Six Reasons to Break Up With Your Prenatal Caregiver

No doubt about it: Deep breathing, visualization and relaxation tools are powerful when it comes to having a positive birth. HypnoBirthing not only helped me, but hundreds of my couples to have comfortable, natural births. But the tools alone aren’t enough, and they won’t serve anyone who walks into the hands of an obstetrician with a sky-high cesarean rate.

Embracing Change
To me, changing practitioners is an indication that the birthing mother feels informed, empowered, and ultimately responsible for her birth outcome. She realizes it’s up to her to hire – yes, hire – the right medical expert. For some, this “right practitioner” is a hospital obstetrician, and for others, a midwife (who can attend your birth in hospitals, birth centers or your own home). Unfortunately in modern culture, we tend to put more energy into choosing the right real estate agent than the right childbirth practitioner. Philosophies and practices can differ dramatically from one practice to the next, and your job is to find the caregiver whose values, goals and approaches are best aligned with your own. What matters is how much you trust her, and the degree to which you are convinced she shares your emotional longing for the most natural, unhurried, satisfying birth and postpartum bonding experience possible.    

While many couples are aligned with the right practitioner from the start, others realize somewhere along the line that they’re with a caregiver who’s all wrong for them. (When I was twelve weeks pregnant with my son, my own obstetrician drew an imaginary C-section line across my bare abdomen with her finger, presumably to acquaint me with the scar she anticipated despite my perfectly healthy, low-risk pregnancy.)

The notion of ending a relationship with one’s caregiver is intimidating to some, but it needn’t be. For me it was as easy as requesting a copy of my records from the receptionist (remember these are yours by law, so you owe no explanation), and handing them over to the new caregiver.

What’s Love Got To Do With It?
Some women admit they aren’t crazy about their caregiver’s philosophy, but insist they just love her as a person. No matter how much you love your OB, just remember, you love your baby more. And sure, you can engage in an emotional and lengthy “break up” conversation if you wish (“I’m sorry, doctor…It’s not you, it’s me”), but make sure doing so will serve you in some way – and I don’t mean to alleviate your guilt. No complaining, no explaining. Your baby is counting on you to align with the right person.

In retrospect, I was lucky to have been with an obstetrician who was wrong for me on every level. Once I was clear on the kind of birth I did and didn’t want, it was obvious I had to leave. It’s far tougher for women who just aren’t sure. Their heads tell them they made a sensible choice, but their intuition nags at them to reconsider. It’s the women in this category to whom I dedicate the remainder of this post: Reasons to break up with your caregiver.

Red Flag #1He engages in presumptuous usage of the word “let”.  For example: Your doctor says he won’t let you go past 40 weeks, won’t let you eat or drink in labor, or can’t let you labor without an IV.

You are the hiring manager here. It’s his job to serve you. Before engaging in any medical procedure, he must inform you of the risks, benefits and alternatives before then requesting whether you grant permission to move forward. (The law of voluntary informed consent has your back on this one.)

Red Flag #2:  She has a high cesarean rate, or worse, doesn’t know what her cesarean rate is.

The World Health Organization has long stated that no country on earth should have a cesarean rate greater than 10% – 15%. Cesareans are our country’s most common major surgery, and childbirth has become our nation’s top revenue-producer for hospitals. (Why most hospitals are for-profit institutions is troubling to begin with.) Consider this: In 1970, one in twenty births in the United States were cesareans. Today that statistic is one in three, and climbing every year. If your OB doesn’t seem to care about her own cesarean rate enough to track and disclose what it is, then maybe you should find someone who does.

Red Flag #3:  He speculates with concern about the size of your big baby or small pelvis.

The pelvis that conceived your baby would hardly recognize the pelvis that’s going to deliver it. Hormones cause the pelvis to relax and “stretch” significantly during labor, allowing an impressively wide passage for your baby. Second, babies’ skulls aren’t fully formed at birth for a reason: The baby’s head is designed to compress in order to fit through the passage. So even if your baby has an unusually large head, nature has this additional trick up its sleeve – it’s called molding – in its magnificent quest toward survival. Third, most of the baby’s weight is in the body, and the body tends to slip out very quickly and easily once the head and first shoulder are presented. So why do we spend so much time worrying about big babies? The head positioning is far more important than the baby’s size. As for macrosomia (the medical term for “a newborn with excessive birth weight”, defined as babies who weigh greater than 8 lb. 13 oz.), it’s best not to get anxious over it. For one, it’s impossible to determine a baby’s weight in utero with ultrasound or any other technology – so there’s no way to know if your baby fits the definition until after the birth. And on a personal note, I have a hard time taking it seriously: My son and daughter both handily satisfied the definition of macrosomia according to their “excessive” birth weights. Not only did I birth my big babies naturally, but unusually quickly, and without molding or tearing. Big babies are born all the time, often to very small-framed women. This is not pathology. It’s not even an anomaly.

