Since your relationship with your OB/GYN will be very important when you get to the point of giving birth I think you need to find an OB/GYN who is willing to develop one with you. I don’t care how good a doctor is, if you don’t know him you cannot trust the choices he offers you. I must admit, I have never had a problem with my Pap smear, and in general, when other medical personnel are surprised that my doctor hasn’t done something (or has done something unusual) it is typically a sign that the doctor is not one I can trust to do everything right. Since you are trusting your reproductive life, your baby’s life, and possibly your own life to this person you should be comfortable with what they do and how they do it. I would say it is time to go find another OB/GYN, one who doesn’t raise these questions. After all, while birth is a natural process, it can also be a risky one, and you want to have confidence in your doctor making the best choices for you and with you. Specifically: Should I expect to meet my doctor before my second trimester? Yes, I have always met my OB/GYN even before attempting to become pregnant. In fact, my OB/GYN is always the one who actually does the Pap smear and pelvic exam. Should I expect my doctor to have preformed a vaginal ultrasound? Yes. It is no big deal to do and gives a lot of information to you. It is also consider standard care these days. Should I expect my doctor to have the facilities to perform vaginal ultrasounds on site? Not necessarily. However, there should be some convenient place for you to have it done and the results sent to the doctor. Should I expect my doctor to be present during any of my ultrasounds? Not necessarily during the ultrasound, but your doctor should explain the results to you in person. Should I expect a certain level of upkeep of their facilities? Unless you are going to a free clinic things should work and be clean. And in a doctor’s office certainly at least the sink shouldn’t be broken. Hand washing is important to good health! Should I expect the occasional mistake? Mistakes do happen, but it sounds as if this is one of a number of oddities with this particular practice.