You are not allowed to not allow me

When talking to families in interviews or prenatal visits or in my childbirth education classes, I can’t stress enough how important it is to choose your care provider wisely. This amazing article on Pathways for Family Wellness (a site well worth checking out) does a great deal to emphasize some of the red flags you should be aware of when meeting with potential doctors and midwives and how to empower yourself with appropriate questions to weed out those that might not be a good fit. 

I know in my prenatal sessions and classes, couples tend to get anxious waiting for me to FINALLY get around to the things they thought they were coming in for–What does labor look like? How do I know when to go to the hospital? What are the tools for having a “natural” birth?–as I spend the entire first pregnancy consultation or the first two hours of my first prenatal session talking about your birth team. 

I have to remind them that all the squats and yoga breathing and mantras in the world aren’t going to make an impact if you have a care provider who doesn’t believe birth is an event not necessarily full of management and intervention and doesn’t really seem committed to helping you have an unmedicated birth. 

One of the ways you can figure out if they are going to be harmful or helpful to your goals of a physiologically appropriate birth is by paying attention to language like “We don’t allow” or “I don’t do that.” If you’ve done your research and know you want to have a water birth, why would you stick with a care provider who says something like, “Oh some doctors/midwives do that, but I don’t.” or “We don’t allow births in the tub here.”? It’s amazing how often I hear pregnant folks say something to that extent and either don’t know that they can switch providers, or know that they have other options, or for whatever reason just don’t think it’s going to be a big deal in labor. IT IS A BIG DEAL! And though having a doula can be enormously helpful in advocating for your wishes in birth, we can’t make decisions for you or fire a nurse a doctor or a midwife for you, and so there’s only so much we can do in the end. 

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Sadly, we in the United States have grown accustomed to poor medical care, a lack of true informed consent, and being told that we can’t possibly know much about our bodies. With most women hearing horrible stories of near-death births left and right, they’ve grown to think that they must also have this kind of traumatic birth, so it doesn’t matter if they “like” their provider much, as long as they’re there to rescue you and baby. It’s precisely this culture of fear and misinformation and lack of choice and trust in care providers that is driving the rising maternal mortality rate in this country (we are the only country–developed or otherwise–which boasts a rising rate). 

So, it does matter who your provider is and where you choose to give birth. If you are currently seeing a provider who uses language that takes away choice and support, SWITCH! Even if they have a nice smile and good bedside manner, if they’re not on your team, fire them. Now and not when you are fighting them in labor. That’s not fair. If you are early on in your pregnancy interview a bunch of different providers. Seriously. How much time did you spend picking out a stroller or car seat? Spend 10 times that amount talking to care providers and staff at the place where you choose to give birth and don’t stop till you’re sure in your gut that you’ve found the best fit. Take a month to do it. Make them sit down with you for an hour and answer all of your questions. 

If they don’t want to give you their cesarean rate, but avoiding a cesarean is your biggest concern in pregnancy, keep hounding them or leave and never look back. 

You are 100% entitled to having the birth you want. There’s no being “selfish” or “smug” or “bossy” or “difficult” in asking for care that is supported by evidence and is kind and supportive. Choosing an appropriate care provider who gives you options, supports your choices, and practices according to informed consent is also not just for parents hoping to not use pain medication in labor. This isn’t you not being particularly nice to a waiter somewhere, this is arguably the most important day of your life and what happens in labor has long lasting effects for you, for baby, and for your family. It’s not about being a “smug hippie” or trying to win an award for best mom, this is about you taking control of a very normal, natural process that shouldn’t leave you battered, scarred, and needing therapy. 

Do not allow them to tell you you’re not allowed. 

If you want more information like this, sign up for a pregnancy consultation package or hourly conversation. That first investment can save you stress, time, money, and help you connect to a care provider in line with your wishes and needs in pregnancy and beyond.

Home or Hospital?

I got the chance to be a part of a truly beautiful, peaceful, powerful, well supported, safe, mother-and-baby centered home birth attended by two incredible midwives yesterday. This little one came almost exactly 9 years after I attended my first birth (also at home) and felt like a wonderful full circle.

If you are exploring your options for safe, patient-centered, evidence-based care in pregnancy, birth, and postpartum, I’d like you to strongly consider at least interviewing some home birth midwives in your area and doing some research around why home birth is a reasonable option for most pregnant folks. I’ve included some videos and links here and look out for my upcoming longer article on midwifery care here on the blog.

For those who are concerned about the out of pocket cost:

Pregnancy Challenge Week #1 -- Choosing a care provider

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?

how to choose a care provider in pregnancy

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.

Except we do…that ACOJ study makes it really clear. Doc’s make decisions based on “opinion” not science.

Except we do…that ACOJ study makes it really clear. Doc’s make decisions based on “opinion” not science.

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.

Unpopular Opinion : I don't do yoga and I don't care if you do

Ok ok ok. The headline is meant to be snarky. Doesn't make it less true for me, though. 

I don't do yoga.

I used to. When I was living in NYC and was starting to ease up on my heavy amount of dance classes, I would take this one yoga class religiously. Even when friends would come to visit me over the weekend, I'd leave them at my favorite Greek diner across the street from the gym so I could make it to my noon on Sunday power yoga class. This teacher was amazing -- her thick Korean accent peppered an hour of challenging flow that always seemed to fit together like a perfect jigsaw puzzle. The class was full, but never overly crowded. I was never bored. My body felt amazing after. 