Red Flag #4:  She treats your due date like a deadline.

The only reason you have a due date is that our culture is determined to turn the art of childbirth into a science. All other mammals seem to be birthing just fine without them. But okay, let’s go along with it: Your due date marks forty weeks of gestation. Now here’s where it gets interesting: Babies born between 37-42 weeks are considered “full term”. Premature is < 37 weeks and post-term or “overdue” is > 42 weeks. By its very definition, your due date is a mid-point in the bell curve of your baby’s likely arrival dates. Research suggests that at least 80% of babies are born +/- two weeks of the due date. What does this mean? Going past your due date is normal. Labor-induction drugs like Pitocin have only been FDA-approved for usage when medically necessitated. Going past your due date is not a medical event. It’s as normal and common as can be. You might not feel concerned about this in mid-pregnancy, but your caregiver’s approach to due dates can end up being the make-or-break of your birth plan. If you haven’t done so already, ask your practitioner when she’ll consider you “overdue”.

Red Flag #5:  He expects you to give birth in the supine position (lying on your back).

The supine position significantly restricts your pelvis. All that wonderful space I mentioned earlier is now countered by the mattress pressing into your lower back. Not to mention, most women find the supine position to be downright unbearable, when other positions (e.g. hands-and-knees or squatting) feel totally manageable. You might as well use gravity to your advantage whenever something in your body is attempting to come down and out. If you’re birthing naturally, the pressure and weight of your baby will tend to guide you into the safest and easiest position for birthing. And at the very least, your caregiver should encourage you to be in a position that’s comfortable and convenient for you, not anybody else.

Red Flag #6:  Your intuition is telling you something.

Having second thoughts about your caregiver, but you can’t put your finger on it?  You don’t have to. But don’t ignore your intuition. Giving birth gently and easily is only possible with trust – a trust in nature, your body and your baby. Relinquishing to these forces of nature is rooted in self-trust.

Your intuition is already telling you if you’re in the right hands.

Are you listening?

 

This entry was posted in About Me (Cynthia Overgard), Midwives and Obstetricians. Bookmark the permalink.

14 Responses to Six Reasons to Break Up With Your Prenatal Caregiver

  1. Rachel Beninati says:

    These are such important red flags to listen to! We need to be more discriminating when it comes to choosing our care providers. You only get one chance at your baby’s birth!

  2. Jaime Hoffman says:

    Such great points! I’m soooo thankful that I listened to my intuition and broke up with my OB at 20 wks! Hate to think about what my birth experiences would have been like if I had stayed with them…ugh!

  3. Eric Daure says:

    So true. If a majority of couples would heed the wisdom of this post, we would soon see a dramatic shift in how for-profit hospitals handle births, as they’d quickly discover that the smaller gain of a natural birth is better than none at all. Keep spreading the message Cynthia!

  4. Rachel Prior says:

    Excellent advice! It is so true that changing caregivers need not be a dramatic episode…I switched caregivers and was petrified to have that “break-up” conversation, only to find that she was actually genuinely supportive to see me go with a caregiver who was a better match!

  5. Michelle D'Ambrosio says:

    I love this! Great job Cynthia!

  6. HollyM says:

    Excellent article! It’s saddening to think how many women believe they have no choice. Education is key.

  7. Lauren Specht says:

    These are such great tips Cynthia! I wish someone had given me this as a little cheat sheet before I had my first child. I had the ‘intuition red flag’ big time and just pushed that little voice down and told it to be quiet so that my very smart, well informed doctor that I just loved could tell me what was best for me. Well thank goodness I woke up before I became pregnant with my son and did my own research. I interviewed 5 practices during my second pregnancy and settled on the final one at 25 weeks pregnant only once I felt 100% secure in my decision. By that point I had questioned more than one OB who had kindly informed me that I should find a practice that better suited me and me ‘strong opinions’. And I am ever so glad I did!

