Outcomes in obstetrics are usually reflected as “infant mortality rates” and “maternal mortality rates”. Here are a couple of web sites I found with those statistics for the Los Angeles area; I’m sure there are others. A call to the administration of the hospitals you are considering may result in their specific results, which you could compare to the overall rate.

http://lapublichealth.org/mch/fhop/fhop98/individ/p81.pdf
http://publichealth.lacounty.gov/mch/ReproductiveHealth/LACMQCC/lacmqcc.htm

The Medical Board of California may be able to give you information about the malpractice or disciplinary records of physicians you are considering.

That said, putting the whole picture together is much more complicated. First, I would avoid teaching hospitals unless your wife is having a complicated pregnancy involving expected protracted special care for the newborn, and even then, many private hospitals have fine neonatal intensive care teams. While Robin Hanson seems to think that people go to teaching hospitals for “status”, those with common problems usually go there because they are on welfare, Medicaid, or Medicare without supplemental insurance. Second, whatever hospital you choose may or may not be used by whatever doctor you choose. Third, whatever doctor you choose, you must consider the entire group with which he/she takes call, since 2/3 of every day is not during “regular business hours”, and unborn babies don’t know that. The odds are relatively slim that any one doctor will actually be the one who handles the labor and delivery, unless it is a scheduled C-section or induction. Most groups have the pregnant woman see all the doctors prenatally so that a relationship is formed to cover this situation.

Once you know your insurance options, I think you would do well to look around for intelligent couples who have already been through the process and get their feedback on doctor groups and hospital experience. Attentive monitoring of the mother’s progress during gestation is the best insurance against labor and delivery complications; previous mothers will know the level of prenatal attention they received. Hospitals (and some doctors) do a lot of marketing (one way or another), but it’s difficult to fake the actual product as experienced by the consumer.

Lastly, remember that throughout most of the world, and for most of the time that modern Homo sapiens has existed, most babies were/are born without any medical intervention. The “advanced” US system, with all its interventional capabilities, ranks somewhere in the 20’s worldwide for mortality results.

I have to admit when I changed med. groups/hospitals for our coming baby I did rely upon a famous name and anecdotal internet reviews. Where might I look for more stats?

Thanks,
Jeff

Legally, injectable alprostadil is available by prescription only. Any licensed MD can prescribe it, but usually the doctor is a urologist, or a GP in a sexual medicine clinic, because of the necessity for being able to handle the possible complications. There is no reliable method to determine the proper initial dose, other than a trial injection. If the dose is too weak, the only complications are disappointment and perhaps embarrassment. But if it is too strong, an erection that will not subside spontaneously (priapism) may develop. If not treated appropriately in the first twelve hours or so, permanent damage to the penis may occur (as well as a LOT of pain). Fresh priapism usually can be resolved by an injection of an “alpha adrenergic agonist” drug, such as phenylephrine: same technique as the original alprostadil shot, and painless. For resistant cases, it may be necessary to anesthetize the penile skin and place an IV needle into the muscle, in order to extract the clotted blood. If there were no risks, it wouldn’t be a prescription item. That said, my patients have used over 300,000 alprostadil injections; I have treated priapism about 20-30 times, all successfully.

Some claim that injections lead to palpable scar tissue in the erectile muscles (corpora cavernosa). This certainly is true of some other agents or mixtures of agents, but I know of no controlled studies that confirm it with alprostadil. Scar tissue, in my opinion, develops because of diminished vascularity, the reason the injections are required to begin with.

My method for dosing was (I no longer see new patients): Interview to determine age, general health issues, ability to follow instructions, and the character of erections noticed when awaking (the stronger the awaking erection, the better the vasculature). Make an informed guess about the dose, and administer a trial injection in the office. If the response is too strong, inject phenylephrine and prescribe the minimal dose (or revert to pills). If the response is absolutely too weak, prescribe a stronger dose for home trial, adjusting it as necessary if still too weak. If the response is moderate, try that dose at home before going higher.

By word of mouth from a former patient, a doctor acquaintance, or even the yellow pages, find a urologist who treats erectile dysfunction as a special interest. I saw very few patients whose health insurance paid for alprostadil injections, but that’s an individual issue that you can determine. If not covered, expect each injection to cost $15-30.

NOTE: If you occasionally have completely normal erections, whether sleeping, masturbating, fantasizing, or during sex, injections are not for you. Injections are for people whose penis has a physical disorder. Such disorders do not come and go.

Thanks for your observations, which are quite accurate, in my experience. As a result of your comment, I inserted an addendum to the post (which see).

So why do the parents pay $40,000+ annually for this type of service?