Monday, June 24, 2013

"Have it Your Way" - Choosing an Appropriate Care Provider for Your Birth by Rachel Zimmer, CNM

Rachel Zimmer, DNP, CNM


If you want a hamburger, do not go to a vegan restaurant.  If you do choose to go to a vegan restaurant, arguing with the chef about making you a hamburger will do no good. Therefore, do not be surprised if you choose to stay at the vegan restaurant if you do not get a hamburger. You just set yourself up to be disappointed. Sounds silly right? 

If you are an expectant mom who wants an un-medicated birth, or a birth without interventions, this is exactly what you are doing by staying with your current provider (assuming your current provider is not supportive of your birth preferences).  Let me tell you how it goes. Mom says to her OB: I would really like to have freedom of movement during my labor and deliver in a position other than my back.  OB says: “OK, we’ll see how it goes. We want to have a safe delivery.”   So what is the reality here? The reality is mom has done some reading and knows that changing positions during labor and birth can help promote a good position for baby as well as decrease her discomfort…  This OB does not care one way or another what mom does during labor and believes she will be just like 90 percent of the moms in the practice and end up with an epidural and on her back anyways.  Want to hear a response from a provider supportive of your low intervention birth plan? How about: “That sounds like a great plan, intermittent monitoring is part of my routine practice. Let’s talk about ways to help keep this pregnancy low-risk so that you can avoid an induction and meet your birth goals.” So moms I am here to tell you, if you don’t get the answer that you are looking for……FIND ANOTHER PROVIDER!  So why do women stay? These are some answers I hear…

“I’ve seen my OB since my very first pap smear…” ie loyalty. I guarantee that this means nothing to your provider. They will still check out at the end of the day and let one of their partners catch your baby.  I am not saying there is anything wrong with that, no one can work 24/7. The point is, so what? Your provider does not remember any of the pap smears that they have done for you and will not miss doing them in the future. That is assuming they will even notice you are gone, which they probably will not. Most OBs see 150-200 women every week and you are not special to them.

“I need to deliver my baby at such and such hospital because it is closest to my house….or because they have a special postpartum suite that I want to have”. Most first time moms are in labor an average of 18-24 hours. Unless you are planning to deliver in El Paso, you will have time to get there.   Your baby will benefit from the decisions you make surrounding your birth and none of this has anything to do with the size of your postpartum room, color of the walls, or if they serve you lobster after your birth.

“My OB delivered my last baby…..or all the babies in my whole family”… This is great, you know what to expect! If you were happy with your previous birth experience then by all means stay right where you are! If you are looking for something different, go elsewhere! Your OB has not changed their practices recently.

“It will be fine, I have a doula this time who will make sure my birth plan is followed”… I LOVE doulas and I think all 1st time moms, if not all moms should have one! BUT most OBs don’t understand the role of the doula and don’t like them let alone respect them. Nor will they pay any attention to them as they advocate for your birth plan.  It’s like arguing with the vegan chef to make you a burger… pointless. And, why do you want to fight to get what you want???? Birth should be a time where your birth team is supporting you and working with you, not against you. Doulas are truly amazing BUT your birth experience will be a million times better if you also have an OB or midwife who is ALSO on board with your plan!

“My family is not supportive of me seeing a midwife”… No one said you have to switch to a midwife. There are some great OBs out there who will support your plans for birth. It is absolutely true that midwives are generally less interventional than OBs and more supportive of practices that promote un-medicated birth. But, there is something different for everyone! Ask about interviews, many midwives will offer “meet and greet” visits or interviews that are free and are an opportunity for you and your partner to meet them, see that they’re not crazy witch doctors, and find out if they are right for you. If not, keep moving on!
As OB providers, we attend anywhere from 50-300 births per year…sometimes more! You as an expectant mom, will experience childbirth once, twice, or sometimes more in your whole lifetime. This is YOUR experience. Don’t let any of the above reasons stop you! Choose people to be part of your birth team that want to help support your goals. C’mon moms! YOUR BIRTH MATTERS! Your OB provider MIGHT remember if the baby they put onto your chest (hopefully) was a boy or a girl. You will remember your birth experience for the rest of your life…


