Choosing a care provider

I tell this story in my childbirth classes all the time. When I was pregnant with my first baby, I had no idea how to choose a doctor for my baby. I asked a coworker of mine who he took his kids to, he gave me the name, it was on my insurance list, so DONE! Doctor chosen.
Only….when I called to schedule the 2 week checkup just after birth, they made me schedule well baby visits for the entire first year, and informed me that they were so busy it would not be possible to change the appointments, ever.
When I did see the doctor, I found he was very patronizing and often would not answer questions. Once I asked a question and he literally patted me on the head and told me not to worry my pretty little head about it, he would worry about it for me.
That was the last time I took my baby to him!
Later I ran into that former coworker, and I just had to ask him “What in the world did you like about that guy?”
His reply was “He is so fatherly and reassuring. I love it.”

Well, OK then.

This was my first glimpse into the idea that what might make someone a good fit for one person might just be the very thing that makes them a bad fit for another. My coworker’s personality was a good match for the personality and practice style of that pediatrician. But that same doctor’s personality and practice style were definitely wasn’t a good match for me!
Shared Decision Making in ChildbirthThere is a misconception out there that there is one right way to provide prenatal care and birth care to women. In truth, different care providers have different practice styles. Some are very proactive about trying to manage any possible complication and prevent them from happening. Some take more of a “lifeguard” approach, standing by watchfully and only stepping in to intervene if a problem presents. Some have a set routine of standardized care, like routine induction on the due date, using pitocin to ensure dilation of 1 cm per hour, and always cutting an episiotomy. Others provide more individualized care and don’t have many hard-and-fast rules.

A woman who values predictability and knowing exactly what to expect might be drawn to the first practice style, while a woman who values flexibility will be drawn to the second.

Varying practice styles are one reason why the cesarean rates vary so widely, and why it is so important to carefully choose the provider that is right for you. It isn’t just cesarean rates that vary, either. I’ve seen providers with vastly different rates of inductions, episiotomies, varying requirements for monitoring in labor, etc. It’s important to ask those hard and direct questions. At a conference, I once heard a doctor lamenting that he was tired of women asking about episiotomies, when the answer was always going to be “I only do them when necessary.” One brave soul asked him when he thought they were necessary, and his reply was “Every first time mom needs one. And every mom who has had one before needs one again.” Thankfully I can assure you his practice style when it comes to episiotomies is NOT very common. But if you hear the “only when necessary” line, it is not a bad idea to ask what that might be, and how often they find it necessary. I imagine that doctor’s rate is 100% or very close to it. I’ve also known a midwife who only does them when necessary and she can count on one hand the number of times she has felt it was necessary.

Personality is different from practice style. There are providers out there who have great personality, are easy to talk to, and seem very laid back in their personal interactions can have a very different practice style, so don’t assume that a pleasant personality means a provider has a practice style that is a good fit for you.

Over the years, I’ve come to the believe that there are very few bad doctors, just a lot of times when there is a bad match between the provider and the pregnant woman.

Changing care providers when you realize that you are with a care provider who is a bad match is a good idea. It can change the course of your birth experience for the better. I loved this story, it illustrates very well how a good personality match may not be a good practice style match.

It’s been said a million times, but it really is true. If you were to compare providing prenatal and birth care to a restaurant. You would not walk into McDonald’s and order Pad Thai. If you bugged them about it long enough, they might try and come up with a version of Pad Thai for you, but it probably would not be all that satisfying. Better to choose a restaurant that actually provides what you’re craving. If you’re working with a care provider who provides very actively managed, standardized care that includes induction, breaking mom’s water at 4 cm, an epidural, episiotomy and routine use of the vacuum, the chances of having a spontaneous unmedicated birth are pretty slim. Even if the doctor is a really nice guy who tells you that “you can do whatever you want for all I care.”

Choose a care provider who regularly helps women have the kind of birth you want to have. It’s so important for reaching your goal.

Some would say “Don’t use a doctor, just go with a midwife!” Expectant moms have many choices in care providers and birth places. She might choose an obstetrician, a family practice doctor, a nurse midwife in the hospital, a nurse midwife in a birth center or home, a licensed direct-entry midwife, or an unlicensed direct-entry midwife. In reality, I believe that the individual personality and practice style are far more important than the type of provider. When I was pregnant with my first, I had many questions. I had chosen a midwife to work with, and at my first prenatal I came with a whole list of questions. When I pulled it out, my midwife handed me a stack of papers and told me I would find the answers in there. I read the papers, and while they answered some of my questions, I still had unanswered questions. At my next visit, I asked those questions, and got another sheaf of papers in response. When I got home, I saw that they were the SAME papers. I was frustrated that my questions were not answered.

When I arrived at my next visit, I was told the midwife was over at the hospital doing a delivery and I was offered the option of seeing her backup OB for the visit. I agreed. This time, my questions were all answered completely. He took his time making sure I understood and was comfortable with the answers. He offered me the option of prenatal testing, with some information on why I might want to do them and why I might not want to do them. I felt so much more confident with this provider that I switched and used this OB for my first two births.

As a childbirth educator, I often have women come to me saying “I hate my doctor!” Sometimes they are with doctors or midwives I am not fond of, either. Sometimes I hear it about doctors or midwives I love! And that’s OK. There is not any one provider that is the perfect one for everyone. (I’m under no illusions that I am the right doula for everyone, either!) Because I want women to have care providers who are a good fit for them, I always encourage those women to think carefully about exactly what it is they don’t like, and to specifically choose a care provider that has those characteristics. Interview as many providers as it takes to find that match. When you ask your friends for recommendations, don’t just get a name, ask them about their interactions with the care provider. Ask them if they feel the care provider has the characteristics you want. But also, look closely at yourself and what your needs and comfort zone is. I love this article about questions to ask YOURSELF when choosing a care provider.

Utah Birth ProfessionalsI keep a Pinterest board for care providers I particularly enjoy working with, but don’t take my word for it, interview them and see if you feel like they are a good fit for your personality and if their practice style matches your desire for your birth.

Every woman deserves to be attended by a care provider who has both a practice style and a personality that is a good match for her.

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