What are the three types of relationships you can have with your care provider and why does it matter?

I was a Guest Poster on The Gift of Giving Life and I answer this question.

Please go over and tell me what you think!

If you enjoy this, please go to my Creating your Best Birth Team page to get a worksheet and MP3.

I have a doula client who when I met her was looking to change care providers.  So I offered her this list of questions to ask.  (I normally don’t concern myself too much with care providers, because most moms are reluctant to change, so unless mom isn’t happy, they are not open to changing)  But since this mom was in process of changing, I thought she might as well make sure she picked a care provider that was actually supportive of what she may want! 

My comments on her discussion are italicized.

T’s take on her discussion with the OB

Clearly he has thought about these things for a long time and has said them to more than just me. But I definitely think he got defensive. He stood there with one hand on one hip and the other waving around.

Basically it comes down to – He said if he’s going to be our doctor, then we have to trust him; lots of people are giving lots of advice that have never been in his shoes and don’t have his liability.

Really, is this what we are supposed to do, just trust all doctors?  They know best?  Or can we talk to them about things and gather information from them, so we can make the best decision for us? 

He basically said consider the source. What are their qualifications? Do they profit off their advice? & What’s their liability? He proudly counted these off to me on his fingers.

I agree with this, he definitely is coming from a different place.  Rather than being concerned that a patient has they type of birth she wants, his number one concern is liability.  In today’s litigious society, I don’t blame him. 

It went on for a lot longer than that. And I tried to interrupt saying that I believe he’s the expert and that’s why I’m asking him these questions, but got a “Can I finish?”

During his lecture, regarding the qualifications of those other people giving advice to pregnant women – he talked about how he’s delivered more than 5,000 babies and how went to an Ivy League school. “They haven’t been in my shoes.” “Why do you think Dr. H. trusted me with all of her deliveries, why do you think Dr. S. trusted me with hers?” (2 doctors I know)

OOOO, OOOO I actually did go to an Ivy League School too!  But I guess it doesn’t count since my degree was in Education.  But I am a professional Childbirth Educator, educated at an Ivy League School.  But I have delivered NO babies and thankfully I have never been in his shoes.  I love that I don’t have to worry about the medical aspect of birth, rather focus on the emotional, educational and supportive aspect. 

He said “If you hire that doula she will make more at your delivery than I will.”

Holy Cow!  If this is true that is really sad.  Any idea how much most OB’s make per birth? 

He said if I want to have as natural a labor as possible I should stay at home as long as possible. Because once I get to the hospital then the nurses must follow AORN requirements (when I wrote that acronym down, he’s like, “you don’t have to take notes on that.”).

Ok, my L&D nurse followers.  What the heck are AORN requirements and how would they affect birth? 

When I asked what his philosophy was on episiotomies (cutting me) He said “If needed.” I said what if I don’t want one. He said, “Why don’t you let me make that call.” He also said, “If I cut you, I have to sew you up, I don’t want to make more work for myself now do I.”

Does he…? Dun dun duuun.

 Wouldn’t it be better to explain the times when an episiotomy is a good choice.  What about saying your episiotomy rate for first time moms.  That would be more helpful.

Some other answers (some from him, some from his nurse practitioner) -

- He said an IV is very important because you can’t get one in once (if) the mom has started to hemorrhage because the veins collapse (yikes). I said what if I want to be in the shower in my room, he said, well, a helplock.

Why must OBs  try to scare moms into doing what they want?

- When it comes to monitoring, he felt that was very important. If I plan to be in the shower then he said I guess it’ll have to be the intermittent one (so I don’t have to be confined to the bed). But I’ll have to work it out with the nurses.

It really isn’t up to the nurses.  The nurses seem to say it is up to the OB, or hospital policy.  No one seems to want to take ownership of this!   Nurses do have an effect on this.  I have had OBs say intermittent is fine, but some nurses are not comfortable with this and they really try to keep it on continuously.  So indeed nurses count, but if an OB requires it than for sure the nurse will want it on.  If an OB is ok with intermittent, then mom has more of a chance of actually getting it. 

- Philosophy on going beyond 40 weeks – his nurse said he’s fine until 41 weeks then he gets very nervous.

His nurse said his goal was to allow all women to tryfor a vaginal delivery. He had said his goal was to make sure you want to come back for your second child “there are 50 other OBs nearby that you could go to.”

He said he had to induce a mom this morning who’s got a 10 pound baby.   He thinks he should c-section her, but she wants a vaginal birth, so he’s letting her try for a while.

Oh, this one really gets my goat.  I have an issue with Big Baby Bull.  I wonder if this mom got her vaginal birth after “trying for awhile”   I really hope she did.    I also wonder how big her baby really ended up being. 

He said don’t eat a cheeseburger before coming to the hospital, because aspiration is the number one cause of death during labor. Then he knocked on the cabinets (because they’re presumably wood).

Ahh, this is worthy of its own post.  Death by Cheeseburger

How did T. feel about this conversation? 

How would you feel?  Would this be the ideal OB for you? 

 T’s feelings coming in the next post.

This is an important reason why you should talk to your care provider about how they feel about un-medicated births.

I love to read Rebirth’s Blog.  She works on the L&D floor.  In this post she says what happens to a mom who is wanting to go un-medicated.

So water now broken, woman happy but contracting more strongly almost immediately, the attending stands over the woman with her arms crossed and says, “So I’m told you are doing this natural?”

Before the woman can answer the attending makes a noise like, “Oh, please!” She then goes on to say, “Trust me, you won’t be able to do it! You already needed IV medication when you weren’t quite in labor yet. Don’t go fooling yourself, really!”

Thankfully this nurse helped encourage mom that she could do it.  Mom did do it!  Horray.

But imagine if she had a nurse who wasn’t supportive.  That undermined her too.  Mom may not have made it, unless she had a really strong support person helping her. 

Talk to your care provider!

You hear “stories” of OB’s who really think everyone should have a Cesarean.  Really ask your OB what they think about birth.  Their attitudes can have a major impact on the interventions you get.

It is fascinating to read this story of an intern and the interaction with the supervising OB during a birth.  To see how this mom’s birth was being railroaded into so many interventions… not because of the safety of mom and baby, just because the OB wanted it that way.

The routines and attitudes of your care providers are important to know. 

Taking this survey is a great way to let other moms know how supportive your care provider and hospital were.  This will then help them to have better births.  I took it and it took about 20 minutes, I was able to save it and finish it a few days later, so even if you don’t have 20 minutes to sit down to do the whole thing, don’t let that stop you.  Fill it out a little at a time and it will make a huge difference!!!

Women providing women with insight into maternity care practices in their communities.

It has been easier to get consumer satisfaction information about a camera than about maternity care services – but no longer. The Coalition for Improving Maternity Services (CIMS) has developed www.TheBirthSurvey.com a consumer feedback website where women provide information about the maternity care they received with specific doctors, midwives, hospitals, and birth centers. Families choosing where and with whom to birth can utilize this consumer feedback, along with data on hospital and birth center intervention rates and practices, to make informed health care choices.

Have you given birth in the last three years?  If so, take The Birth Survey and provide feedback on your experience, your doctor, midwife, birth center, or hospital at www.TheBirthSurvey.com

I have been lucky to have 2 positive hospital births, as a doula I have seen some good hospital births where mom was supported and treated with respect and some where mom wasn’t. 

Part of the problem with a hospital birth, is you don’t necessarily know if your doctor will be on call and you don’t know what the nurse you will get will be like.  Having a supportive care provider and being treated with respect can make such a huge difference in a mother’s birth experience. 

Here is a wonderful VBAC story where an anesthesiologists support and some good nurses really made a difference in this mom having her VBAC. 

Here is a sad story from a Nurses view point where she saw a mom not getting the support she deserved during a birth.  How could a women feel good about her birth after being treated like that?

There are no guarantees that if you pick a midwife for a homebirth you will be treated better, unless you really TALK to your careprovider and let her know what you need and want and see if she can give it to you.  I guess I am just saying, you still need to do your homework whether you have a hospital or homebirth.