what a doctor’s practice is regarding induction of labor and/or how long they will let the pregnancy go. There are differing approaches regarding the optimal time to deliver if a woman is still pregnant near her due date. Some advocate for delivery in the last week before the due date, or right around the due date, while others advise going up to two weeks past the due date. There are pros and cons to both. To that end, it is a good idea to ask about this several weeks before the end of the pregnancy so you can be certain that you and your doctor are on the same page.
Another concern that sometimes arises near the end of pregnancy relates to the position of the baby. In the vast majority of pregnancies, a baby is head down in the last few weeks, but if it is not in that position there are different approaches. Just like dealing with delivery planning, it is important to ask your doctor how they would handle this issue. Some doctors will perform a Cesarean delivery and some will be willing to attempt turning the baby to a head down position in an effort to avoid a Cesarean delivery. In most cases doctors will not offer a breech delivery, but it does not hurt to ask as there are some groups that do offer breech deliveries.
One last note is dealing with group practices. Few doctors still practice as solo practitioners. For any questions related to major issues, especially delivery planning, it is important to clarify if all partners in the group practice similarly. For example, you would not want to find yourself in a situation where one doctor said they would consider a twin delivery, but the other covering partners would not at the last minute.
Each pregnancy can bring new experiences, and this is true even for women who have had several children. Women, as well as their partners, should never feel embarrassed to ask any questions that are bothering them. Open communication with your doctor can significantly improve your pregnancy experience, which is exactly what your doctor wants for you.
Dr. Yoni Ratzersdorfer is a board-certified OB/GYN who has been in practice in New Jersey since 2015. He is a strong believer in supporting women’s birth choices to achieve the birth they desire. He is a physician at Maternal Resources, a thriving boutique style practice, with offices in Hackensack, Jersey City, Hoboken, Howell and New York City.
