Monday, July 14, 2008

breastfeeding help - online

here are two websites that have come in handy for
breastfeeding.
one has videos and the other is full of detailed info
that le leche lactation consultants use.

www.kellymom.com
http://www.drjacknewman.com/index.php?option=com_content&task=view&id=18&Itemid=42

good and trustable breastfeeding support is hard to
come by. just follow your instincts. not all dr. and
nurses are trained in lactation.

Sunday, July 13, 2008

Dr. Takeuchi, Koto-ku

I am very sorry for the delay... My hubby not too
> sure
> if he can speak very good english.
>
> Dr Takeuchi
>
> http://enjoy.pial.jp/~t-kodomo-clinic/
>
>

Saturday, July 12, 2008

Giving birth at Toyoshima Ladies Clinic, Nishi-Ogikubo

Hi Lara,

Number 2 huh!! That'll be me next year I guess, but I'll be having the
next one in Australia. That'll be interesting.

So I also had a really positive experience at the place I gave birth,
but it's not really ideal for you because it doesn't fit three of your
requirements.

I gave birth at Toyoshima Ladies Clinic in Nishi-Ogikubo. I started
out at a fancier place in Kichijoji but there were so many rules. I
hate rules. Toyoshima has virtually no rules and is very easy-going.

My plan was for a water birth and Toyoshima is one of the few places
in Tokyo that offers this and their pool looked very inviting.
Unfortunately due to my water breaking and the delayed onset of
contractions, this ended up not being an option.

I speak Japanese so I'm not sure whether any of the staff speak
English, but they were all super kind. Dr Toyoshima is not a man of
many words but would answer any of my questions if I had them. The
midwives were wonderful and told me that if I had any questions to
skip asking the doctor and go and knock on their door and they would
answer them anytime. Very reassuring.

Toyoshima is a bit old, but for 430,000 you get a private room and
delicious vegetarian meals for five days. My husband and baby roomed
in with me for the entire stay and friends and family can visit
anytime from 9am to 9pm. There is a special family room that is an
extra 10,000 yen per night and that has it's own private bath and
toilet and anyone you want can stay there (it's a big tatami mat room
with a tv which would be good if you have other children). It can't be
booked though and is first in, first served.

You can write a birth plan and discuss the birth with the midwives
beforehand. I felt totally in control of all aspects of my birth and
felt very supported. You labor in your private room and the midwives
would periodically come in and check on me, and when the time is ready
you can get in the birth pool or move to the delivery room. There are
absolutely no rules about who can be in the delivery room. They have a
cd player if you want music and aromatherapy. I was also given lots of
homeopathic treatments.

I had an active birth with no drugs (not available here) and was
provided lots of different props for labor - the bean bag was amazing.
I pushed on a birthing stool which really worked for me.

So anyway this has ended up being a very long post but I just wanted
to share my experience at Toyoshima.

If you read Japanese I totally recommend checking out the Benesse
Women's Park website - you can search for places to deliver in your
specific area and there are usually reviews on each place. That's how
I found Toyoshima.

Here's the website:

http://women.benesse.ne.jp/

You need to become a member to read the full reviews, but this is a
seriously helpful website if you are looking for pediatricians,
maternity clinics etc all over Japan!!!

cheers,
kat

Giving birth at Seiku Iriyo Center - National Children`s Development Center Hospital, Setagaya

HI Lara,

I had my first baby in Australia and my second the following year 2006 in Tokyo at The National Centre for Child Health and Development ( Seiku Iriyo Centre. aka Seiku Byoin) in Seijo, Setegaya Ku. I know its not in your area of preference but its really worth a look at as ita meets all your other criteria and is an excellent hospital.

The best thing about this hospital is that specailise in babies/children so if anything goes wrong they can handle it and the baby stays in the same hospital as you. They take complicated pregnancies and unlike some other hospitals they are fully staffed all the time so thats a real bonus in a worst case senario.






- pain relief: you can have an epidural. It was much better than my first one in Australia and I could still feel enough to push and I could walk almost right after.


