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.