Well Rounded Birth Prep

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Tuesday, August 3, 2010

How to avoid the ol' bait-and-switch with your OB/midwife/pediatrician

I've run across this situation enough times by now that I feel pressed to warn those who are unaware: when you ask a friend, family member, co-worker, etc. for a referral for an OB, midwife, or pediatrician, for crying out loud make sure you ask them WHY they loved or hated that care provider.

Here's the thing. Your friend (or family member, co-worker, etc.) may value completely opposite things than you do! I have a friend who loved her OB because he routinely encouraged scheduled, elective inductions, which she thought was so convenient. Another friend's choice of hospital was based on the fact that she knew that if she was admitted in early labor, they wouldn't send her home, but rather, that they would proceed to augment or induce labor so that she could be "guaranteed" what day she would deliver. It's a mother's right to make these (hopefully fully informed) decisions, but I would certainly like to know that *these* are the reasons a friend referred a provider or place to give birth, if it were me.

It's hardly a case of bait-and-switch if a mother had a preconceived notion of what to expect if the doctor/midwife is very upfront with his/her expectations and standards of practice, but it can feel that way if the mother feels that she was misled (or if she neglected to ask what was the norm for his/her practice).

Two different friends have told me about their experiences with a certain OB, whom I'll call Dr. J (not his real initial). One told me that "tried really hard to make it seem like he was understanding and would be flexible" regarding their birth wishes. The first warning sign, however, was when Dr. J told this first-time-mother, who was only a few months along and in excellent health, "Sure, you can have the natural birth you want, so long as your baby doesn't get too big." When she told me that, I encouraged her to have a more in-depth conversation with him at her next checkup because his statement set off warning bells in my mind. A provider who says something like that to a mother (especially a healthy, low-risk mother, early in pregnancy) is sometimes just waiting for a "reason" to intervene. I told her to ask open-ended questions that would allow him to tell her what he thinks about different aspects of her birth plan, as opposed to yes/no questions. She had an eye-opening experience at the next appointment and promptly fired Dr. J and sought a provider who was more supportive of her wishes.

Another mother told me a similar experience with her delivery with Dr. J. When she asked Dr. J about her options regarding her birth wishes, he replied, "We don't do that here." Not because of safety, but because of "policy." Unfortunately, she found out about Dr. J's policies too late to switch providers and was really nervous about having him there for the delivery. Nobody should have to go through that kind of trepidation while trying to give birth.

It's not uncommon for doctors who do not practice evidence-based care to have sweet personalities and the kindest, gentlest bedside manner, leading their patients to trust them and care for them. I'm not implying that all sweet, kind doctors will mislead patients, nor am I implying that doctors or midwives who act like jerks are more straightforward. I'm simply stating that their personalities alone are not--or, at least, should not be--the sole factor in selecting a doctor or midwife.

Another mother shared that she disliked her previous midwife because she asked about her diet, which made her feel guilty about what she ate. We talked a bit about the fact that diet during pregnancy has a huge part to play in growing a healthy baby and preventing PIH (toxemia, pre-eclampsia, HELLP syndrome, and Pregnancy Induced Hypertension) and gestational diabetes, but she wanted a care provider who wouldn't ask what she ate. She didn't imply that the midwife was improper in her attitude or demeanor in asking about the mother's nutrition, just that she didn't want to talk about it. Again, good to know if you hear a referral like that, so that you can assess whether that's how you feel about nutrition during pregnancy.

This same issue comes up with pediatricians. If a friend refers her pediatrician, is it because he or she is nice? Or is it because he or she will prescribe an antibiotic any time she brings her children in with the slightest sniffle? Is that what you are looking for in a pediatrician?

I believe that this misconception of nice=competent is one of the primary reasons that so many care providers get by with "bait-and-switch." This is what it's called when a care provider promises one thing and delivers another, no pun intended. Some moms are apt to trust any advice their doctor/midwife gives them because they trust their doctor/midwife. Sometimes that trust hasn't been earned by proof of skill or knowledge or competence; sometimes that trust is because he or she is "so nice." Ask questions. Dig deeper. Sometimes, *how* they answer you is more telling than *what* they say. (Are they offended that you are asking questions? Do their egos seem bruised? Do they seem miffed that you would question their authority?)

Be informed consumers and informed advocates for yourself and your family. That's all I'm sayin'.

Here are a few resources for choosing a care provider who will line up with your birth philosophy:

Mother's Advocate: Choosing a Care Provider (free printable pdf)

CIMS (Coalition for Improving Maternity Services): Having a Baby? 10 Questions to ask (free printable pdf)

Preparing For Birth's printable PDF "Questions to ask when choosing birth location and care provider"

Ten Ways to Spot an Incompetent Midwife by Birth Sense

In Search of Dr. Right: 11 Questions to Ask by Birth Sense

Here are a few questions to ask yourself when shopping for a pediatrician. (Source: Connie Livingston's Parent's Yellow Pages For the Greater Dayton Ohio Area; Birthsource.com)

6 Tips for Choosing a Pediatrician

1. Does he/she have the same philosophy as you? What about their partners?

2. Is there more than one office for convenience? What are the hours? Is the office clean? Do they mix well babies with sick babies?

3. Are the staff friendly?

4. What does the pediatrician do to stay current?

5. Do they take your insurance?

6. Do they make you feel comfortable no matter what type of question you ask?

I would add, 7. Do they respect your right and responsibility to make informed decisions for your child, even if those decisions differ from common protocol?

What have been your experiences (positive or negative) with finding a care provider who supports your birth philosophy or parenting philosophy?

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