- birth plan: yes! followed to the letter! no cutting!


- language: English is spoken by most of the Doctors and some midwives/nurses. They went out of thier way to make sure I understood and was comfortable before they did anything to me or baby. The Anesthitist ( did I spell it right?) was fluent and I had to meet with him about a month prior to my due date so he could explain all the risks and the proceedure so I was sure I wanted one.


- cost: if you get a private room the cost is more but its around ¥500,000 - ¥600,000. They had to do some extra stuff on me so mine was up around ¥700,000 for a week stay and delivery.



Another good thing is that as its a kids hospital there are plenty of play areas / books/ toys for your older one while you wait, even an outside play area. There is a good bakery/cafe in the basement and a good restaurant on the top floor. They have a pager system so after you check in with your card you can wander around in or outside till your appointment.


I cant tell you how happy I was that I had my baby there, it was better than my experience back home and pre natal care at Seibo ( Mejiro). If you have any other Q,s Id be happy to help.
Good luck!


Simonne.

Giving Birth at Toho Fujinka, Koto-ku

Hi Lara,

Perhaps this clinic is too far for you but it's worth considering...

Toho Fujinka nr Kiba Station in Koto-ku. I had my second baby there and it was a much more positive experience than the one I had at Aiiku. Their philosophy probably doesn't match your criteria, however, I think you (and others) should know about it.

It's a private clinic so more expensive than the norm though pretty much all the private clinics I checked were around 500,000 yen whereas the local hospital nr me was much less though spaces were limited due to the usual medical downsizing of departments

They offer no pain relief but after having an epidural for my first delivery, I opted for no pain relief. Epidurals are not all they are cracked up to be! Longer delivery, more medical intervention is usually required (fetal heart monitoring, oxytocin drip and of course an episiotomy!) My recovery was long and painful. I seemed to be the only new mum who was still walking like John Wayne the day I was released from hospital. I also had a week long headache. Though not everybody has a bad reaction from an epidural. Second time round I had no episiotomy and was up and about immediately!

They accept Japanese health insurance which I'm guessing you and your husband have. Check ups can be expensive but you'll get some free with your mother and baby book. Check out your ward office as I know Koto-ku now offer free antenatal check ups for residents of that ward (as of April this yr - bad timing on mine and my husband's part!)

You'll be expected to write a birth plan and have several opportunities to meet the midwives at your check ups. No English spoken by the midwives - my delivery was at night just me and a midwife. The owner of the clinic speaks pretty much fluent English but you'll only get to meet her when you are discharged. She 's more hands on with the fertility side of the clinic. I'm guessing other Drs speak some English but if you have a Japanese surname Japanese people usually speak to you in Japanese.

Very friendly and personal feeling to the clinic not like at some other bigger hospitals. My son was with me and my husband at the hospital though he did not witness the birth! Both he and my husband were asleep in my suite whilst me and the midwife got on with the delivery. No need to worry about last minute babysitters! Rather a luxurious stay aswell - great food which can be eaten in the lounge area with other mums so you're not confined to your room all day. Free aromatherapy massage during your stay too. Several gifts of baby clothes, baby towel blanket, baby care bks etc... all part of the 500,000yen 5day package! You'll need the chance to relax as once you get home with a toddler to look after aswell, you won't be having meals cooked for you or have any chance for a massage!!

Rather long..... There must be other places that offer high level of service. Some of the midwife birth houses I've heard are good. Perhaps there is one near you?

Hope this helps

Gina Sawamura

Birth Houses in Tokyo

This is veering even more off topic, but several of the midwives from
Aqua Birth House attended our home birth. They were wonderful. When
you are starting to look into birth options, or if anyone else wants
to know more about Aqua Birth House, let me know (although I have not
visited the birth house itself, I know the people who work there). I
have heard of 2 other birth houses which would be similar and would
let you stay with your family during your stay.

