When Cosmo meets What To Expect
Saturday, January 22, 2011 at 6:47PM
By ANaturalAdvocate
Changing healthcare providers can be stressful at any time, but when the situation is as time-constrained and fraught with emotion as pregnancy it can be even more so. Patients have to undergo a personal analysis to determine why they are unhappy, whether things can change, and what to do (and how quickly to do it) if the situation is no longer acceptable. Recently, Yahoo.com spotlighted an article by Caitlin Brody (written in 2009 for TheBump.com) with suggestions for how to leave your OB.
Normally I would be terribly excited to see such an article. Provider choice! Women taking charge of their own healthcare! Assertiveness! I have a few qualms, though.
1) The explicit comparison to dating, beginning with the title: “When to Break Up With Your OB.” The article continues:
Sometimes, it’s just not working out. It may be awkward to part ways with your doc, but it may be best for you and baby. Here’s how to know when to switch OBs. From awkward first interviews to relying on friends for personal recommendations, finding the right OB is kind of like dating.
Descriptions like this, to be colloquial, kind of creep me out. A relationship with a healthcare provider should be professional, not intimate. There’s no need for “awkward first interviews” (just ask your questions!), just as there is no need for vajzzling or whatever it is the kids are up to these days. I’m as big a fan as any of a provider that is communicative and friendly with a good bedside manner. I don’t think, however, that I’ve ever had - or wanted to have - a “dating-like” relationship with my provider.
Plus, is this really the tone that should be taken with regards to an article about ending a patient-provider relationship? Is this the tone that would be taken in a men’s magazine, or to a mixed group of patients? The theme of treating pregnant women like young girls seems to have been taken to a new level here, even to describing needing to “cut the cord with your doc,” as though the OB is a maternal figure for the pregnant woman.
2) The assumption that all women want OBs. While I understand that most American women (presumably the audience of this article) may use OBs as their primary provider during pregnancy, many don’t and this article would have been much better directed at providers in general. Brody seems to state that you would only “break up” with your OB for another OB. The same concerns and lessons learned would go well towards any patient-provider relationship, however. I don’t know that “when to break up with your endocrinologist” has quite the same ring, though.
3) The idea that all pregnant women are the same and want the same things. Brody says, “it’s not unusual for a doc to see a different patient every 15 minutes. But remember, your 15 minutes are yours.” The indication is that it’s totally fine for a doctor to rush in and rush out - just so long as they don’t look like they are doing that: “One big no-no: hovering by the door, or generally just giving off the vibe she’s ready to jump to the next patient.” What about someone who wants more than 15 minutes? There’s always the quantity v. quality debate, to be sure, but is having both (or at least some of both) not even a possibility?
4) The major concern about the feelings of the OB. “Don’t be angry,” “How to Break It Off (Gently),” and “Start on a positive note” are some of the tips given. While I don’t recommend flying into the office, middle fingers blazing, what if you ARE angry? Brody suggests bringing a friend to help keep things level-headed; I suggest using your anger for good and letting the OB know exactly what your problems are and why you do not think they were fixed. Keep the colorful language to a minimum (this is a professional relationship after all), but there’s nothing wrong with showing emotion when needed and the idea of bringing a partner along to keep you level-headed is almost infuriatingly patronizing, especially when paired with the suggestion to “thank her before you leave.” Mind you, the last sentence does say that “What matters most here is your comfort level,” but that’s lost a little in the rest of the concern about the OB’s feelings.
On the other hand, the article does have some great tips for how to end a relationship with your OB provider, whether we’re talking OB, primary physician, midwife, or doula, and I find the following advice (some explicit in the article, some not) helpful:
-Be direct and as specific as possible when stating concerns with your provider. NB: Keep in mind that “I’m not comfortable” is still a totally valid reason to switch providers.
-Be honest. Talk to your provider, if you can do so. Sometimes, letting them know your thoughts can change the whole relationship. Sometimes not, so be prepared, but you could be surprised.
