Hand to Hold's Official Blog: Written by Parents for Parents

5 Things I Wish I’d Known When Choosing a High-Risk OB-GYN

High-Risk PregnancyThe year after my son was born at 26 weeks, my ob-gyn suggested I see a high-risk specialist to discuss the possibility of having another preemie. Here are five things I wish I’d known when I was choosing a high-risk obstetrician, or a maternal-fetal medicine specialist.

  1. Make sure your regular ob-gyn and your high-risk doctor communicate. A year passed between my initial consultation with a specialist and when I became pregnant. During that time, a large hospital system purchased my ob-gyn’s practice; my high-risk doctor had recently vacated that same hospital system. There was friction within the bureaucracy of the medical system that had nothing to do with me and my doctors. The better the working relationship between your high-risk doctor and your ob-gyn is, the better your care will be.
  1. Don’t let your doctors forget the little things. I was being followed for unexplained preterm labor. We talked about cerclages and cervical length, and I had weekly checks on my cervix. As it turns out, my cervix was fine, while the rest of me slid into a train wreck none of us saw coming. My high-risk doctor did not check my blood pressure or the protein in my urine. My regular ob-gyn appointments were only monthly, and after the hospital group purchased her practice, urine analysis was no longer customary at every appointment. So, no one noticed as the protein in my urine increased, and no one was watching my blood pressure climb. Preeclampsia probably would have happened anyway, but I might not have been in another state with near fatal high blood pressure had my monitoring been more thorough. My high-risk doctor was horrified to discover my ob-gyn had not been monitoring the protein in my urine, but if I had a redo, I would better advocate for myself and ask why some of my routine care was so minimal. The little things can turn out to be really important!
  1. Ask where your high-risk obstetrician has hospital privileges. I assumed the relationship I was building with my high-risk physician would extend into the delivery room if I had my daughter early. A stranger had delivered my son, and it was important to me that the birth experience be more positive the second time. My high-risk ob-gyn never volunteered that she was restricted from delivering at my hospital because of a contract with her previous employer, and I never asked. I assumed she would deliver me in an emergency, and I only discovered in the hospital that she was barred from visiting me. I had no relationship with either of her colleagues. I also discovered that the high-risk ob-gyns rarely delivered their patients because the on-call surgeon for the hospital did the emergency C-sections. But, in a twist of fate, my preeclampsia boiled over on a busy night, and one of the doctors in the high-risk practice performed my surgery. In hindsight, I wish I had asked more questions about the delivery procedures of the high-risk practice before I was in an emergency situation.
  1. Make sure you trust your doctor. In the area of high-risk pregnancies, so much is still unknown. After I’d had two incredibly rare deliveries, both without any explanation, I asked the doctor who delivered my daughter if he thought it would be safe to have a third baby. “Your case is rare,” he said. “But, I’ve known women like you to have inexplicable deliveries and then go on to a perfectly normal birth experience. We just don’t know.” You and your doctor will make many critical decisions without being able to see the big picture, and you’ll want to have confidence in the person in the corner with you.
  1. Seeing a high-risk doctor can bring such peace of mind. My second pregnancy was stressful because it was high-risk. I was terrified I would have a baby even earlier than 26 weeks. But, my weekly appointments became part of a routine that comforted me. I resolved not to worry between appointments so that I could enjoy my pregnancy, and I treasured the ultrasounds that allowed me to watch my daughter grow bigger and stronger week by week. Also, the process of sitting in the waiting room with women who had much more tenuous situations than mine helped keep me grounded. Rather than compare myself to people who seemed to skate through their pregnancies, I was able to keep my situation in perspective.

If you have any suggestions about choosing a high-risk ob-gyn, please share them in the comments.

Summer Hill-Vinson About Summer Hill-Vinson

Summer (MS) delivered her son 14 weeks early in July 2010 as a result of preterm labor, and he was in the NICU for 3 months. She unexpectedly developed severe preeclampsia with her daughter, almost had her in another state while on vacation, and delivered her 11 weeks premature in January 2013. Both babies weighed 2.5 pounds, and they were in the same NICU for a combined 150 days. Summer, a journalism instructor, is writing a book about her family's NICU years.


  1. Great tips! How far did you go with your second? I’m now pregnant with my second… My first unexplained labor and delivered at 25wks. I’m currently on my labor (24+5) and nervous as heck! I’m also being followed but like you said the chaos that is life in the medical world makes things truly like the NICU and the high need to advocate exists. I’m being seen by a mix team of ob-guns at the high risk clinic who I have less confidence in and do very little. As well as a private clinic who has been more than amazing and does so the urine screens every time… Fingers crossed for a fully cooked baby!

    • Thank you, Lisa. I went to just under 30 weeks the second time, which was definitely an improvement! I can imagine how nervous you must be as you approach the point when you had your first baby–I was on pins and needles during Week 26 of my second pregnancy. I’m glad they’re keeping a close watch on you, and I hope you get a big, healthy, full-term baby!

  2. This was very helpful to me, thank you! I’m a 40 yr old chronic pain patient, and in getting out of my fruitless marriage, I’ve stumbled into a wonderful relationship with a man who would love nothing more than to explore the possibilities of having a baby with me. I just broached the topic with my pain management doc, and one of the many things he mentioned was that he would refer me to a high-risk ob. My first pregnancy, while not ideal by any stretch, wasn’t exactly high risk, but that was also 15+ years ago, so I’m definitely starting this entire journey all over again. Your article have me something concrete to work with, so I’m very grateful! Thanks!

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