Since that time, however, I have never once taken a yoga class I fully enjoyed. And I've tried, trust me. Not dancing 6x a week meant that I had to outsource my typically long stretching routines and yoga seemed like a great way to to it, so I tried. And tried. And tried. I've tried in 4 other states, 7 other cities, 2 other countries since then. Everyone is always telling me to do it so I tried my darndest, damnit! 

It's not because I have been enlightened to what crap yoga is, guys. I'm not and that's not my point. The point is that yoga...or any other one modality of not necessarily the answer to everything for everyone

How many hours of my life have I wasted doing something I honestly don't like? How much money? Why did I let myself get talked into it so often? 

Broad City's community yoga experience...we've all been there, yeah?

Broad City's community yoga experience...we've all been there, yeah?

Part of it is that I feel a bit like a trader not being into this thing that nearly every one of my colleagues have as part of their lives and/or practices. Yoga seems to have glided into the idea of "wellness" more so than nearly any other thing, and birth work is far from an exception. Honestly, I’ve felt downright judged from many in my work circle for not having a yoga practice, and I’ve felt on more than one occasion that other doulas don’t want to work with me because I don’t do yoga. I vehemently believe that it is their right to not want me to be a primary back up for literally any reason under the sun, but judging me for not doing yoga and still being a doula? …That’s kind of crazy to me. It’s not like I didn’t get certified in birth and postpartum care, it’s that I don’t stretch the same way as they do. I get that they probably incorporate yoga breath, etc., into their client care, but it’s not the primary component of attending births. It’s also something I can learn and teach outside of a yoga class. I dunno, maybe I’m overly sensitive, but the yoga pressure can feel really intense in wellness circles and it’s a bit much at times.

As female small business owners in a fringe profession, we almost always have to diversify our service offerings to make ends meat, which means picking up complimentary care modalities, of which yoga instruction is just one. I'm not claiming that becoming a yoga instructor is a piece of cake here, but it can take a lot less time than many other body work professions and there's such an abundance of studios and gyms to be a part of, that it can make sound business sense to tack this training on. Instruction creates a cyclical flow of clients, too -- You pack your classes with pregnant folks who then learn about your doula services along with doula clients who learn about your yoga classes. Since most pregnant folks are told early on about prenatal yoga, there are some lower hurdles to leap over in getting bodies into your classes. It’s a circle that makes sense. Plus, things taught in yoga classes about calming your mind and breathing, plus the physical stretching CAN be very beneficial in birth. It’s just NOT the only way to come to those practices, especially if your a pregnant person who just doesn’t like yoga. Or doesn’t like gyms. Or who doesn’t have the resources to go to an expensive class. And all of that is 100% okay.

I'm not saying a word of this with judgement about folks who participate in or teach yoga. I have judgements about the broader Western yoga culture (Ehhh $200 stretch pants? Body shaming companies? And sorry, why is no one screaming on a rooftop about cultural appropriation here?), but that's not the point I'm trying to make with this post. I’ll leave that for my happy hour ranting with friends.  

Speaking of happy hour, what about all these classes that advertise themselves as yoga, but are about drinking and socializing? That’s all fine, but is it yoga just because you wear stretch pants? Or things like trap music yoga…? Why don’t they just call it Double Appropriation of Brown People Stretching Hour instead? Restorative yoga classes are sometimes just a $20 nap. I honestly think to each their own here and you might get a lot of enjoyment out of these things, but calling any dang class with a mat “Yoga” speaks to a larger issue with the huge commodification of wellness and the entrapment of code words in that realm. Just because something is labeled “natural” or “wellness” and so forth, doesn’t mean it has anything to do with improving your health. Or at least it doesn’t need to be drilled into you that it’s mandatory if it works for some, but not for you.

No, my point here is that there is no one-size-fits-all type of wellness.

That will likely be a running theme in these articles. Just because something worked for someone else, doesn’t mean you’re wrong for not enjoying it. Just because something is “natural” doesn’t mean that it is essential to a healthy life. Yoga is not going to save you if you find it boring. It won't save you if it's cost prohibitive. It won't save you if you simply don't want it to. That goes for EVERYTHING.  Not doing yoga doesn’t make me or anyone else particularly Not centered, Not mindful, Not relaxed, Not focused, Not able to be present and calm for my clients or myself. Loads of people have come to yoga for those things, but I find ways outside of that one practice to be still and grounded. You can, too.

I try my hardest to create a system for my clients that doesn't have an air of proselytizing about any one type of care or modality when counseling them about any area of wellness. Even if deep down in my biddy heart I really really think that the evidence points toward you eating that dang pickle or taking that dang herb or doing your yoga, if you're not into it, I'm not going to push it. I truly wish more care providers were willing to do that and try to connect clients to those who are that way, too. 

If you are needing some support in your general reproductive health or with a specific reproductive health concern, in pregnancy, or in postpartum and want to connect with a consultant who will hear your needs and not try and push you down a particular path, come see me for a session. 

ps- Check out one of my all-time favorite articles on the cult of wellness and how it’s steering us wrong by Amy Larocca in The Cut.