-You deserve to be heard. I’ll just repeat this: you deserve to be heard. Not to go all “woo” on you, but I think that’s a pretty good mantra for anyone considering a provider switch.
-“You always have permission to call it quits.” I think this is truly important for pregnant woman, who are often concerned with finding the right provider “in time.” I have had acquaintances and friends who changed/fired providers in the last weeks or even in labor; while I don’t necessarily recommend it (as it would drive me particularly neurotic), a patient always has the ability to change providers if the need arises.
Have you ever had to switch providers during a pregnancy? What would make you switch, if you have not? What tips do you have for women looking to switch?
Reader Comments (20)
I switched providers with my 2 of my 3 pregnancies. With my last I switched @ 27 weeks because my provider was now running the OB clinic and no longer seeing very many patients. I was only there for that one doctor. Upon discovering this I switched providers immediately and had a successful vbac. With this pregnancy I switched @ about 20 weeks to a midwife because I realized he was only giving me lip service to the option of another vbac. Even the hospital where he preferred to deliver had close to a 50% cesaren rate overall. It was very scary to realize my DR was setting me up for the bait and switch. I was nearly in tears when i realized I ahd to find a new provider. Here I am in a new city don't know many people or even where to get a recommendation for a new provider . I am so thankful for a lactation consultant who suggested a midwife and opened the door to a whole new and for me much better world of maternal care.
Aurora, I'm so glad you were able to find a new provider that you liked in spite of being in a new city and being scared. :)
Thanks for your comment.
Also, ANaturalAdvocate wins a prize for working in vajazzling. I'm surprised we haven't seen that glossy mag headline yet... Want Better Care from Your Gynecologist? Vajazzle and They'll Never Forget You!
I switched providers with my first pregnancy. I don't remember exactly why, but I know I didnt like him for some reason. Im glad I did. Shortly after I left he got his license revoked and got shut down...kinda scary! Trust your instincts. If you just get a bad vibe, you may want to consider switching.
I switched. Between appointments, I discovered and read Henci Goer's "Thinking Woman's Guide to a Better Birth." I had always found my OB pushy, arrogant, and intervention-happy. Goer's book gave me the impetus that I needed to leave.
One thing I don't get is how women make a big deal about leaving. Your OB is not your friend. Don't worry about people-pleasing or hurt feelings. Just matter-of-factly go to your new provider and have them request your medical records. Done.
I switched in my second pregnancy to a provider over 2 hours away. The OB I had been seeing in town practically laughed at me when I expressed my desires for a VBAC. It was VERY obvious to mg I would never have that birth with him. Best decision I ever made! Not only did I VBAC, I did it at 42 weeks and pushed out a 9lb baby :-) Take that Dr. I've-had-special-forceps-training
Pasting these hilarious, satirical break-up lines from the Facebook page:
It's not you...it's me.
It's not me, it's YOU!
"I'm just not that into you."
"I'm just kind of into women, so I don't think this is going to work out right now."
"i have a headache" -from listening to your shit....
"I feel like I can't be myself around you"
"Things have become so mechanical. I want to see other people."
"I just feel like we're going through the motions. You don't make time for me!"
"There's no passion anymore. I feel like you don't care about me."
"I talked to some women you were with in the past, and now I'm afraid you're going to hurt me too."
I just canceled our last 'date' and never said a word. Didn't need to make it into a big deal, never received a call begging me to come back. No boom box outside my window. Honestly I think he didn't even notice
Reply: No long (white) coat and Peter Gabriel on the boombox? That is trifling! Forget him!
After my unnecessary, I just did the duck and run, never called back.
If you've been seeing a midwife for concurrent care, I guess you could just confess to having an affair and see how they take it.
