Interviewing a New Doctor
After you find a few physicians meeting your criteria, review our list of questions with those doctors. This will help you decide if he/she is a good candidate. You may prefer a midwife, but know that if you develop more severe symptoms, you will need to consult with or be transferred to a maternal-fetal medicine (MFM) specialist for management as midwives are not trained to care for HG. Many midwives prefer a more conservative and natural approach which means you may not be able to get medication before symptoms are severe. Consider a midwife practicing with specialists or have both a midwife and a MFM involved in your care.
Having a doctor who offers a variety of medications and IV fluids and/or nutritional support before you have severe, prolonged symptoms is the best strategy in managing HG effectively.
If you have HG now and don't feel you are getting adequate care, seek a second opinion. These questions also apply to you and will help you find a doctor.
Use these questions to determine if a doctor you are considering is comfortable treating HG and will intervene before you get too sick. Treatment strategies vary greatly by doctor, so you have to ask. If a doctor has a preset plan that is followed and not adapted to your specific symptoms or the care that worked in a previous pregnancy, you may have difficulties getting the care you need. Trying to educate and change the care offered to you is often more difficult than transferring to another clinic.
Think through the problems you had last time (or are having now) and ask how this doctor will respond to them or prevent them if possible. For example, how will they manage medication reactions, reflux, depression, muscle atrophy, malnutrition, thyroid dysfunction, etc.
Review as much info on our site as possible before your first visit and become familiar with our clinical tools to share with your doctor. This will help you be informed on your options.
Questions to Ask
- How many women do you see with HG each year?
(If they say only a few, they may be uncomfortable being aggressive early on, or may not realize how sick you are until you are very sick.)
- What do you think causes HG?
(If they say it's largely psychological, just normal hormones, or they don't know, find a different doctor.)
- How do you treat HG?
(Allow them to respond to this before asking the more specific questions listed below. Determine if they have a preset plan or if they treat based on your individual symptoms and response.)
- Do you always start with promethazine (Phenergan), antihistamines (Unisom) and/or sedatives (Compazine)? Or can I start with the medication that worked best last time (or a different one if nothing helped)?
- At what point can I start on a medication?
(It's important that doctors are willing to prescribe medications when symptoms begin since you have had HG in the past. This may prevent complications and make HG less severe.)
- Do you use Zofran (ondansetron) or Kytril (granisetron)? How many weeks do I have to be to start on this medicine? What is the max dose you prescribe daily?
(With HG, the small possible risks of medications are usually outweighed by the benefit of avoiding dehydration and malnutrition. Read more on doses and strategies.)
- If I don't improve with those drugs, what would be the next step?
- Do you ever use steroid therapy?
(If you have severe HG and/or have not responded to medications in the past, you may want to consider this. Review more on it on our Medication page.)
- Do you prescribe home IV therapy or nutrition like TPN or offer other options for nutritional support? If so, at what point (how many pounds do I have to lose, how long do I have to vomit, etc.)?
- What other options do you recommend for treatment besides (or in conjunction with) medications? (e.g. Acupuncture, homeopathy, psychotherapy)
(If they believe strongly that HG can be controlled with alternative medicine, you may have difficulty getting adequate care.)
- Since I have had HG before (or now) and we are trying to get pregnant, can you give me a prescription to keep at the pharmacy for a week of (the medication you want to try first) to have on hand in case the nausea/vomiting begins while you are not available or I am away from home (if you travel).
(If another doctor is on call, they may not be willing to offer you medication without first seeing you.)
- Are you comfortable with my using homeopathics or other natural treatments?
(If you plan to try them. See our Complementary & Alternative Medicine section.)
- What are my options for contacting you after hours if I am getting worse since you will know my condition best?
(Do you have to talk with the nurse or an on-call person first? Is that your only option? Sometimes you may not get past the office staff or they may not realize the urgency.)
Feel free to refer the physicians you interview to our site to educate themselves on management of hyperemesis. We have developed many resources including a protocol to help them determine how best to care for you. We also have many links to medical research articles they can read to learn more.