Rachel grew up in the Dallas area and is a graduate of The University of Texas at Arlington majoring in nursing. Rachel has a special interest in music, sports, and Spanish. Rachel attended Baylor University Louise Herrington School of Nursing beginning 2008 and graduated in 2011 with her Doctor of Nursing Practice (DNP) degree in Nurse-Midwifery. Baylor University was the first school in the United States to offer the DNP/Nurse-Midwifery program. She then received certification through the American Midwifery Certification Board (AMCB) and is an active member of the American College of Nurse-Midwives (ACNM). During her graduate studies she performed clinical rotations at Parkland Health and Hospital System in Dallas and completed her residency here at MacArthur OB/GYN and Baylor Medical Center at Irving. The focus of her graduate project was utilizing social media to provide childbirth education to women.

11 comments:

Patricia, Nahum and Shayna said...

What about, "there is no other ob in a 2hr (or other personally acceptable radius) and we can't afford a midwife."?

Malina said...

A good post that covers some easily remedied reasons people stay with a provider they aren't 100% happy with. Unfortunately it isn't that simple. You left out one of the biggest reasons moms do not get the provider or care they really want. Insurance and money. Women's choices are limited when their insurance only covers particular providers and they don't have the money to afford the provider or facility they want.

hollie marie said...

As a labor & delivery nurse, I appreciate your input. I agree that women should have the birth of their choosing, and that always starts with the provider they choose. Unfortunately, it's just not always that easy. In the area that I live, we don't have CNMs. Not only that, but most of our docs are totally opposed to no/low-intervention births. If a patient DOES choose a provider who supports their birth plan, our call schedule often inhibits a patient from being delivered by her own physician, leaving her at the mercy of the on-call doctor (who may or may not go along with birth plans). I also agree with Malina. I've worked with CNMs before and many private insurances don't offer the same coverage to CNMs vs MDs (totally backwards!).
-Hollie
holliemims.blogspot.com

Scott Hinton said...

Rachel, this is an awesome post.

To all of you responding to the post, I think you miss the point. The point is that you do your research and make the best decision with the knowledge and resources that you have available to you. If you don't, your ignorance will be used against you to manipulate the outcome of your birth experience.
As Rachel says, the birth of your child is a lifelong memory. Some people spend more time researching which car to buy then what care provider to go with.
If your insurance doesn't cover the provider you want, maybe you should switch your insurance provider. Anyone can purchase insurance from any provider. You do not have to go with the one your employer provides. Many people buy their insurance privately and are able to get the exact coverage they need instead of all the other stuff they don't need and at a lower cost.
There is a lot of information and resources available to those that wish to find it.
I know of some midwives and doulas that offer services at a discount or even for free to people that are in a tough spot. Some will barter in exchange for other services. There are cash pay discounts.

Olivia said...

Midwives are surprisingly affordable--$3000-5000 for all prenatal, birth, postpartum care--and most have payment plans. Sit down, add up all your co-pays. For prenatals, hospital, etc and see where that gets you!

Brandie L. Anderson said...

It's really too bad in this day that insurance companies are choosing our medical care. In reality, they know nothing. They will cover something that costs them more in the blink of an eye. I've seen letters written by patients to insurance providers itimizing the costs of the birth they had and the costs of the birth the company wants them to have. They soon receive a check. I think letting your insurance company take the hit for your choice is just another excuse. Not to mention the fact that if you do get stuck with a care provider that likes interventions, you can still advocate for yourself. You have a right to say how you want your body treated.

Jim Peters said...

I really like what you are saying in this. It was very interesting to read. Do you have any suggestions for gift sets for baby showers? You seem like someone that would know about this.

Hobbit Mom said...

It is completely false that anybody can purchase any insurance they choose. No insurance company will insure a pregnant woman unless they "have to" due to a group contract or state subsidies or something like that. Also people under the age of 19 cannot be turned down due to Obamacare, but that's only a small percentage of pregnant mothers. You can be turned down for almost anything, so even if you plan ahead and switch insurance before getting pregnant, you may not have any options available. It remains to be seen how well the new rules will work when Obamacare kicks in fully next year.

mrs malka miller said...

I had four homebirths. I paid for them out of pocket. They were worth every penny.

therealetty said...
This comment has been removed by the author.
therealetty said...

Midwife Rachel delivered my daughter about 3 and a half years ago and I absolutely loved her!!!!!! (: