Swiping Right on Your Provider
Let’s say you’re online dating.
You’re looking for a long-term committed relationship, and down the road you’re hoping for moments of intimacy. You want someone you can trust, who has your best interests at heart, someone you feel safe with, someone who values your consent and your trust.
It’s rare that the first person you connect with ends up being the person that you have a long-term relationship with, and it would be even weirder to go on another date with someone who you didn’t feel safe with, or didn’t listen to you, or who made you feel like they didn’t have time for you.
Though it’s a different context, hiring a care provider for your pregnancy and birth is expected to lead to intimacy (having someone touch your genitals is intimate and requires trust and consent, no matter the context). You want to know that you can trust this person and the other people in their practice to care for you and your baby, and that they have your best interests at heart. You want to feel safe with them and you want to be able to fully consent to anything that happens during your care—not only in pregnancy, but in labor and birth when you’re physically and emotionally vulnerable.
And yet so many people hire the most convenient provider (granted, this may be their only option based on where they live and what their transportation situation is like), or work with the OBGYN they already have, even if they don’t feel that great with that person or practice. Some people don’t know how to feel with their provider—I’ve heard plenty of clients say they like their provider “okay” or “well enough,” and assume that’s the best they can expect. Some people work with the same OB practice they had before, even if they had a bad experience the first time around.
Additionally, many of my clients have red flags pop up in prenatal appointments; maybe they felt rushed or didn’t have their questions answered, or maybe they felt belittled for expressing a preference (like, “oh you may not want the epidural now, but believe me, you will, haha”), or maybe the provider who initially expressed support for a VBAC is now saying “we’ll see…”, or maybe you’re not sure if your provider will “allow” birthing upright, and so on (can we just stop giving permission to our providers to “allow” us to do anything?), or maybe you’re 39 weeks and they’re already trying to schedule an induction, even after you made it clear in the beginning that you’d like to avoid one unless medically necessary.
I believe that we shouldn’t just feel “okay” with our providers, just like we shouldn’t feel “okay” about the person we bring home to meet our parents. Beyond questions of competence and safety, we need to feel heard, respected, and valued.
In the case of your provider, it’s important to remember that you are the one hiring that person—they work for you, you don’t work for them. You have every right to educate yourself, ask questions, receive clear answers, to take up time and space in their practices, to choose for yourself, to decline a procedure or request labwork… you have the right to advocate for yourself and your baby, and to be heard and respected, even if it goes against the recommendations of your provider. (For more on this read “Seven ACOG Positions Every Parent Should Read”).
So how do you find a provider that you absolutely love and trust? A provider who you feel safe with, and respected by?
When you’re on the other side, you want to feel good about the choices you made.
Check out multiple practices
Shop around! Start off by investigating your options—you have a choice between an OB and a midwife, the medical model of care or the midwifery model of care, a midwife at home or in the hospital, a nurse-midwife or Certified Professional Midwife or a Direct Entry Midwife, a hospital or a birth center, a hospital-affiliated birth center or a freestanding birth center. Not all options are available in all places, and not all options are covered by insurance, but you won’t know unless you inquire.
Set up an interview. Find out more about the provider and their philosophy of care. If you really want to avoid a cesarean, work with a midwife (they have lower cesarean rates), or consider a birth center or even home birth.
FInd out their stats ahead of time. The Leapfrog Group compares hospitals across the United States, providing data on cesarean birth,
2. Get the scoop from birthworkers
We know what happens in labor and delivery. We know which doctors and midwives treat people with respect. There are some truly wonderful obstetricians and midwives out there, and we’re happy to recommend them. Ask doulas, chiropractors, prenatal yoga instructors, midwives, and whoever else who works in and around maternal health.
3. Ask tons of questions
Your provider should be able to comfortably answer your questions (here’s one list of suggestions). What’s their primary c-section rate? When was the last time they performed an episiotomy, and in what percentage of births do they perform them? Do they support vaginal birth after cesarean (VBAC)? Are they trained and comfortable with vaginal breech birth (this one is sadly pretty rare, although I’ve referred pregnant folks carrying breech babies to some wonderful providers who are skilled in vaginal breech when I worked in Boston and New Hampshire! Even more sadly, here in New Jersey, no matter what provider you’re with, all but a fast surprise breech is an automatic c-section, in which case, you might cast a wider net and consider Pennsylvania or New York if the situation arises). You might not be looking for a VBAC and it’s unlikely that you’ll have a breech baby, but these questions serve as a litmus test as to their overall approach to birth—in short, how comfortable are they with physiologic birth?
You may want to do some work around this before you even go into the conversation. What is that you want? What makes you feel safe? Because it’s not about where and with whom you give birth, it’s about you feeling great about that decision.
4. Listen to your gut
That is all. Just listen.
5. Watch out for red flags
Here are some of mine: your provider doesn’t spend enough time with you to answer your questions. Your provider doesn’t remember your name. Your provider makes you feel like you’re silly, stupid, or naive. Your provider says one thing early in prenatal care, and then for no clear medical reason says something entirely different later on. Your provider is dismissive of your trauma history. Your provider “doesn’t allow” doulas. If they interrupt you or won’t listen to you. If they joke about your birth plan. If when you opt for something outside of their recommended course of care, they threaten you by implying they will call CPS (this, this happens!). If they don’t take your symptoms seriously (especially if you are African-American and providers in the system are more likely to dismiss your symptoms).
6. Don’t be afraid to switch providers
They work for you. You never signed a contract saying that you would be their patient until six weeks postpartum. You have every right to switch to a provider who will provide the care you need, whether you’ve only had one prenatal with them or if you’re 42 weeks.
7. Know your rights
No matter who your provider is, you have a right to make a fully informed decision. Outside of the case of RARE emergency scenarios that require a fast response, you have the right to have every recommendation fully explained to you including risks and benefits, to be able to do your own research (typically in pregnancy), and to have time to think about it and discuss it with your partner and/or doula, and to decline a recommended course of care, either temporarily (as in “I want to labor for a few more hours before moving to that option”) or completely (“we are declining antibiotic eye ointment for our baby”).
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And what if, at the end of the day, you are stuck with who you’ve got and you’re making the best of it? Be prepared to advocate for yourself, and know your rights. Hiring a doula can make a huge difference, help you to self-advocate, ensure that your voice is heard, and that you have space to process the good and bad of it. If you can’t afford to hire a doula, then find out whether there are doulas in training or community doula programs that provide low-fee or volunteer services.
Further reading…
Birth Monopoly - Excellent resource on your rights in childbirth
“Informed Consent, with Cristen Pascucci” - Birthful Podcast Episode 229
Your "Postpartum Plan" is as Important as Your Birth Plan (Ananda Lowe)
