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Finding the Right Maternity Care Provider

This past weekend I listened as a woman explained that due to her medical condition (epilepsy), her OB had advised her at her first prenatal visit that she could terminate her pregnancy.  I understood that.  For liability reasons her Dr. HAD to make sure she knew that 90% of babies born to mothers with epilepsy are normal, and if that 1 in 10 risk of having problems is too high for her, she had that option.  Fair enough.

But then I listened in amazement as she went on to say that her Dr. reccommended “termination” again at her 2 month visit (apparently she went to her first visit lickety split!), and her 3 month visit, and her 4 month visit, and her 5 month visit…at which point she finally told the Dr. to quit advising this, that she intended to keep the baby even if the baby had deformities.  BTW…her baby was healthy & normal at birth.

I had to wonder what it takes to get a woman to switch care providers?  I mean really, the guy wants to kill your baby, and you are still trusting him to make life and death medical reccommendations for said baby?  Why, even if you were pro-choice (which this woman isn’t), would you continue on with such a glaring difference of opinions?

Unfortunately in America we seem to have bought into the idea that the most important things about choosing a care provider are if they are on our insurance plan, how close they are to our home, and if we like the waiting room decor.  Okay…I might be exaggerating a bit on the last point…but really…the things we take into account really aren’t often important.

I admit…I’ve been guilty of the same kind of decision making.  In choosing my first OB, I just stuck with the GYN I’d seen for about 4 years prior to pregnancy.  I had chosen the practiced based on reccommendations from friends that they were a “Christian” practice.  Let me tell you, as a committed Christian, I often dread having Christian clients who chose their care provider because they are Christian.  Why?  Because they tend to put the care provider on a higher pedestall than they would a non-Christian provider, and don’t question much of what their care provider says to make sure that it matches up with what they personally desire.

And trust me…there is a LOT of variation in practice philosophy amongst care providers (since, as my father used to say, Dr’s PRACTICE medicine–its not really a science so much as an “ideology” where entrenched beliefs often are contradicted by medical research), even Christian ones.  Just looking at the Christian birth care providers I’m familiar with, there are some that:

• will cut episiotomies without consent, 
• state outright that they do not trust vaginal birth and much prefer planned cesareans, 
• will allow women a lot of lattitude in how a hospital birth is carried out–asking her every step of the way if she wants option A, B, or C and avoiding cesarean whenever possible, 
• will attend homebirths with a woman who has had 2 prior cesareans.

Now at a certain point during my first pregnancy I started realizing that the practice I was using was a philisophical mismatch with me, but I didn’t switch.  Why?  Because I felt too busy perhaps?  All I can say is PLEASE don’t follow my example!  It is only through the grace of God that my inaction did not result in my having a cesarean.  Care provider choice does matter.

I do know that many women don’t switch care providers do so out of a desire to “not offend” their care provider.  I had one client who was driving over an hour to see her care provider, knew she didn’t like the practice, and still didn’t switch for this reason.  But here is the thing…as much as a woman may “love” her care provider…her care provider doesn’t love her!  It’s strictly business, and while care providers do have hearts, and their hearts may be saddened if their clients have tragic things happen, they just CAN’T allow themselves to be emotionally involved…to do so with all they see would be too draining. 

Nicole over at “It’s Your Birth Right!!” has written a great pair of posts (Part 1 and Part 2) on “Choosing Wisely.”  She’s been an L&D nurse, and is now a CNM, and has some great insight.  One of her bottom line suggestions that I think is great is that a woman should interview at least THREE care providers before choosing one.  Wow.  Like I said…I didn’t interview my care provider in my first pregnancy.  And even with my second pregnancy I only interviewed one care provider–the one who had been the on-call Doc when my first was born.  Again…3rd pregnancy, I only interviewed one care provider, although this time I’ll use the excuse that I knew I wanted a homebirth, and to my knowledge, at that time I only had one care provider option for homebirth.  Used her again for my 4th birth.  It wasn’t until my 5th birth that I actually interviewed 4 different care providers (and kind of half-way interviewed a 5th over the phone), and chose one.

And guess what? 

She wasn’t covered by my insurance.  And yet she probably cost me less than either of the “in network” providers I interviewed would have cost considering that I would have had a $300 deductible and 20% co-pay for the in network providers. 

She was the furthest away from my house.  Of course after signing up with her I found out she would do home visits for a small fee, and so my appointments literally took only 30-60 minutes of my time, and ALL of that was face time with the midwife, unlike the 2-ish hours I often spent on appointments during my first pregnancy between driving (just 10 minutes from work!), waiting in the waiting room, having vitals taken by nurse, waiting in the exam room some more…then seeing the OB for 5-10 minutes.  Even when I did drive to her office for two visits, I still only devoted a bit less than 2 hours to the visit, and saw my midwife for 30-ish minutes.

Tags: chose care provider, Doctor