Would you change providers this late?

Sammyatemypeas · September 2014

I've not had a great experience so far with my physician. She personally is great and got five star reviews, however, I'm her 10:00, not her patient (if that makes sense). If she's not on-call the day I deliver, I'll get the MD who is. I'm nervous that they won't listen to my wishes or respect that my body knows what it's doing and try to intervene. I watched The Business of Being Born last night and now I'm really thinking of switching providers. I'm 33w1d. Would you?

golfingdarwinfish · September 2014

No, I wouldn't. I especially wouldn't if the reason I was changing is another physician from her practice may deliver me. that's common in many practices, and unless you can find a practice where that is not policy, and they are willing to take you at 33 weeks, you're going to find the some thing elsewhere.

Also, you may not like the new ob you switch too, then you are up against a rock and a hard place where you are definitely being delivered by a provider you dislike. I can't imagine changing again at that point. Building trust in a new provider is going to take time, especially if you're already paranoid someone is going to intervene when they shouldn't.

The Business of Being Born is an incredibly bias documentary, so if that is what is driving your sudden uncomfortableness at 33 weeks, I would definitely pause and think through the actions you are considering. At the end of the day you did not go to medical school, complete a fellowship, etc., and if you choose to be delivered by an OB, you have to trust that their training and experience makes them more competent to decide when to intervene than you.

SusieBW · September 2014

ITA with PP.
I would consider switching providers at 33 weeks if there was a really strong reason for it. From what you described, I wouldn't switch under those circumstances or for those reasons.

I think that your better approach at this stage is to talk with your provider about the documentary and some of the concerns that it raised for you. Have you met with the other providers in the practice group? See if you can get your next appointments with them and have the same conversation with them. Like PP said, it's an extremely biased documentary, though really informative, and most OB practices have the same on-call policy that you're describing. My DD was delivered by a staff surgeon at the hospital who had nothing to do with my OB practice, and I met that morning. That's the way it often goes.

windwithfingers · September 2014

What @dorothyzbornak97 said. I love my OB and she's super go with the flow, but there are two other doctors in the practice, so I met them and explained what I wanted in case one of them ends up delivering the baby.

I was also really worked up by the Business of Being Born, but it's only one side of the story and super biased, PLUS the ladies who made it are now on a crusade against birth control, which lowers their credibility in my eyes.

beachbumsc · September 2014

I'm actually thinking about it, but I would be switching from an OB and a hospital delivery to a Midwife at a birth center. The midwife I would be switching to is one I just finished my Hypnobirthing class with and while they typically don't take new patients after 30 weeks, she's willing to make an exception for me. They are checking my insurance and everything right now before I make a hasty decision. If I was switching from one OB to another- I probably wouldn't at this point. At my OB's office, there are three doctors and I would get the one who is on call- I think that is a pretty standard practice.

Sammyatemypeas · September 2014

The Business of Being Born isn't what sparked this hesitation. I've been seeing this provider since 9w and if that's not long enough to build a relationship, then I'm really screwed. My first was born to my provider that I saw through my entire pregnancy. He came in specifically when OB called and told him I was in labor. It's not so uncommon to want your OB there, otherwise what is the point of seeing them throughout pregnancy?

Sammyatemypeas · September 2014

I do plan to voice my concerns at my appointment but if I have to fight every person who may be in the room to get what I want/need, then it's worth it to me to search elsewhere. And yes, I do trust my body to know what it's doing. My daughter came out perfectly fine after 34h of labor and i love that my provider at the time didnt say "hey, youve been in labor too long. Here's pitocin, a vacuum and an epidural." Working in healthcare my entire life, not every MD everywhere always knows best.
There are several other providers, meaning 6, and I'm currently doing my work on them and their practices as well. The whole point of the patient/provider experience is feeling taken care of and heard. A policy my company touts (I work for the hospital I'm delivering at), yet it remains to be seen.

golfingdarwinfish · September 2014

Sammyatemypeas said:

I do plan to voice my concerns at my appointment but if I have to fight every person who may be in the room to get what I want/need, then it's worth it to me to search elsewhere. And yes, I do trust my body to know what it's doing. My daughter came out perfectly fine after 34h of labor and i love that my provider at the time didnt say "hey, youve been in labor too long. Here's pitocin, a vacuum and an epidural." Working in healthcare my entire life, not every MD everywhere always knows best. There are several other providers, meaning 6, and I'm currently doing my work on them and their practices as well. The whole point of the patient/provider experience is feeling taken care of and heard. A policy my company touts (I work for the hospital I'm delivering at), yet it remains to be seen.

