June 13, 2013

Not Sure About Your Doctor? What To Do!

Recently after one of my Prenatal classes, a discussion formed between two students and myself; one of the women was 14 weeks, the other 25 weeks along. The students were having second thoughts about the care providers they had chosen and were thinking, at this point, what could they do about it? The options for how to handle this are a bit different since these two moms-to-be are at different points in their pregnancies. The woman at 25 weeks along had said she had been with this doctor for a long time and hadn’t realized until now that her doctor is rather conservative with his medical practices and had already expressed some restrictions that would be placed on her. She also mentioned feeling a bit overwhelmed at the idea of changing practices at this point and was not even sure if it is an option anymore. The mom at 14 weeks said she too was surprised by the lack of choices she would have in terms of pushing positions her doctor would allow and that she didn’t know where else she could go. She also expressed how much she really liked her doctor and didn’t want to hurt any feelings by trying to switch to a different practice.

In terms of not wanting to hurt the doctor’s feelings, I reminded the student, the experience of birthing is something a mother will carry with her for life; the doctor, on the other hand, will not. Doesn’t the mom deserve to feel supported the way she needs to be and give herself and baby the best care provider match possible?

What to do if you have made the decision to switch care providers
First, call around and see who will take you. Before jumping into a new practice, set up an interview to make sure this new doctor is indeed a better match for you. A good starting point for interview questions is this article: “5 Questions To Ask Your Care Provider BEFORE Your Birth

Unfortunately what the 25-week pregnant student learned is, here in NYC, it is rather difficult to switch care providers past 23 weeks. I reached out to a doctor I know personally (he preferred to remain anonymous) and asked why this is. He responded “First, there is a financial disincentive to take late transfers. The global OB fee is less if there are less than 7 prenatal visits.” He went on to say, “But my issue is the practice of ‘doctor shopping’. Or, [the patients] are running from advice they don’t want. To be really honest, my experience with late transfers is that they are looking for someone to tell them what they want to hear and they can be very difficult sometimes. Also, transferring late doesn’t leave me a lot of time to get to know a patient and to build a rapport.”

What do you do if you can’t find a new doctor who will take you? Here are some tips that can help you feel more confident about your upcoming birth without switching providers!

1. Get a doula!
If you are now realizing you may not be finding the support you want from your current care provider, a doula may be a good person to bring along to your birth. Several studies have shown that the presence of a doula can reduce the rate of routine interventions and cesareans. A doula’s assistance in the birth tends to result in shorter labors with fewer complications. Doulas also help to reduce negative feelings about one’s childbirth experience, reduce the need for pitocin (a labor-inducing drug), forceps or vacuum extraction, and reduce the mother’s request for pain medication and/or epidurals (1). The doula can also act as an ambassador between you and the hospital or care provider. She should not be argumentative with your care provider; however, she can help guide and remind you of your birth choices if common, medically unnecessary interventions are being introduced that you had previously requested not be part of your birth.

2. Stay home as long as possible!
One way to maintain some freedom in your birth is to stay at home as long as possible. Even my doctor friend recommends this strategy! Having the aid and watchful eye of a doula will help you determine when an appropriate time is to go to the hospital. The doula is trained in reading the emotional and physical sign posts of labor. By showing up to the hospital too early in labor, you run the risk of either being sent home or starting to follow the protocols of the provider whom you are not super comfortable with. For example, some care providers want to see the mother progress at a certain rate, perhaps dilating 1 cm per hour. However, most labors cannot be as predictable as that. Some women can go from 4cm to 10 cm in just two hours and others may take 12 hours. So if you are looking for a bit more space and freedon in your labor, staying at home for as long as possible is a great idea.

3. Educate yourself!
The more you know about the different, commonly introduced medical interventions in labor, the more you can advocate for how you are hoping your labor will play out. Of course there are no guarantees that your labor will be picture perfect, however you can make more empowered, thoughtful decisions if you understand the pros and cons of different medical interventions and also what complications you might encounter. Also, if you approach your care provider from a place of informed calmness, you may be able to negotiate some of your requests. One scenario I have seen work is in regard to pushing positions. Some providers really want the mother to deliver on her back in a reclined position. If this is the case and your provider won’t budge from this, you may be able to ask to push in any position comfortable and beneficial to you, but when the baby is crowning, switch positions to follow your care provider’s lead.

4. Have a strong support team!
Choose your delivery room posse wisely! Think about who will give you the most confidence and support throughout your labor. These are the people you want to have by your side. Also, befriend the nurse! Yes, the nurse takes direction in medical care from the primary care provider; however, the nurse can definitely be of great assistance, especially if you choose to forgo a doula.

I hope this article has helped you identify some reasons you may feel you want to change care providers and some options if you choose make a change, or find yourself unable to switch. If you discover that you are in it for the long haul with your care provider, please don’t despair! There are definitely ways to find the support you are looking for and to still have the birth you hope to have.

1. DONA International



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