Red Flags: 3 Signs Your Care Provider is Not a Good Fit for You

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(Please note: for the purposes of this list, I use they/them pronouns to refer to care providers in order to make the language open to all possibilities.)

  1. You feel anything less than SEEN, HEARD, AND RESPECTED in your visits.

You deserve to be treated as if your time, concerns and questions matter.  Do you have time to ask your doctor or midwife all of your questions or do you feel rushed?  Do you feel satisfied and confident with the responses to your questions or are you met with disapproval for asking them? Examples of “red flag” responses to questions might include: “I’m the one who went to medical school.  Why don’t you let me decide that?” or “You don’t need to ask so many questions.  I’ve been doing this for a long time,” or “You think you want a natural birth now but just wait!  You’ll be begging me for the epidural when you’re in labor.”

If someone so readily dismisses your desires or insults your values in a prenatal visit, this is not a good sign that your wishes will be respected in labor.  (A related sign of disrespect is the use of the word “let”, as in “I don’t let my patients go over 40 weeks.” You are the consumer and this is your body.  Your care provider’s job is to provide you with information and recommendations based on their education, experience, and the evidence so that you can make the best decisions for you.  It is NOT their job to decide whether or not you are allowed to do anything!

 

2. They do not practice evidence-based care.

You deserve care that is based on what the best evidence shows is safest and healthiest for you and your baby, not just care that is most convenient or routine for your care provider.

A care provider’s rates of interventions (such as induction, episiotomy, or cesarean) tell a story about the sort of birth they routinely attend and the mode of care with which they feel most comfortable.  If these rates are not within recommended guidelines or if your care provider tells you they are unwilling or unable to provide statistics on these things, then it’s red flag time.

An independent childbirth class can help you understand how to find and use evidence, and how to ask questions about your care in the moment.  Some wonderful resources for researching evidence include:

http://evidencebasedbirth.com/

http://www.improvingbirth.org/

http://www.childbirthconnection.org/

Responses like, “This is just how we do it in this practice because we’ve found it works best,” or, “Sure, I’ll let you do whatever you want as long as the baby isn’t in danger,” don’t answer the actual concern or show a willingness to make a real change in the way of practicing.  Look for specific details on how they plan to support you in having the safest and most satisfying birth for you, and a willingness to work on a solid plan with you for following through.

Outside of a provider’s statistics, the stories you hear from others about care received from them can also help paint a picture of their routine of care. I’m not suggesting you change care providers based on one negative story.  Doctors and midwives are human and therefore, like all of us, have bad days and make mistakes.  But if there is a pattern that develops in several stories, it can be indicative of a mode of practice or birth philosophy.  It’s unrealistic to think a care provider will suddenly begin behaving differently than their history suggests they have consistently behaved in the past.  When asking for feedback about a care provider, pay attention to the stories coming from people who value the same sort of birth you’re planning (whether or not they had this sort of birth).  Your local ICAN chapter may also be a good place to learn about care providers who are a good fit for your birth preferences.

 

3. You have a bad feeling.

Trust your intuition.  Even if you can’t put your finger on a specific reason, your inner wisdom has something to tell you. Those feelings coming from your gut actually play a valuable part in smart decision making!

 

Your choice of care provider has a big impact on your birth outcome and birth satisfaction.  You and your baby deserve the best possible care at this important time.

If, after reading this list, some red flags have been raised, here’s are some posts about exploring the idea of switching to a new care provider.

http://www.fitpregnancy.com/pregnancy/pregnancy-health/how-change-your-care-provider-during-pregnancy

http://pregnancy.about.com/od/choosingapractitioner/a/changingdoctors.htm

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Your childbirth educator, doula, local birth support network, or ICAN chapter can also be great resources for making this decision. 

Have you had experience switching care providers in pregnancy?  Were you glad you made the switch?  Did you have an experience that made you wish you had listened to your gut and made a switch?

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4 thoughts on “Red Flags: 3 Signs Your Care Provider is Not a Good Fit for You

  1. My provider was decent. I used them for babies #1 and #2 but by #3 I changed because a nurse practioner informed me that I could not nurse #2 while pregnant with #3 and they left waiting in an exam room for over an hour at one of my appointments without any type of explanation.

    • Thanks for sharing. It’s definitely not evidence-based to say you can’t nurse while pregnant. I’m glad you were able to make a choice that felt more comfortable for you.