Reply: Admit to an affair with the midwife? Oh, no. I live in Indiana. That would get me demands for STD testing and a friendly little call from Child Protective Services. We don't have THOSE sorts of affairs in the Bible Belt. Not if we're mothers and therefore embody "family values" if we know what's good for us, anyway.
Hold your heads high, friends. There is no (misogynistic) "walk of shame" in this metaphor, either. We all make the best decisions for our health care and bodies that we can. If anyone gives you stink-eye for seeing a midwife or deciding on a repeat cesarean, tell them where they can go!
Jill those are hillarious!
Thanks to the mention of vajazzling, I now have this mental picture of a vajazzled woman in labor, with all the little crystals popping off at top speed when her vagina stretches to birth the baby's head, pingpingping! That poor OB could lose an eye!
I left an OB for a homebirth midwife with my second pregnancy, at 24 weeks. The OB lied to me about having a full placenta previa (I didn't). I'm not sure how she expected that to slip by me... I did talk extensively with the ultrasound tech and radiologist at the 20-week appt. the OB based my diagnosis on. She restricted my activities, berated me for gaining too much weight, mentioned we'd schedule the c-section at 37 weeks... I wanted to see my records, she refused.
I did some research and decided I wanted a homebirth: I'd originally begun to see that particular OB because she was supposed to be particularly supportive of natural birth and affiliated with a birth center. The whole reason being that I wanted to avoid even a glimmer of the extended (and, as it turned out, unnecessary as they were the result of interventions during the birth) hospital stay that my first daughter faced as a newborn. Scheduling a c-section based at 37 weeks based on an outright lie didn't sound particularly ethical to me so... I made the appointment with my new providers, had them request my records, ignored the phone the 5 or so times the original OB called and that was that. I had a homebirth two days before my due date. It was one of the best decisions I ever made, for me and - perhaps especially - for my family.
Thank you for this post!
I should have switched providers for my first birth - I had misgivings about my OB but just wrote them off as "pregnancy jitters". She almost killed me with retained placenta => hemorrhage.
As far as tips go for other women, I think you've got most of them covered. Feeling "uncomfortable" is absolutely grounds to switch! You always have permission to call it quits!
I would add one, though: don't fall into the "good patient" trap. Ultimately this is about your safety, your baby's safety, and your lives. Act accordingly.
To be completely honest, I didn't come up with the idea of vajazzling for the OB alone - it was a question in my last due date club (along with how much to trim/shave so the OB can find your vagina - I'm serious). I'm glad to see that you guys above have been able to switch providers for the better!
I left my provider of 12 years when I was 20 weeks into my third pregnancy (a VBAC). I had originally gone to that practice because it had CNMs, six of them, in addition to OBs. I thought I could get a lower intervention birth with the CNMs, but I eventually learned that most of them might as well have been OBs for how much value they placed on natural childbirth or patiently allowing labor to start and progress. I ended up with a high intervention, kind of traumatic vaginal delivery of my first son with one of their CNMs (after a different CNM had tried to strongarm me into a due date induction with an unfavorable cervix even though my pregnancy was totally normal) and then a breech cesarean with my second son (after I was told that I would be sectioned even if I showed up at the hospital in labor, and I had to fight to move the cesarean from 38 weeks to 41 weeks). For some reason, I was STILL there during my VBAC pregnancy, hoping I could get a low intervention birth THIS TIME. I started noticing the VBAC "tolerance" rather than VBAC support at my early visits. VBACs were a little "risky", but I might be able to have one if I went into labor on my own before 41 weeks, had IV fluids and didn't need any augmentation. At every visit, I was asked if I "still wanted a VBAC." I am a long-ish gestator, so I was worried.
From ICAN, I got the name of a VBAC-friendly provider who was covered by my insurance plan and set up a meet and greet. I laid my whole history out there and the fact that I would not be willing to have an elective RCS. He was totally on board and thought a vaginal delivery was a much better plan than a RCS, so I switched. I requested my records from the previous practice, paid them a bunch of money as a "copying fee" and included a letter explaining politely but firmly why I was switching. That was that. It was the best childbirth-related decision I ever made.
