Monday, May 4, 2009

Crisis Initiates Growth...Choosing a Care Provider

"Sometimes it takes crisis to initiate growth." Rachel Naomi Remen

I have had several moms lately who had births with care providers that they needed to fight with in the last weeks in order to even get a semblance of the birth they desired. When they sat down at the postpartum they discussed moving to a different care provider in order to be listened to next time. But sadly it took having a birth they did not love in order to be willing to consider a move to that new provider.

I am often saying, "you don't go to Kentucky Fried Chicken and ask for sushi." I explain that if your care provider is not listening to you when you are fully clothed and not in pain, what makes you think they will do so when you are in labor.

This week I had a mom share that when she talked to her care provider about her birth ideals, they said, "I hope you will rely on our medical expertise to make the right decisions when you are in labor." Which she took to imply that she could not make the right decisions- although she wanted to be fully informed. They were letting her know who would be making the decisions for her labor. But you know what? She continues to seek them for her maternity care. It makes me wonder if she will get the birth she desires. She very well may, but she will need to really fight to get it. I don't understand this. Fighting in labor should not be a part of a woman's labor experience.

This week I had a mom ask what would have been different at her birth if she had been with a provider that I encouraged her to consider in her early part of her pregnancy. The fact is, I do not know if the actual outcome would have been different. But I do know she would not have spent the last two weeks of her pregnancy fighting with her care provider, practicing what she would need to say to him to get the birth she desired, and now wondering if things would have been different.

Midwifery care is very different than physician care most of the time. Occasionally you will find a doctor who practices like a midwife. Just as some times you will find a midwife who is powerless and made to jump through hoops that the physicians demand of her. Although I am a strong proponent of the midwifery model of care, the most important things in choosing a care provider is: Do they respect you? Do they involve you in your health care? Do they listen to your concerns? Do they answer your questions clearly and in a way that makes you truly informed? Do they believe you can make good decisions for you? If they are being condescending and flippant to your questions, dismissive in their responses and rushed, I think you know the answer.

If you are having a hard time being heard or listened to- then my advice is change. Women are very concerned about change- but "Sometimes it takes crisis to initiate growth." Don't wait until crisis occurs to initiate the change that helps you grow into the birthing woman you need to become in order to get the birth you desire.

Let's talk about why folks pick a care provider- specifically a maternity care provider. Often times you pick a provider based on a recommendation from a friend. BUT, do you know what kind of birth you want and what kind of birth your friend wanted? Perhaps the thing she loved most was the fact that he induced all of his moms by 40 weeks. And perhaps you were looking for a care provider who based induction on medical need only and did not feel inductions were best for a normal pregnancy. So choosing a care provider based on this recommendation would not be in your best interest.

Maybe you are choosing your care provider based on where they practice- or do their "deliveries." If the care at that facility is the type of care you are looking for, odds are this provider goes along with the protocol at this particular hospital. For instance, if you are looking for a water birth and this facility provides this, chances are the provider does them. BUT don't assume this. Realize that a care provider can determine if he follows the hospital protocol or if he is a bit of a change agent and he is cutting his or her own path at this facility.

Perhaps you are choosing a care provider based on where their office is - especially if you are concerned about where it is in conjunction to where you work. But I often warn folks that this is not a great reason to choose a provider. Just like there may be a favorite restaurant across town that is always worth the drive... so may a care provider be this same way.

Some women feel more comfortable with a care provider of their same gender. I know I steered clear of a male massage therapist most of my life- but found that Harry is the massage therapist for me... and he is a guy! So, be open to possibilities of a person based on more than their sex. Many times we think a woman who has been through childbirth will be the best. But I have to say two of my favorite midwives have never birthed a baby from their body!

