I’m starting a series of challenges to expectant parents to encourage them to take small steps toward better care, more informed decision making, and a smoother transition into parenthood.
Over the next few weeks, I’ll be posting on action item in this vein, with some information for why and some resources for how. I imagine the challenges will be steeper for some families than others. I also imagine that it will vary person-to-person which action items are more difficult than the others. Some families, too, I imagine won’t face a ton of barriers, but just needed some guidance on the fact that these things are available.
So let’s start with the challenge for Week 1:
I challenge any pregnant person, at any stage in their pregnancy, to go out and interview 4 primary care providers in their area.
While this might seem most beneficial for families earlier on in their pregnancy journey, if you are not feeling 100% supported, informed, and comfortable in your care, it is not too late to look around. Truly, most of my birth clients wind up hiring a doula in their late second or third trimesters because they thought they were going to get more education and support in pregnancy at some point from their providers and realize fairly far along that they need to outsource.
It doesn’t have to be that way. Don’t accept sub-par care for ANY REASON.
If you are not digging the approach your primary care provider is offering, or you know that the person you are seeing for primary care in pregnancy will not be the one working with you in birth to make decisions, why would you expect them to suddenly jive with you come your day of birth?
Do you want to be pressured into decisions you don’t agree with when you are having a baby? Do you want to have to come in expecting to fight off things you don’t agree with? Do you want to continue care when you are skeptical of where advice is coming from? Do you want to feel like you are paying a TON of money to still feel lost after months of working with someone through your pregnancy? Do you already feel like you’re having to give up a lot of your parenting desires to appease your provider’s thoughts around your care? Do you think your visits are long enough? Do you feel exhausted from having to outsource a lot of your education to get the support you need?
The communication you are getting through pregnancy is a dress rehearsal for the big day with that provider/practice/place of birth. You don’t need to wade through care that feels inadequate and hope for the best. A doula can only do so much to help you in this circumstance, too. It really matters who is guiding you in the clinical components of pregnancy and who will be there to help make major medical decisions with you in birth.
So here’s is what I propose -- Spend 1-2 hours a week for two weeks in interview with 4 additional providers and/or go on a birth center or hospital tour or open house or to a meet the midwife event.
I read an article recently that said that on average, we watch about 550 hours of Netflix per year. We spend an average of 53 minutes on Instagram per day and 2.5 hours scrolling on our phones total through each day on average. I’m challenging you to spend 2 full hours A WEEK for two weeks face to face with the provider who is going to be your primary point person for one of the most intense and important experiences of your life.
I want to encourage you to pick 4 providers who offer something different than the care you are currently receiving -- a midwife with hospital privileges, a family practice doctor with hospital privileges within your network who can transition into your baby’s primary pediatric care provider, an independent homebirth midwife team or two, or going to a free standing birth center’s open house tour.
I promise you that this won’t be a waste of time, even if you feel these providers or locations feel like a stretch for you for whatever reason. You are not bothering them, this is part of your job. If you switch providers, they won’t be hurt or care, it’s part of their job to work with new people all the time. They are there to answer your questions and address common concerns/dispel myths about their care. You will feel fairly certain in these hours that you have seen what other care looks like and if you choose not to switch, you can feel confident you made the right choice for your family. If you have been questioning your care, you have started a foundation toward understanding that something different exists and how to access it. There is a very clear and palpable difference in the styles and types of care each different type of provider can offer. It’s worth the investigation.
The Harvard School of Public Medicine did a large survey a few years back and discovered that most families choose the place they’re going to give birth (the hospital where they’ll give birth for 99% of American women) because it was the closest one to them. This is not necessarily the best fit for most families. They also found in the same research project that it was clear that the setting and provider made the most difference in whether or not a birth ended in a cesarean surgery, not risk status or how the labor progressed. This is due in large part to litigation-based care and not evidence based care, doctor opinion, and the lack of continuity of care with shift-based primary and birth care, and lack of continuous labor support in hospital settings. With that in mind, isn’t it worth spending 4-8 hours investigating your options?
Here are some questions to take to these interviews :
What is your training and background?
How many years have you been practicing?
What is your philosophy on pregnancy and birth support?
How do you approach clinical testing and exam options? Do you perform those all yourself?
If I hire you, how likely will it be that you will attend my birth?
Where are you able to support me in birth (home, birth center, hospital)?
What is your personal cesarean rate/rate of the place you attend births/transfer rate (for out of hospital midwife practices)?
How often do you attend unmedicated vaginal births?*
How long do your prenatal sessions typically last? What topics do they cover?
Do you offer centering programs or childbirth prep classes in your practice?
Do you encourage working with doulas?
How much communication can I have directly with you in pregnancy and labor via phone/text/email?
How many pregnant persons do you support in a month?
What does your follow up care look like?
Are you available around my due date?
What is your rate and do you accept insurance/sliding scale?
You should be looking for more than just a pleasant bedside manner. Many families say to me that they stuck with their provider because they felt unsure of how to switch and anyway, their provider was “nice.” Since an ACOJ paper pointed out that ⅔ of standard OBGYN practices were based in low-tier or opinion based evidence, I’d say it’s a good idea to look beyond proximity to your home and how nicely your provider might be telling you inaccurate information.
And I don’t mean to pick on doctors alone -- You might find your dream clinician by switching to a new practice or different hospital. Not all midwives are identical and it might take interviewing a few to find a fit you feel comfortable working with. Home birth might be off the table for you in your mind, but you hadn’t thought to check out the free standing** birth center in your area.
Hiring a doula earlier on in your pregnancy journey can help a lot with this. Doulas are interacting with primary providers and individual birth centers and hospitals often and can give you a pretty broad starting point for some providers who might prove to be a good fit. They can also help affirm your decisions, ease your anxieties about switching, and help you sort out some of the ins and outs of the insurance issues.
This is also a big part of my pregnancy consultations services and I can do in person or virtual consults on this topic exclusively if you’re needing further resources for how to choose a provider that’s right for you. In ten years of this work in many different states, a few other countries, in hospitals and out, I can tell you that who you have by your side in pregnancy, birth, and postpartum makes an ENORMOUS impact on your safety and satisfaction with the experience, completely independent of the outcome. You need a provider in line with your wishes in birth and parenting. I’m here to help you find them.
If you’ve accepted this challenge and want to share your story, please feel free to comment below, send me an email, or touch base with me on Instagram @Rosewoodrepro. Happy hunting!
*If that is something you are hoping for it is important to ask this that specifically. Many doctors are trained to use “natural” birth to mean “vaginal” birth, regardless of medical management leading up to that outcome. You might want to also ask for more specific information on how many inductions they oversee a month/year, how often they use vacuums or forceps in births, how often they support parents not wanting medical pain management, if they “labor sit” or spend non-management time during birth in the on call room, their thoughts on “post-dates” inductions, what they consider to be a “high risk” pregnancy, if they treat pregnancies in persons over 35 years old as “high risk,” etc.
**A note on the language around “birth centers,” many hospitals are now calling their maternity floors “birth centers” and maybe having a nurse midwife or two on staff, but this is very very different than a free standing birth center with independent, case-load midwives, something many families don’t realize till they do the hospital tour late in the third trimester and realize it’s not a separate unit from the standard hospital birth care and are disappointed.