Oh, and my VBAC was at 41+1, just one day past the deadline my first practice would have set for me. Normal delivery, much better than either of the previous ones.
An OB who couldn't find a vagina without assistance should probably be sent back to Anatomy 101, stat. Now that you mention it, I'm kinda surprised there isn't some sort of GPS vagina-finding software out there. Using eyes and common sense is just so primitive-- leave that for the hippie midwives!
KK, I don't know if I've ever heard your background. Thanks for that.
My wife and I had a hard time at first finding a doctor in South Alabama to help us get pregnant. We did finally and she was fantastic, but she doesn’t deliver babies. We took the recommendation of our fertility doctor and made an appointment with Dr. A. He was so nice and welcoming our first visit. We were just so relieved that his head didn’t spin around upon finding out that we were *gasp* lesbians, we totally forgot to feel him out for important issues. But he was so nice and cool, he couldn't be one of “those” doctors, right? Just, wow, can first impressions be wrong. Our second appointment: Natural birth - “Now ladies, you just don’t understand what hard work this is, they call it labor for a reason. I’ll drive and you won’t have to worry about a thing.” Epidurals? “Well of course, I don’t want you flopping around if I have to extract the baby.” Our eyes widened... Cesarean Section? “I don’t like to do those because they are more work for me and I don’t get paid anymore to do them, so that’s not something you should worry about.” I blinked, surely we’re on candid camera, this man can’t really be saying these things. We both just nodded dumbly from there and dutifully made our next appointment at the desk.
I called every home-birthing, midwife-using, alternative-anybody I knew and cried 45-minutes on my drive to work. Luckily I have some of the best friends in the world and they pointed us in the right direction. We did wait to cancel that next appointment until after we’d secured another with one with the only CNM in our area. Looking back after a beautifully successful birth, I kinda want to go to Dr. A and give him a piece of my mind. But after talking to many people about it, I think that’s what many women in our community would expect when entering an OBGYN’s practice. Which makes me sad but, at what point did our eyebrows sky rocketing up not send the message? Maybe he pegged us for weirdo tree-hugging hippies that he didn’t want to deal with anyway, so by pushing all the right buttons we’d run screaming into the night.
Do I wish, just a little, that I had read him the riot act about his positions on these issues? Yes. Would it have changed him? Probably not, and neither would knowing how beautiful the birth was with out all his interventions. Did I meet some of the most amazing women because of his opinions? Yes and I grew closer to some really amazing women I’ve known for a long time. So thanks Dr. A for pushing us down that path a little farther till we found what we were really looking for the whole time. He made me a staunch birth advocate and more aware of my rights as a person.
Katy, I'm glad you and your wife found what you were looking for.
I keep reading (on the FB page, too) the theme of gratitude to providers for being honest about their attitudes because it motivated people to find something better for them.
I'm glad to hear these stories of finding new providers, too. I think there's a fairly common theme that we just want to be told the truth and allowed to make decisions from there. Much like the sign in the OBs office - "no doulahs" - just be upfront. Some people want that, and should know they'll get that; some people don't want that, and should know they'll get that. :)
I left my first care provider around 30 weeks I think. It was stressful, but I knew it was right for me.
I have had quite a few of my Hypnobabies students change care providers. Once they realize what their options are and their original care providers wouldn't do what they wanted, they found one who would!
I left a hospital-based midwife/OB group for a birth center-based midwife group at 28 weeks. I had been debating back and forth, and I finally worked up the nerve to make the switch when I realized that all my anxiety was caused by the fear of telling Group 1 that I was switching (didn't want to make anyone feel bad), and NOT about any concerns about the birth center group. Of course, then I ended up in the hospital anyway, but my birth center midwives did their best to protect me from the hospital machine.