It sounds like you really don't need our advice or thoughts. Good luck with your decision and delivery!

MsMacual · September 2014

I would switch if I was concerned about more than the possibility of having one of several OBs attend my delivery. I don't disagree that the Business of Being Born is biased, however, it raises a lot of good points about how medicalized labor and giving birth can be in certain settings with some providers. It sounds like as you are becoming more educated about giving birth, you are thinking more about how you would like things to go and potentially are questioning if your provider and his/her colleagues are supportive of the approach that you would like to take. While there is no guarantee with any provider that you will have your ideal birth, your provider can be a huge factor in being able to achieve something close. I would not hesistate to switch if I felt that my provider and his/her colleagues were not supportive of my birthplan.

I chose to use midwives with both of my pregnancies and births (differet groups- both hospital based). In both cases I will deliver with the on call MW and they do their best to make sure that each patient meets all of the MWs in the practice before they deliver. I actually think that this model has some advantages as the on call person often is there for a 24 hour shift and isn't watching the clock thinking that they want to get home for dinner or to do whatever else.

LightBright515 · September 2014

I don't really see you being open to other suggestions. Just do what you're going to do.

ariel06 · September 2014

I guess I probably wouldn't switch at this point for your reasoning. For my clinic, my doctor delivers for sure for business hours and then one of the seven doctors from my clinic is always on call. My first two were delivered by other doctors and they were great. The reason I chose my particular clinic is they all have a similar philosophy.

Maybe see if you can meet with the other doctors who might deliver you rather than switch completely. I can't imagine in only a few appointments like you have a relationship with any doctor.

megaroo64 · September 2014

I think you have already made up your mind. However, do you have another option to switch to where you know they are going to be the person delivering your child and you know you can build a relationship with them in 7ish weeks?

Personally, I wouldn't switch. I got the random dr. on call when I had my son, and she was awesome and completely receptive to my wishes. Just because the person might be a stranger, doesn't mean they are necessarily going to be an intervention-pushing bully.

SusieBW · September 2014

Sammyatemypeas said:

The Business of Being Born isn't what sparked this hesitation. I've been seeing this provider since 9w and if that's not long enough to build a relationship, then I'm really screwed. My first was born to my provider that I saw through my entire pregnancy. He came in specifically when OB called and told him I was in labor. It's not so uncommon to want your OB there, otherwise what is the point of seeing them throughout pregnancy?

My biggest concern in choosing an OB is the relationship that I have with them during my pregnancy, and that I'm happy with their care and how they handle everything while I'm pregnant. I don't expect that my OB will be the one to deliver my baby, unless I end up scheduling a RCS. It would be nice if my OB was the one on call, sure, but I don't expect it. I also never bothered to meet with the other OBs on staff in the practice, because I feel like they are going to be playing such a small role in the overall process. It's just not as important to me, I guess, to have a relationship with the OB who is actually the one catching the baby as it is to have a relationship with the OB that I see all the time during my pregnancy and who will be the one to handle any complications that arise with my pregnancy.

Midwives are different, and if I were having a midwife birth, I would probably feel differently.

aminalex · September 2014

I dealt with this exact thing as well toward the beginning. I brought up to my OB that I wanted to go as natural as possible. She immediately became standoffish and told me that if the labor was going well, she would do periods of monitoring with periods off monitor. That's not what I wanted to hear. I found out later on, that the hospital has specific rules that are beyond her control (even the birthing center that I tried to get into had even more specific rules... ). I also realized that a. She probably won't be there during the birth (she's in a group of 4) and if she is it'll be for a small period of time b. She will not do anything to harm mine or the life of my child. She only has our best interest in mind and c. Much of what happens during labor is beyond any one person's control and to go with the flow a bit.