They recommended Nisseki (Red Cross) to me as a backup hospital, and
said it is very midwife-friendly. Nisseki is the main backup hospital
for Aqua Birth House (as well as for several other clinics and
hospitals, I have heard -- which means they definitely must have the
option of anesthesia, although they are natural-birth oriented).

Christine

Giving birth at Red Cross Hospital

Hi
>
> I gave birth to my first child at the Red Cross (Nisseki) hospital
> in Hiroo and am back there again for second due in December. I can
> highly recommend it.
>
> They did not offer pain relief, but I heard from a fluent Japanese
> speaker that it is possible if you know how to ask and are
> determined. She had 2 babies there both with epidural I think. They
> also now have a water birth facility which you can use if your
> doctor gives the OK and you take a course. They will also help out
> as much as possible with Aroma oils, foot baths and a hot tub if
> your (waters haven't broken). They were also very supportive about
> an "active labour" allowing me to wander the halls and stairs at
> all hours and had a lot of equipment such as birthing stools to
> help things along. Though I could not give birth standing if I'd
> wanted to.
> They are very pro natural birth and will not intervine if at all
> possible, though I had to ask several times to get a status exam to
> tell me how many centimeters I was dilated!!!
>
> They encouraged me to write a birth plan and tried very hard to
> stick to it, although I got an episiotomy, which seemed to be
> expected, they tried very hard to avoid it.
>
> Several doctors speak English, I was with Kasei sensei for Nick but
> am with Kido sensei for the next one, both are ladies. The midwives
> generally don't speak English but for the birth and labour I seem
> to have been assigned two English speakers who were extremely helpful.
>
>
> The cost is reasonable, it was about 700,000 but I had a private
> room and was in for 6 days due to a long labour. The quoted cost is
> about 500,000. By the way. Meguro-ku now gives 14 vouchers for
> discounted antenatal check-ups with Japanese insurance, my last
> visit cost just 1,500.
> With the private room the midwives were very flexible with letting
> my husband visit very late, though he could not stay over. The food
> was not bad at all.
>
> As it is a "baby friendly" hospital they encourage rooming in and
> are very helpful with breastfeeding and also after care for those
> unwanted cases of mastitis!!!! Theyare happy to take care of the
> baby for a few hours and for the first night if you want though.
> And they give the husband a lesson in baby bathing!!!
>
> All in all we were very satisfied. I Think theystill hold a tour
> Mondays at 3pm.
>
>
> Hope it helps
>
> Norma
>

Saturday, July 5, 2008

Deliverying at Red Cross Hospital, Private Midwife

Open system

Hello Lara and all,

Well Lara I know I talked to you a bit about my fantastic birth
experience here in Japan but thought I`d post to let everyone know a
bit about it. I used a relatively new system here called `Open
System`. What it mean`t was that I had a private self-employed midwife
who took care of me all through my pregnancy, birth and aftercare. It
was basically the same principal as preparing for a home birth except
this midwife has a special arrangment with the hospital where I
actually went to the hospital and `borrowed` a room to give birth in.
None of the hospital staff were directly involved in my delivery,
though it was a quiet night and a nurse came in to help out a little
from time to time. What was reasurring about it was that in the case
of anything going wrong there were hospital doctors there who would
take over. It was fantastic, she was fantastic and I wouldn`t dream
about using anyone else but...

..big downside is location. She lives out my neck of the woods (Adachi-
Ku) and is based in Katsushika ward. I gave birth in a room at
Katsushika Ninnseki-byoin (Red Cross hospital)..so it might be an idea
to check out Hiroo Ninnseki in case they have a similar arrangment
going on there. I`m going to contact her this weekend to see if she
can recommend anyone over your side of Tokyo.

On the plus sides..
...continuity of care. She used to come to my house on Saturdays so my
hubby was home to help translate. Her fee for a visit was 5000yen but
she would stay as long as I wanted to talk things through, give
advice, and sometimes even massage me!! Sometimes she stayed 2 hours!!
She also attended all my appointments at the hospital..for blood
tests, scans etc..she even went to the hospital early and picked up a
ticket so I never had to wait in line. She doesn`t speak much English
but seemed to understand a lot of what I was saying..but you`d
probably need to speak some Japanese of have a Japanese partner to
help out. It was wonderful to see the same person everytiem and I
really build a bond with her..in short, I love this woman!!!!