  8. Thank you for your thoughtful response, Kristy. Around two-thirds of my HypnoBirthing couples (of at least 100 per year in total) choose to birth in hospitals, which is a great reminder that there is no right or wrong place to birth – only right and wrong practitioners, and that each woman should (in fact, must) birth precisely in the place where she feels emotionally and physically safest. You clearly made the right decision for yourself, which is precisely the point of my article. Those decelerations were something no woman would want to experience without feeling she was in the safest of hands. As for the cord, you remind me of my own home birth with my 9 lb 7 oz daughter, because she, too, had the cord wrapped around her neck on the way out. I know it’s everyday life to my midwvies, but it gave me a bit of a shudder. One thing all women can agree on is that a safe outcome remains the top priority.

  9. Lydia says:

    “The World Health Organization has long stated that no country on earth should have a cesarean rate greater than 10% – 15%. Cesareans are our country’s most common major surgery, and childbirth has become our nation’s top revenue-producer for hospitals. (Why most hospitals are for-profit institutions is troubling to begin with.) Consider this: In 1970, one in twenty births in the United States were cesareans. Today that statistic is one in three, and climbing every year”

    The WHO has retracted the 10-15% suggestion.

    Out of curiosity — how does the birthing population compare in 1970 versus today? We all know that obesity is on the rise, but I think we are also dealing with a higher risk population across the board. For example, I have a friend with a heart condition who in the 70s would have never lived long enough to give birth and now she’s planning her pregnancy.

    Finally, and most importantly, the stats on c-sections cannot be taken in isolation. Out of curiosity, how has the perinatal mortality rate changed between 1970 and today?

  10. Lydia, Thank you for your post and your willingness to engage in discussion on this important topic. You raise an excellent question regarding maternal health. First, it’s inspiring and important for women to know that the U.S. is fortunate to have some practitioners today whose rates of cesarean are very low (e.g. Midwife Ina May Gaskin’s “Farm” in Tennessee, which has overseen thousands of births over decades, and has never had a cesarean rate greater than 2%). It’s also important to note the WHO has never upward-revised their recommendation of 10-15%. There has, however, been political pressure on the WHO to “retract” their statement, because it seems to have ruffled feathers with a coalition of c-section-centric groups, including ElectiveCesareans.org and csections.org. Those groups formed a coalition and asked the WHO to retract the statement – they did not ask them to adjust it but to do away with it altogether. This sort of politics and conflicts of interest are exactly what make birthing decisions so difficult for pregnant women.

    Politics aside: Last year (April 2011) a report issued by the California Pregnancy-Related and Pregnancy-Associated Mortality Review revealed the disturbing fact that maternal mortality has actually increased in California, quite alarmingly. The report contains this statement: “The increase in caesarean sections — which now account for almost one-third of all U.S. births — was identified as another trend corresponding to the rise in maternal mortality.”

  11. Lydia says:

    Hi Cynthia,

    My understanding is that there are no reliable scientific studies supporting the old 10-15% recommendation. I would be very interested to learn otherwise.

    I had understood that the increase in maternal mortality is not a clear-cut issue and that there have been significant reporting changes over the past 15 years that have captured maternal deaths that were previously missed. This change in reporting has made comparing maternal mortality over time a dicey and complicated proposition.

    Obviously, with regard to Ina May Gaskin, rates of c-sections are not very informative without an understanding of the risk level of the population she attends and her perinatal mortality rate. Additionally, as I understand people travel to TN to have her attend their births she is dealing with a population which has a very high dedication to natural childbirth. Are these parents more willing to push the envelope to avoid c-section versus your average woman in a hospital who when presented with certain risk factors thinks better safe than sorry? That would be interesting to tease out!

  12. Ina May’s risk-level would give us some information, but fortunately, she provides all her birthing statistics to help us use our own judgment. According to her published statistics on more than 2,000 births over a thirty year period:
    - The cesarean rate was 1.4%
    - Of 108 women who attempted VBAC (vaginal birth after at least one prior cesarean), 106 achieved a vaginal birth. (Note, only a 1.8% cesarean outcome in this “high risk” group.)
    - 100% of twins (15 sets in total) were born naturally and vaginally. (Note, in a country where carrying multiples is considered high risk and 90% of twins are born by surgery)
    - about 60 of the vaginal births were breech (another “high risk” group)
    - maternal mortality = zero.

  13. Jenna says:

    Excellent post. I share similar sentiments on this post… http://thebirthofadoula.blogspot.com/2011/03/mama-knows-best-thoughts-on-switching.html

    Thanks for taking the time to write… I’ll be sharing this one for sure.

  14. Thanks for sharing your article, Jenna.