I will try to find a compromise at the moment if need be (i.e. what will happen if we give lo 10 more minutes to do it in his own before considering other options?). And at the end of the day, i'll have time after lo arrives to find a doc I really love.

Don't switch now. Go with the flow. Give up some control and you won't be disappointed!

applebottomgenes · September 2014

I could totally be wrong, but don't the OB's just come in for the glory moment? I would be more concerned with your hospital and their policies on birth and what not. Also, be nice to nurses. This is the only advice I've gotten, I'm bringing Baked by Melissa and Dunkin Donuts because I"m a kiss ass.

Would you benefit having someone in the room with you that has your birth plan? Whether that be your husband, other family members or midwife (or even a doula if you go that way)...choose someone you know will be stern but polite. At the end of the day it comes down to your and the baby's health so as PP said, you have to be ready to 'go with the flow.'

**Take my advice with a grain of salt, I've yet to have the pleasure of birth

Sammyatemypeas · September 2014

I've not been with the OB for only 7 weeks. I've been with her from 9w-current. That's 24w. I've reviewed my hospital policies and in my research I've found they have four midwives on staff. I've kept my MD appt as well as scheduling one with a midwife under the same practice.

This isn't my first birth and I know what I want this time around. My MD also became standoffish once I told her my plans. Her NP leaves something to be desired. It wasn't a big deal to be an ob transfer to a midwife since it's under the same facility.

Sammyatemypeas · September 2014

I'm also new to bigger city hospitals. I come from a small town where my mom was the OB nurse on the floor for 23 years, my provider was also our family practitioner for 15yrs of my life. It was very intimate and personal. I wanted the same for my second. I hear everyone's input and take it in regard, despite what you think.

Roseypants · September 2014

applebottomgenes said:

I could totally be wrong, but don't the OB's just come in for the glory moment? I would be more concerned with your hospital and their policies on birth and what not. Also, be nice to nurses. This is the only advice I've gotten, I'm bringing Baked by Melissa and Dunkin Donuts because I"m a kiss ass.
Would you benefit having someone in the room with you that has your birth plan? Whether that be your husband, other family members or midwife (or even a doula if you go that way)...choose someone you know will be stern but polite. At the end of the day it comes down to your and the baby's health so as PP said, you have to be ready to 'go with the flow.'
**Take my advice with a grain of salt, I've yet to have the pleasure of birth

This! They are seriously only in there to deliver the baby at the very end. They make check on you a few times throughout, but that's it. I'm not fond of my Dr. either, but it's hard to find the perfect one. I would just suck it up if it were me. It's really the nurses and hospital staff that help you throughout the labor. They do this day in and day out, so I would imagine they will respect your wishes on how you want to handle your labor.

golfingdarwinfish · September 2014

Sammyatemypeas said:

I've not been with the OB for only 7 weeks. I've been with her from 9w-current. That's 24w. I've reviewed my hospital policies and in my research I've found they have four midwives on staff. I've kept my MD appt as well as scheduling one with a midwife under the same practice. This isn't my first birth and I know what I want this time around. My MD also became standoffish once I told her my plans. Her NP leaves something to be desired. It wasn't a big deal to be an ob transfer to a midwife since it's under the same facility.

I think the PP was saying that you will have only 7 weeks to get to know a new practitioner.

If you wanted the same experience for your second, why didn't you consider all of this earlier and change practitioners when you first realized all the "big city hospital" dynamics? Did you ask your ob in the beginning if she would be the one delivering LO?

Regarding the bolded - I'm not sure how the NP being standoffish matters when you are 33 weeks - you made it 24w. Unless shes' going to be in L&D with you and somehow directly impacting your birth experience, her being 'standoffish" is sort of moot at this point.

Comparing and contrasting your past experience with your present, I don't think this practice had a chance of coming close since you have a vision of what you want in your mind. Hopefully the midwife can help you get there.