...great with birth plan..she forced me to write one and spent a whole
session going through it..a believe me ANYTHIng goes. Right down to
the track lisitings for the CDs... My sister-in-law gave birth two
months after me with her and was allowed and I`d say encouraged to
have her toddler present during the birth..very cute..she was fanning
her Mummy down to help out. I should probably mention now that she
doesn`t do pain relief..when I asked about gas and air she just said I
wouldN`t need it and at first I was sceptical but went with it and her
confidence and was reasured. She also doesn`t cut. When I asked her
she simply said 90 per cent of her mothers don`t tear again I was
sceptical but went with it and came out unscathed. Don`t know how much
this was down to my lucky fluke with an easy birth or with her
expertise but she did apply counter pressure to my prenieum (forgot
how to spell that!) the whole time with her fingers...she`s very hands
on by the way..a lot of massage, aroma and even breast massage to get
the milk flowing..a bit weird for us gaijin but supposedly standard
practise here in Japan.

..she`s also a qualified breast-feeding consultant like Iona and put
babs to me tummy immediately without cutting the cord and let her
crawl up to my breast to latch on..babies CAN do it themselves..it
toook about 40 mins. She`s also relly flexy with who does what..hubbys
are welcome to be as involved as they wish..

...it was cheap...I think we paid about 280000 but her fee for the
birth and afteracre visiting me at home was about 110000 and the rest
went to the hospital ..so with the 350000 back from the gov we cut it
about even..but I didn`t stay in the hospital at all..I came home the
same morning (crazyfool!) Of course a stay would have bumped up the
price a bit. The hospital was lovely and I gave birth on a futon bed
in a tatami room with shoji and a sofa..very nice.

Anyway, enough of my gushing...I let you know what she says when I
speak to her this weekend
and if anyone is interested in her details just get in touch. Her name
is Mika Yanagisawa.
Cheers, Helenxx

Friday, July 4, 2008

Heather`s review of Seibo Hospital - giving birth

Hi Lara,

I gave birth at Seibo Byoin with Dr. Sakamoto. He's expensive so if cost is
an issue - this may prevent you from using him. However, I heard from a
friend that he recently opened a clinic in Omotesando and that he takes
Japanese health insurance at that clinic. You'd probably still need to pay
for the birth, but at least the check ups would be covered.

Dr. Sakamoto has a reputation for cutting - but I managed to have a totally
natural birth with no episiotomy. He offered but I was determined and had
coached my husband on how to keep me going. Seibo totally respected my birth
plan even to circumvent hospital rules in administering the Vit K supplement
by syringe instead of in a bottle.

I doubt that Dr. Sakamoto will be your first choice, but thought it was at
least worth sharing a different perspective. That being said, we are hoping
to deliver at one of the birth houses next time around. The trouble with
most hospitals is that you can't bring in your toddler except during
visiting hours. For this reason we hope to get into the Aqua Birth House or
similar next time.

Good luck,
Heather

Thursday, July 3, 2008

Seibo Hospital - what to expect when going into labor

Congratulations! You are almost there! It is very
exciting. I hope this helps!

If you want to keep track of your contraction, there
is a cool website, called Contraction Master.

If you can, get in a bath or shower, it REALLy helps
with the pain. The TENS machine might help also. It
really made a difference for me. You will not feel
anything when you use it but if you turn it off, you
will feel the pain.

Regarding Seibo

1. They will give your child a robe like outfit to
wear. So no need to bring clothes for your baby except
going home clothes.

2. They will give you a robe and you will have to
bring your own PJ. I would bring several pairs so you
dont have to wash them.

