Monday, November 25, 2013

Red Flags and "breaking up" with your doctor.

Care provider RED FLAGS 
This is a short article with some valuable information, click the link to read more!

This list of Red Flags is a good guide when determining whether to stick with your provider, or change care.  Many women choose their birth team for reasons that seem reasonable, but may not actually be applicable.  For example, if you have chosen your care provider because he or she has provided you with sound gynecological care for a number of years.  You have a relationship with that person and because the title says OB/Gyn you assume that that person should be your Obstetrician as well.  Not necessarily. You may have had several friends refer you to their OB and you trust them to offer you guidance in this process.  Perhaps, or perhaps not.  You chose your practitioner based on geography, appointments close to home or the office, and the doc has privileges at the hospital nearest you.  Caution.  Convenience is not generally a word associated with parenthood, best to learn that one right away!

Before deciding on a care provider, it's a good idea to educate yourself about some of the options you have (or may have) available to you in the birth process.  Some of the biggest decisions involve the degree of intervention you are willing to accept in terms of policy/procedure/routine intervention, not medical necessity.
Educate yourself about:

  • Pitocin (also called oxytocin, however misleading)
    • How it relates to premature birth and the risks associated with it
    • How it relates to the increase in cesarean section
    • risk factors for baby
  • Epidural/Spinal Anesthesia for "pain"
    • How it may effect the baby's heart rate, and your baby's ability to breath and nurse
    • How it relates to the increase in cesarean section, vacuum assisted delivery
  • Continuous Fetal Monitoring
    • How it relates to our inability to have freedom of movement to cope with discomfort
    • How it relates to an increase in the perceived need for anesthesia
    • How it relates to an increase in cesarean section
Once you know how you feel about these very COMMON practices in the hospital environment, you will be better able to interview a potential provider.  It reminds me a little of planning a wedding; a wedding planner might say that once you choose your dress, that decision determines the formality and scope of the whole event.  Your provider is to the birth as your dress is to the wedding. It is important that he/she is on the same page as you regarding these very important elements of this monumental event.  Considering this 2008 CDC report ( 2008 CDC report on anesthesia use during labor ) , it's easy to presume what page most OB's are on, so it's important to find out if you are working with the exception or the rule.

Even if you have been seeing this Gynecologist for years, if you don't see eye to eye on the management (or lack of management) of your labor and birth, you are fighting an uphill battle.  The fact that they are a good fit for your gynecological care doesn't predetermine any kind of birthright in being chosen as your OB.  They are separate, isolated roles even if the OB/Gyn title has a lilt of obligation.
Honestly, you only have to see this person once a year, and BELIEVE ME, it is not personal to the doc, don't make it personal.  That seems odd perhaps because of the intimate nature of the medicine they practice, but this is still business, your business, your lady business, your internal lady business.  Own it.  IF you go back to the other gynecologist after the birth, at your annual exam following the birth and postpartum care period, you can simply tell your gynecologist the truth. A few examples might be:
"I did a lot of research and was more comfortable with Dr. __because she has a very low cesarean rate"
"I was really wanting a low intervention birth and chose  to deliver with a midwife"
"I am really comfortable with you for my annual care, but had a conflict with the intervention rates of  your practice"
No apologies, do not apologize.  It is your right to choose.

Even If your friends gave this professional a glowing review, if the OB doesn't share your particular feelings about the use/overuse of these interventions, then the referral, while very nice, isn't the right fit.
This can be hard in a close knit friendship, but avoiding a slightly challenging conversation with a friend shouldn't be the reason for choosing a care provider for one of the most important days of your life. You just have to find the kindest way possible to tell them that their doctor wasn't the right fit for you.  Some examples of how that conversation might go are: 
"I'm so glad you had a wonderful experience with him/her, we have already chosen a provider that I feel really comfortable with."
"I'm so glad you had such an awesome connection with your OB, I'm going to keep interviewing until I feel that same sense of trust"  
"Thank you so much for the referral, we will interview him/or her along with the others on my list."
This isn't a sorority, it's not a club.  Each woman, even in a tight knit group of friends will have preferences that will vary slightly (at least) in events of this magnitude.  You wouldn't all want to have identical weddings, right?  Individuality and respect are invaluable in any good friendship. Also beware of friends/family trying to validate their own experiences by pressuring you to have the same one.

The closest OB, the closest hospital.  Not unless you either:
A. Happen to live closest to the hospital with a high intervention/cesarean rate AND you have a high risk pregnancy that requires the services or you have no interest or opinion about/desire to have input, control, awareness of what is happening to you, your body, your baby,  during your delivery.
B. Happen to live next to the hospital that has low intervention rates and you desire to be involved in the decision making process and wish to have minimal intervention.
Everyone else needs to do their research.  The difference, in my area for example, can mean a variation of 10% or more in cesarean sections alone, within a few miles.  All hospitals that provide obstetric care are not equal.  Research the way you would for any other big life event, wedding, marathon, triathlon, long road trip, overseas travel, or major abdominal surgery.

Choosing a low intervention birth in a high intervention environment is a battle you can win (sometimes) with a well written birth plan, a supportive partner willing to be the bad cop when necessary, an experienced doula who can act as a medical advocate and also, if you can, get the planets and stars in alignment.  Why, though, would you want your birth to be a battlefield? There are other OB's, in hospital midwives, out of hospital midwives that may offer your desired experience with kindness and expertise.  Often the lack of support for a low intervention birth is directly related to that particular doctors discomfort/lack of experience attending a birth without all of the armor.  Their beeping machines, wires, tubes, pumps, etc, make them feel secure in their practice of medicine but it doesn't always, or even usually improve birth outcome or experience. 

Changing care can seem daunting, but I think that is because many women believe that they essentially have to "break up" with their doctor.  So many people go WAY out of their way to avoid confrontation or uncomfortable conversations and this is no exception.  Good news, you don't have to.  All you need to do is interview (while still attending your prenatal visits) other providers.  Once you have chosen one, you just tell that provider (doctor or midwife) that you wish to change care.  Their administrative staff will send a records request to the administrative office of your current provider and their office will fax it to them.  Usually at this point it's done.  You may receive a phone call from your old OB's office if you don't show up for your standing appointment, and very occasionally you may get a call from the Doc inquiring about why you chose to change care.  In this rare instance, I would take the opportunity to be honest....and kind....explain why.  Some examples might be:
"I researched your cesarean rate and was uncomfortable with the risk."
"I want a birth with low or no intervention and felt you were not going to respect my choices"
"Our prenatal visits were not long enough for me to discuss my concerns"
"I was concerned by your lack of support in my choice to hire a doula"
"I left our appointments feeling frightened by your narrow margin of "normal""
"I felt like I was being treated as a high risk pregnancy even though I am healthy and low risk"

I would love to have the opportunity to have you in my classroom, please see the link on the right for my schedule for 2013-2014.  If you are not in the puget sound region and want more of what you are seeing here, please take a look at my published curriculum/DIY Childbirth Education Workbook

All my best for the beautiful welcome for your precious baby.

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.