I had a client once tell me that the medical school a doctor graduated was very important to them. When I chose to have my breast reconstructed immediately following a bilateral mastectomy, I chose a doctor who did a particular reconstruction technique that was important to me. But for normal births, sometimes the less intervention is the better. Therefore knowing all the fancy technology may not be of grave importance. You have no idea if your doctor graduated in the top of his class or the bottom. You have no idea if he is keeping up with the newest techniques or has been content in not learning anything new. There is one doctor here in Atlanta who is skilled in the old techniques of assisting a mom to birth a breech baby. That skill is one that is dying since few are learning the old ways.

Some will choose their provider based on who is on their health care plan. This is purely money driven as health care costs have escalated. I just would say, sometimes the things we want badly in life are not reimbursable and we have to stretch beyond the limits sometimes. I have clients who choose a home birth or out of network birth in order to get the birth they desire. It costs them but they feel it was worth it.

So, I am going to offer the five reasons why I think you should choose a care provider.

1. Does this provider take time to listen to your desires and then communicates that they will do their best to help you achieve those desires? Do they enter the room knowing your name and welcome a time of discussion regarding your needs and desires? Or do you feel rushed and herded through?

2. Does this provider practice evidence based medicine? Do they read the research and base their protocols on what is best for you or the way things have always been done? For instance a good question to ask may be how many of their first times moms end up "requiring" an episiotomy. It should be a negligible number- that is what evidence shows us. A tear may be harder to sew up but it is better for the mom to sustain a small tear than have healthy tissue cut and then tear into a larger repair.

3. What percentage of patients have a vaginal birth in this practice? Keeping you safe and the baby safe is important- but that does not mean the increase in cesarean births is a price that should be paid for doing so. Cesareans are on the increase in the US and it is definitely due to the litigious medical environment in which we live.

4. Does this provider support the type of birth you desire? I mean it is one thing to say sure you can have a natural birth- if that is what you desire... but if they have most of their patients end up with epidurals, it may be in your best interest to wonder if they do really support natural birth. If they are patronizing regarding your desire for a natural birth they are probably not full of ideas to help you achieve this type of birth. Are they encouraging you to take a class to learn some techniques to help you with your goal? Are they affirming that you can do this?

5. What is their induction rate and when are you considered late? Your due month is between 38 weeks and 42 weeks. You are not officially late until you are 42 weeks. And since so often due dates are subjective, this is just a guess most of the time anyway. If they make comments about nothing good happens after 40 weeks, they may be suspect of a high induction rate.

So, choose your care provider wisely. This is a decision that will effect the outcome of your birth. Your birth outcome can effect the way you feel about yourself for a lifetime. Choose carefully but also realize that if as you "date" your care provider along your journey of pregnancy, you decide that he or she may not be the one you want to be "married" to for the birth... you can change!

4 comments:

The Tuckers said...

I really love the Kentucky Fried Chicken quote :)

Teresa Howard said...

Blogger Amy said...

Teresa, who is the Dr. in Atlanta that will deliver breech babies?

May 5, 2009 11:05 AM

Joe Tate at Emory Midtown- the old Crawford Long

Anonymous said...

Wooo Teresa! Nice job. I just so enjoy reading your posts. Sometimes I feel like I am stalking you...read your blogs everyday. I will saythat my daughter chose wisely and ended up having a 38 hour labor and cesarean. Know what? She is content with it - as content as she can be anyway. Know why? She was supported, respected and SHE made the final decision after feeling everything else was tried. She was criticised a bit by some family who were there waiting for the birth - but it has not phased her. She did what she had to do for her and her baby and will again - hopefully soon. Being listened to and respected is almost as important - if not more so - than the outcome. No one can predict the outcome and even with the best and most respectful careprovider outsomes vary and there are no guarantees but...
I shared the quote with a colleague who is due in 5 weeks - she loved it. Take care,

Crystal

momyshaver said...

OMG; I love it! I use a version of the KFC quote with my clients and they seem to "get it" ... (actually, the first time I heard it was from a FP doc during my 3rd or 4th pregnancy..!!!)

I love your insightful postings on the doula list so I subscribed here. Keep writing!