This post has been brewing in me for some time now. Let me start with a disclaimer... as a doula, I have enormous respect for the men and women who are medically trained to provide care for pregnant women and their unborn babies. I believe that most have the best intentions in mind when it comes to caring for their patients. I know that they pay one of the highest malpractice premiums out there. I think that many are doing the very best they can do.
That being said, I've had a number of women in my life, friends and clients alike, who've shared that as they got further along in their pregnancy, they felt uneasy about their relationship with their respective OB. For some of these women, as they brought up their hopes for labor and birth during a prenatal appointment, they found their OB not all that supportive or willing to really listen. When asking to discuss their birth preferences plan, their OB snidely responding with "It's the patients who come in with a birth plan who end up with an unplanned c-section." For others, they felt like their OB had a typical way of going about things (suggesting induction at 39 weeks and/ or urging induction at 40 weeks, performing cervical checks starting at 37 weeks, etc.) and when the patient questioned if this was medically necessary or just routine, the OB growing visibly frustrated and curt with the patient.
These women who've shared with me aren't demanding or inflexible in nature. They aren't trying to be difficult or suggest that their OBs don't know what they're doing. They've simply wanted to have a two-way relationship with their doctor- one where they can ask questions and share their wishes for their prenatal care and impending birth, without feeling belittled or like what they've researched is all bunk because they're not the one who went to medical school. They are hoping that the one they've entrusted with the care of themselves and their unborn baby would be open to conversing and making the best decisions for their care based on their individual situation. Some of these women have chosen to stick it out and remain with their OB despite not seeing eye to eye and others have chosen to look elsewhere for a care provider who is more in line with what they're looking for.
In reflecting on the conversations I've had with these women, I thought that sharing via my blog might help others who find themselves in similar situations. I think there is a proactive approach and a reactive approach that can be taken. For women who are not yet pregnant or early on in their pregnancy, be proactive. If you're not pregnant, do some research before you're "on the 40 week clock." You don't have to know exactly what kind of birth you hope to have, but begin to think about what values you have when it comes to giving birth and what type of care would be a good fit for you during pregnancy. Would you feel more comfortable with a midwife or doctor who practices from a medical model or a midwifery model of care? There are OBs who practice more from a medical model and others who practice more from a midwifery model. The same can be said for midwives. Another thing to consider is the care provider that you currently see for gynecological care. If you're seeing an OB/GYN for your annual, you may love them for GYN care but find out they're not the person you'd fit with best for OB care. Ask around if anyone you know has had them as a care provider during pregnancy. Google their name and see what kinds of reviews come up. If a friend has recommended her OB or midwife, feel free to call and ask to set up an interview.
If you are early on in your pregnancy, NOW is the time to begin the dialog with your care provider about the way they view labor and birth. Find a list of questions (online or in a pregnancy book) to go over with them. Get a feel for if this person is the best fit for you and your partner and your hopes for your care during pregnancy, labor and delivery. If there are red flags, don't ignore them. You have time to find a better fit. Ask for referrals from friends who have a similar birth philosophy to yours. Contact a doula in your area and see who they suggest.
If you are later on in your pregnancy, your approach is going to be a bit more reactive. As you get closer to term and you feel like you're seeing your care provider's true colors come out, don't assume that it's too late to do anything about it. There are OBs and midwives who are comfortable with accepting a patient late in their pregnancy. Depending on your insurance, you have flexibility to change to a different provider. One of my clients was 37 weeks and felt more and more like the OB she was with was not going to be as supportive of her wishes for labor and birth as she once thought. After discussing her situation with me, she decided to seek out another OB and switched to their care just shy of 38 weeks. She shared with me that instead of going to appointments with her guard up and on the defense, she finally felt like she could go relaxed and knowing that she would be listened to.