Sammyatemypeas · September 2014

True. Honestly I have no good reason for not addressing all this sooner. My last visit was the one that sparked to whole tug of war with myself. And I didn't process that I'd only have 7w with the midwife either so that's a valid point. I've been incredibly passive until now. I wish I had done things differently from the start, but alas, that's not how it ended up.

Emerald27 · September 2014

I'm too lazy today to read all the other responses. So I apologize if this is redundant.

Have you considered hiring a doula who can be your advocate during baby's birth?

Have you worked out a detailed birth plan to discuss with your doctor and bring to the hospital?

MrMrsandBaby · September 2014

Doula. Midwife. Those seem to be the way you want to go. If you want to switch, do it now, you are running out of time.

DaniGrace89 · September 2014

I just switched practices because we moved.

Our new practice has midwives and doctors. We chose to go with a midwife because in our practice, the doctor is in the hallway during the birth (in case everything goes wrong), and the midwife will provide more emotional support than the doctor can.

In general though- switching doctors wasn't a huge deal to us. Getting our records faxed over, etc was sort of a pain- but in general we are pretty relaxed about these types of things.

Emerald27 · September 2014

MrMrsandBaby said:
Doula. Midwife. Those seem to be the way you want to go. If you want to switch, do it now, you are running out of time.

This is so true. I switched to my midwifery practice at 28 weeks. They do not allow you to transfer in any later than that, so I was really lucky that I made the decision when I did. It may be too late to change to some providers, especially midwives.

Sammyatemypeas · September 2014

My hospital's delivery rooms are all set up to be birthing center setups. They all have the tubs, spare bed setups, etc. You can elect to use the tub or what-have you. The facility I'll be delivering at also has my ob doc. The midwife I scheduled with is in the same office so I won't need to change anything. All my med recs are right there. I don't know why "big city" is always in quotes. I come from a town of 2k and the city I'm now in rounds 3mil. So I am used to things being done differently. No shame in that. I've called insurance prior to scheduling with a midwife and they do cover them so I'm set there. It wasn't an issue to switch because they are both in the same practice. I just feel like I'd like the midwife experience better in this case.

aminalex · September 2014

starla487 said:

If there are no pre-existing health issues for you or your LO, why not seek out a birth center? I don't know if any will accept new patients this late in the game, and you are only running out of time. But in a "big city," there is probably at least one hospital nearby which has a birth center attached to it.

i live in NYC and there is one birthing center at St. Luke's Roosevelt. I think there are a couple in Brooklyn. I called and if you are anything but a perfect patient (lowest of the low risk), they will kick you to the L&D floor (which is a different set of midwives and doctors). They also won't take you if you are more than 12 weeks along. Super crazy.

Sammyatemypeas · September 2014

That is crazy. I'm a model pregnant lady in the medical world. I wish it were the same for my personal world...

Aurora1181 · September 2014

IMO the hospital might matter more than the doc. As pp's said, you'll work with the nurses more than the doc anyway. I spent more time with my anesthesiologists than my ob! The hospitals facilities were more important to me, since I had twins and complications. But if you want to switch, go for it! As for the movie, I watched it when someone here recommended it.. And I was not a fan. Very biased, purposefully and unnecessarily inflammatory IMO.

Sammyatemypeas · September 2014

The hospital will remain the same. I'm really leaning to the midwife. I'd love guidance rather then some lady holding my leg until the MD is set to catch. I have made an appointment with the midwife who is under the same practice and will see how they both go.

persephonerose · September 2014

If the hospital remains the same you might end up not getting what you want anyway. Most hospitals have set policies and practices. If you are worried about getting "your birthing experience" then you should check to see if the hospital is friendly to your desires. If they aren't it wont matter if you use and OB or a Midwife, the hospital will still try to convince you to do things their way.

I am sure someone has already mentioned that nursing staff from your OB's office wont even be with you in L&D. It is a completely different set of nurses. Those nurses are hired by the hospital so they will try to follow the hospital's standard procedures.

swimgirla · September 2014

I switched at 32wks from my OB to a midwife and birth center. The OB just rushed in and out every week and was halfway out the door any time I had a question. I'm already much happier with my new midwife, 2nd appt tomorrow.

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