3. They will also provide you with industrial size
sanitary pads and you should have enough to take home.
You might want to buy an extra box when you go home if
you bleed alot. They are a lot softer than normal
sanitary pads. You will bleed on and off for a while.

4. Things to bring to the hospital

a plastic cup for drinking
slippers
a clock
a pen
baby themometer ( need to check their temp. every
morning)
CDs, DVDS,...anything to entertain yourself.
Dont think they have an internet connection

5. There will a be heaps of people coming in and out
of the room during your stay. They all just walk in
unannounced. Dont be surprised.

Think at 6 am - a nurse brings a clean robe and
reminds you to weigh your baby. Remember to calculate
their weight with diapers and robe. You will write
down the gross and net weight on the sheet next to the
scale.

Then breaskfast lady with breakfast. She will bring
breakfast for husband if you request it. Fill out the
form they bring with your meal.
Your choice is Japanese style or Western style.
She will pick up the tray an hour later.

Then the cleaning lady will come to vaccum and clean
the bathroom (I am assuming that you will have a
private room )

The nurses come around in the morning to check
jaundice and they will tell you a number and if it is
in the safe zone. Most babies have jaundice so dont
worry about it.

Then the nurses will come and collect your baby for a
check up with the in house pediatrician. Since they
collect all the babies, it will take at least an hour
or two.

....etc.

I think on the 4th night at midnight, they will come
to collect your baby to give him/her Vit K. If you
want them to take your baby at a later time, pls tell
them to come back later. Some mothers ask them to come
later when their baby wakes up.

You will have to record the number of times your baby
pees or poos everyday. They will give you diapers and
wipes at the hospital.


Midwives are helpful during labor. They are great.

If you have problems latching on, pls call Iona with
Le Leche League. Some of the midwives will tell you
differnt things at Seibo and they have their own rules.
ie. they will not let you use a cup to feed your baby.
only a bottle for legal purposes.

Wednesday, July 2, 2008

Dr. Kusakawa review, St Luke`s

I've taken Patrick to Dr Kusakawa at St Luke's for all his check-ups since
his first one as a tiny baby and I've found him to be very nice, speaks good
English, is pretty sensible and down to earth about general care and
medicine. He also seems happy to take time to go through any concerns and I
never feel like I'm being rushed out of the room or asking something
stupid! :)

I've only seen him for check-ups though, not for illnesses. The two times
I've needed a doctor for Patrick between check-ups I've gone to the Tokyo
Medical and Surgical Clinic and seen Dr Marshall, who is a GP.

Cheers,
Allison

Dr. Yoboah, Dr. Suwa review

Following up....

Hello there,

Dr. Suwa's phone number is 03-3444-7070
and the address is
#103Nikko Royal Palace
5-16-4 Hirroo
Shibuya-ku 150-0012

I actually went to see her for my son's first month check up.
Yes she seems to be very competent, spoke English very well but I have to say she was a bit "cold" and the place depressed the hell out of me. It was not really child friendly (I could not dispose the nappies in their bins?!).
I now go to Dr. Nicola Oduro-Yoboah at the Tokyo Medical (yes I know... ). She is not a pediatrician but has experience with small children. I hesitated to go to her, but she has been recommended to me by friends. I have seen her twice and she seemed very competent and comfortable with children. I also find her really easy to talk to and she promptly replies to my emails. A long with the competency I think it is very important to feel comfortable and build a good relationship with your child's care giver. Regarding the fees Dr. Suwa does not seem cheaper but I think she takes Japanese National Insurance, whereas Tokyo Medical doesn't.

Hope this can help,
Bettina

Dr. Yeboah review - Tokyo Surgical & Medical

Dylan and Harper both see Dr Yeboah at Tokyo Surgical & Medical. She is
just fabulous. Really listens and is not quick to hand out antibiotics.
She is British and has a fantastic bedside manner with the girls. Harper
has also seen Dr Martin at the same clinic once when Dr Yeboah was not
available and she seemed like a nice doctor as well.

Cheers

Dr. Kawashima, Dr. Che, pediatrician

Hi Christina,

I see both Dr Kawashima and Dr Che.

Dr Che can be reached at any time day and night on his
mobile phone when Dr Kawashima is just a few blocks
from my house, which makes them extremly convenient
for me.

Both Doctors agree on following the vaccins as they
are indicated on the french medical notebooks of my
kids.
And fill the notebooks each time wich makes it easy
for the follow up when I am in France.

Also, Dr Kawashima is giving herb medicines when an
antibiotic is not necessary.

The thing is, Dr Kawashima is not getting any younger
and although he is ok for the light problems and
monthly check up for babies, when I am really worried
I go to see Dr Che...

Did you have a problem with Dr Che (medical mistake)
or is it just a personality problem?

Dr Kawashima has a smooth way with mums when Dr Che
can be more sarcastic...

Hope this helps, Asia

Dr. Martin review, pediatrician, Tokyo surgical and medical clinic

Dylan has always gone to Dr Martin at the Tokyo Surgical & Medical
Clinic, opposite Tokyo Tower.
She's not a pediatritian, but a GP (general practitioner), so she
sees us too.
She ticks all the boxes on your wish list.
She is always willing to do all the necessary tests to find out
what's wrong.
She is Japanese, but more than fluent in English, as she practiced in
LA too.
She is really great with Dylan, she has stickers for him, a toy
medical kit in her office & she's very patient.
She is also good with my views about not giving medicine unless it's
really necessary.
The TMSC has a 24 hour on call doctor, which rotates, so sometimes
it's her, but someone is always available to talk to you.
I would thoroughly recommend her for anyone.
Louise

Dr. Inagaki, pediatrician, Yoyogi Hachiman

I dont know your location but Dr Inagaki on the Odakyu line, 3-4mins
walk from Yoyogi Hachiman station is very good. He just moved to a new
building this year and it has a great play area for children while they
wait to see him, he speaks English and will also treat mums if both mum
and baby have colds.

Ushka

Dr. Inagaki, pediatrician, Yoyogi Hachiman

I dont know your location but Dr Inagaki on the Odakyu line, 3-4mins
walk from Yoyogi Hachiman station is very good. He just moved to a new
building this year and it has a great play area for children while they
wait to see him, he speaks English and will also treat mums if both mum
and baby have colds.

Ushka

Dr. Suwa, pediatrician, Hiroo

Hi Christina,
Have you tried Dr. Michiko Suwa in Hiroo? I just went to her for
the first time for my daughter and I thought she was very prompt,
professional, and reasonably priced. She is on the American board of
pediatrics, so I am sure she studied or spent time in the US and her
English is great. I don't have her phone number off hand, but she is
located right on the shopping street in Hiroo a few doors down from
Subway. I am sure you could do a google search for her info. She
also takes appointments as well.
Good luck and I hope you find a doctor that you like!
Adrianna

Dr. Review - TNMG forum

This is a listing of the recommendations I have received from other from TNMG. This is the personal opinion of the sender, not mine.

Tuesday, July 1, 2008

Constantly doctor shopping




What Are Your Options?
When it comes to medical care for your child, there are generally three types of qualified providers: pediatricians, family physicians, and pediatric nurse practitioners.

Pediatricians
Pediatrics is the medical specialty fully focused on the physical, emotional, and social health of children from birth through adolescence. The primary focus of pediatrics is on preventive health care.

Pediatricians complete 4 years of medical school, followed by 3 years of pediatric residency. To become board certified, a pediatrician must pass a written examination given by the American Board of Pediatrics. Pediatricians must recertify by taking examinations every 7 years. This means pediatricians keep up-to-date on changes in children's health care. A pediatrician also must take a certain number of continuing medical education courses each year to be eligible for license renewal in the state where he or she practices.

Some pediatricians have additional training in a subspecialty area such as cardiology, critical care or emergency medicine, or hematology. These specialists usually have 3 years of additional training after their residency to be board certified in their subspecialty.