  2. I don’t agree with a couple of your assessments
    #1. about the sex of the provider: all OB’s or Midwives are not necessarily females. I realize there is a disclaimer at the start of the article, however it would have been better to say she/he throughout.
    #2. We don’t all keep statistics. Just because we don’t, doesn’t mean we are bad providers or have bad statistics. Besides, numbers can be misleading. I can work in a high risk practice and have to induce patients for medical reasons, then move to a low risk practice and not have to induce anyone. Just because “the numbers” were high before is not a reflection of poor practice patterns (high induction rates) but of the population that was being cared for. For instance, I’ve done prenatal care on hundreds of women who were/are going to have a repeat cesarean. Are they my patients? Yes. Does that mean I have a “high C/S rate”? No. It means they had appropriate prenatal care from a great provider (IMO!). Then they had their C/S as they had planned with the OB/Surgeon.
    #4. about a provider telling a client that she can do what she wants as long as the she and the baby are not in danger. That is EXACTLY what our job is. I don’t want you as a client if you can’t trust me to take care of you and the baby- I mean, what is the point then of getting care from any provider? I tell my patients that all the time. I don’t care if you swing off a ceiling fan, or drum in the backyard under a tent, but you have to trust me if I tell you there is a problem. You also need to trust me if I say you CAN do it because a huge number of women hit that ceiling and think they can’t and are demanding a c/s or transport to the hospital when they are right on the cusp of delivering.
    #5. Re being rushed or having late or canceled appointments: Women need to be aware that there are other clients that are just as important who may be having a baby, a crisis, an emergency. I am sure your provider would put you first in each of those situations as well. When it is your time, I will be with YOU and someone else will be waiting or have an appointment needing to be rescheduled.

    These things should be discussed in the beginning so there are no misunderstandings and hopefully that will make things flow easier. It IS important to have questions answered, and to be able to trust the judgement of your provider, but your provider also needs to be able to trust you as well. I LOVE my clients. They are so awesome- each in their own way. For a short time at least, I think of them as family- and sometimes think of them more often than my family (at least my extended family!). Providers are people too, and even if they may seem to have an insensitive moment or two, most really do have your best interest at heart. Sometimes you may find that it is just not the right fit. So change. It is ok. As a mom of 11, I have changed several times. You do need to trust your gut!

    • Thanks for taking the time to share your thoughts, Nancy. It sounds like there are many things we agree on but I’ll try to speak to your disagreements!
      #1 I’m not going to bother with because, well, I already did.
      #2 That doesn’t fly with me as a consumer or as an advocate for consumers. Care providers are required by law to keep certain statistics and, while I know the specifics of what’s required vary by state, it’s still a valid question for someone to ask in order to get a picture of practice. In a respectful back and forth, it seems like it would be totally appropriate to explain the factors affecting your rates and putting them in context. If you aren’t required to keep stats on a certain intervention and choose not to do so, it still seems fair to expect an actual answer to a question about it. If I ask you “How often do you find it necessary to cut an episiotomy?”, don’t you think you owe it to me to at least estimate an answer and explain the relevance of the number rather than just saying, “I don’t keep that sort of number. Don’t worry about it.”? If it matters to the patient, it should matter enough to respectfully answer it.
      #4 (Did I miss #3?) I think it’s emotionally manipulative and passive aggressive to answer a question posed by an expectant mother with “as long as the baby isn’t in danger.” Honestly, is it not safe to assume that the very first thing every woman wants is the safety of her baby? Can we also assume that it’s what you want as a care provider (and human being) without having to put it out there like that? Because what’s really being said behind that sort of manipulative language is often, “If you don’t just go along with what I’m recommending, you’re endangering your baby and thus a bad mother.” So, let’s just drop that line because it can be assumed, above all other things, that it is first and foremost on everyone’s list of priorities. Women don’t ask about how to avoid interventions because they don’t care about their babies. Quite the opposite. I want to be with a care provider I can trust implicitly if she tells me, “This situation requires X.” and I’m going to build that trust by being treated like an adult, having my questions actually answered, and by being trusted in turn. Someone who throws out the “baby danger card” all the time is not showing me respect. That’s fear-mongering which doesn’t belong in a relationship built on common trust.
      #5 There is a respectful way to handle the sorts of timing conflicts that occur within this setting. There’s a huge difference between being shuttled through an appointment, having my questions dismissed, etc. and being told, “I apologize that we’re off schedule today. Your CP is at a delivery. Would you like to reschedule or wait for the other on call provider?” That’s not the sort of situation I’m referring to. Having to wait because the person ahead of me got thorough, respectful care is absolutely forgivable. Being rushed through my appointment time with you because you don’t want to be thorough and respectful of me, not so much.

      Women aren’t stupid. We understand the difference between someone having a bad day or a bad moment and a pattern of disrespect. So often, we’re encouraged to ignore the gut feeling we have about these things and not make waves. It’s not job to help women build the confidence to trust in themselves and speak up for their basic rights.

      I appreciate hearing about the thoughtful care you have for your clients. What a great quality and gift to bring to your work and I’m sure all benefit from it. Thanks again for sharing.

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