Family Physicians
Family physicians must complete 3 years of residency after medical school. Family medicine residents train in pediatrics and several other areas such as internal medicine, orthopedics, and obstetrics and gynecology. They usually spend several months training in each area. Afterwards, they are eligible to take the certifying examination of the American Board of Family Medicine. They are also required to earn continuing medical education credits and take periodic recertification examinations.

Because they train in many areas, family physicians are qualified to care for patients of all ages. This means your child would be able to see the same doctor from birth through adulthood. It also means that all members of your family can receive their primary care from him or her. A family physician will know the medical histories of all family members and may also be more aware of the emotional and social issues within your family that can affect your child's health.

When seeking a family physician, be sure to ask about age policies - some family physicians see only a few children or don't see children younger than a certain age.

Pediatric Nurse Practitioner
Another type of child health care provider is the pediatric nurse practitioner (PNP). These professionals generally have earned a master's degree in nursing and have special training in obtaining medical histories, performing physical examinations on children, making medical diagnoses, and providing counseling and treatment. Like pediatricians, PNPs may specialize in a particular area, such as neurology or endocrinology. PNPs work closely with doctors in hospitals, clinics, and private practices. The numbers of PNPs is growing each year, and approximately 18,000 PNPs actively practice in the United States.

Some parents may be hesitant to have their child receive care from a PNP, possibly worrying that the PNP is less extensively trained in children's health care. These feelings are largely unwarranted. The presence of PNPs in the practice can have many advantages. Parents often find that PNPs spend more time with them than doctors discussing health and child care issues. Plus, if a PNP encounters a more complex medical problem, he or she is trained to consult the doctor. Still, if you want to see only the doctor or feel the doctor should be consulted after the PNP has seen your child, most practices will honor your request.

When and How Should You Start Looking?
Your search for a health care provider should begin well in advance of the due date of your baby. Babies often come early and you will want to do some research to help you find a health professional whose style and personality will complement your own.

A good time to begin your search is about 3 months before the baby is expected. If you're in a managed health care plan, your choice of participating doctors who provide primary care for children may be limited, so be sure to check the plan's online list. But be aware that paper lists get outdated quickly. If you have any questions about whether a provider participates in your plan or if you are interested in a doctor who is not on the list, it's best to call the health plan directly. Also call if your child has any special medical needs that would require an out-of-network doctor.

Once you know the limits imposed by your health plan, compile a list of candidates from people you trust - your relatives, friends, neighbors, and co-workers who share your parenting philosophies. Your doctor, obstetrician, or nurse-midwife can also be a good source for recommendations.

If you've recently moved to a new area, you may not have personal or social connections established to ask for referrals. In this case, you may want to contact area hospitals or medical schools for recommendations or ask the pediatric residents or nurses where they take their children. You can also request a list of board-certified pediatricians from the American Academy of Pediatrics (AAP) and board certified family physicians from the American Academy of Family Physicians (AAFP). Local hospital "nurse line" referral services, the local medical society office, medical directories in public libraries, and the yellow pages may also be helpful.

Once you've gotten some recommendations, you can begin to check them out more thoroughly. In each state, a medical board investigates complaints against doctors and may take disciplinary action, ranging from citing a doctor for non-payment of certain administrative fees to suspending or revoking his or her license for criminal behavior.

Disciplinary action is rare but fortunately very easy for parents to uncover. In most states, the information is public and is posted by state medical boards on their websites.

Now you are ready to begin the interview process. Considering that this doctor will be the first to treat your baby, you will want to be sure that you feel comfortable with the doctor's personality, office staff, location, and environment. A prenatal appointment is an excellent opportunity for both parents to ask questions and get acquainted with the office staff.

During the interview, you should find out how the practice works by addressing the following topics:

What are the office hours? Flexibility of the doctor's schedule may be a concern, especially if you work outside the home; you may prefer a doctor who offers weekend and evening hours.
Is this a solo or group practice? If it's a solo practice and your doctor is not available on weekends or evenings, what are his or her coverage arrangements? If it's a group practice, ask about the qualifications of the other doctors in the office. Who will see your child if your doctor is on vacation or otherwise unavailable?
Does a PNP work in the office? How does he or she fit into the practice arrangement?
Which hospitals is your doctor affiliated with? Will your doctor come to the hospital when you deliver to examine the baby once he or she is born? If your baby needs to be hospitalized, who will care for him there?
How does the office handle phone inquiries during and after hours? Are special times set aside for parents to call in with questions or is there an open advice line (usually staffed by a "phone nurse") during working hours? How are after-hours calls handled? How quickly can you expect a call back from the doctor on call after you have contacted the answering service? Are after-hours calls routed to a "nurse-on-call" system? This is a service that employs a staff of nurses to give parents advice about how to handle most common childhood illnesses. If your child's illness is thought to be serious, the nurse will transfer the call to your child's doctor or a covering physician, or advise you to go directly to the emergency room. Otherwise, a record of the call will be relayed to your child's doctor the next day.
Is email an option for communicating with your doctor?
Will your child's doctor handle emergencies, or will your child be referred to an emergency room or urgent care center? Are these facilities equipped to handle pediatric emergencies?
Are lab tests done in the office? Most offices can perform basic tests, such as complete blood counts, urine testing, and rapid strep tests rather than send samples out to a laboratory.
What are the payment policies? This is especially important if you do not have prepaid health coverage. What are the fees for services? Must they be paid in full at the time of the visit or can payment plans be arranged?
What are the policies regarding referrals to specialists, in the event your child needs additional care? Is the doctor financially penalized by your health plan for referring patients to specialists, and if so, will this influence the doctor's referral practices? If you are in a health management organization (HMO), it's important to ask how your doctor handles out-of-network referrals.
Making a question checklist will help you organize your thoughts and be thorough during the interview. Some doctors offer group classes for expectant parents to learn about the practice and discuss newborn care, while others offer one-on-one interviews. Many insurance companies encourage these prenatal appointments or classes and will cover cost that may be involved; however, be sure to check with the doctor's office and your health plan about charges for meet-and-greet sessions to avoid surprise costs.

What Should the Doctor's Office Be Like?
The interview is a great time to observe office procedures. Scrutinize the reception area; how many children are waiting? More than a handful may mean overbooking, or it may simply mean the doctor is spending extra time with a patient who needs it. Is there a place where sick children can be separated from those in for a well visit? Is the area clean and child-friendly? Is the staff polite and considerate to patients in the waiting room and to people on the phone?

While you're waiting, talk to other parents to determine whether they are satisfied with the care their child is receiving. Is their child comfortable with the doctor? Do the parents feel confident the doctor is thorough and competent? The overall atmosphere in the waiting area will give you a good idea what the practice is like.

What Is the Doctor's Personality?
Another important aspect of the interview is getting a feel for the doctor's personality. Does he or she see parents as partners in a child's care? Is he or she patient and willing to explain things carefully? Do you get the impression that he or she would be supportive if you requested a second opinion? Are the doctor's age and gender important issues to you?

Good communication between a doctor and parent is essential to building a good working relationship. Is the doctor is a good listener who seems responsive to your concerns? Are you comfortable asking questions or do you feel intimidated?

You also should be sure that your parenting style matches your doctor's in the important issues. How does the doctor feel about circumcision? Breastfeeding? Alternative or integrative medicines or techniques? Use of antibiotics and other medications? Does the doctor focus on preventive care, including immunizations, child safety, and nutrition? Philosophical issues may not seem important before you give birth but if you consider that this doctor may see your child for years to come, agreement on larger issues becomes more significant.

Although you may feel overwhelmed with preparing for your baby's arrival, imagine how you'll feel after the baby is born. Choosing the right health care provider will help you feel confident your baby will be well cared for throughout childhood and beyond, and will ease some of the anxiety all new parents experience.

Updated and reviewed by: Barbara P. Homeier, MD
Date reviewed: June 2005