Thursday, July 17, 2014

Breaking Up (with your OB) is Hard to Do

I've heard it countless times now.  A woman discussing her obstetrician and lamenting wistfully over the fact that she can't just leave him and find another care provider.  

"It's too late."  

"I don't know where else I'd go."  

"But I've gone to him forever!"  

"I know he does x, y, and z even when I don't want him to...but he's a good doctor."  

"I don't want to mess with my insurance."  

"I would feel so bad changing!"

and others...
It begins to sound eerily like a domestic situation.

Why is it so hard for women to change their birth and woman care provider?  

I have a theory.
(I know.  Watch out.)
Birth is one of the most intimate experiences a woman has.  Akin to sex, she is vulnerable, naked, and experiencing enormous physical and hormonal shifts.  She is investing her body, emotions, soul, her entire self into the event.  She does things that in any other setting would leave her embarrassed.  She entrusts her wellbeing and the wellbeing of her child to this other person oftentimes when she is compromised by pain or the foreignness of a hospital.  She is expected to "perform" and to do it "correctly" or risk being snuffed at and snubbed or wheeled to the operating room as a diagnosed "failure."  Even when she has never given birth and is going through a normal exam, she is opening herself up in ways previously only known to sexual partners.  

Whether we want to or not, we as incarnational Christians cannot pretend that isn't true.  We cannot pretend that this is "just business."  We aren't free to separate our bodies from our souls like the Gnostics.  And, I think, as tempting as it might be because of the vulnerability of the moment, we cannot accept a doctor or midwife who treats it as just another cervix to be checked or vagina to watch. 

Why is it that we feel we can pick a name out of the insurance provider book or take any old resident on call that we've never met and find that acceptable?  Why is it that even when things are bad, when he doesn't respect our choices or does things to us or our babies that we asked him not to or speaks condescendingly towards us....why is it that women accept that?

A huge part of that inability to break up with your OB is because we've developed an intimate relationship with them.  Whether we like it or not, the moment we get on that table for an exam or discuss our sex lives or allow them to see us naked, things change.  The doctor or midwife doesn't necessarily notice.  For them, it more than likely is just another body, another cervix, another day at the office.  (There are many providers who DO break that pattern, however, and thank God for them.)  But we now, whether we birth with them or not, feel a connection.  We've revealed more of ourselves and are more vulnerable than we were before.  For many women, it's understandably hard to just cut that tie after such vulnerability.  

And if that's not enough, then there's the actual birth.

And in flows the oxytocin.

Most of you probably know what that is but in case you don't, oxytocin is the "love hormone."  It's the hormone that helps bond you deeply to another human being.  It is released in torrential amounts in the female body during three significant moments - orgasm, natural birth, and breastfeeding.  It literally bonds you to the person you are with and thank God for it.  When used correctly, it becomes the superglue that chemically bonds two people together.  It strengthens marriages and mother/baby bonds and helps us overlook faults and stay in relationships.  It's beautiful and awesome and a gift from God.  Yay oxytocin!

When used in a disordered way, say in premarital sex, it causes heartbreak and unhealthy attachments.
See where I'm going with this?
This oxytocin flooding our body during birth bonds us to our babies and husbands, yes, but it can also give us an (admittedly much lesser) bond with the other people in the room as well.  And that, I believe, is one of the reasons women seem to feel a sort of loyalty to their provider even if the provider's treatment is less than acceptable.

  It's interesting to note here, too, that for most of history, a woman's birth was attended by other women, usually sisters, mother, aunts, and cousins.  If my little theory holds up, then birth would have strengthened the bond with those women in her life, something that to me, seems more natural and desirable.  This, the profound physical intimacy of birth as well as that oxytocin bond are just some of the factors that have made me personally more and more uncomfortable with the very modern trend of the majority of birth attendants being male.

Another aspect of that mother-provider bond, no matter HOW you give birth, is the emotional investment that it is to become a mother.  It is a hard thing to admit that maybe things could have gone better for our baby, that maybe a difficult or traumatic birth could have been prevented or that we could have made a better decision (as small as that decision may have been).  Our defenses are immediately provoked, because we love that baby so much, by the idea that maybe things could have been improved.  So we can sometimes cling to the hope that the doctor surely did all he could or that she was always working in our best interest (even if evidence points to the contrary).  That's normal and understandable.  We want so badly to know that we are doing well by our children.  I'm learning more and more as a mother that in all aspects of parenting, our need to believe this has the potential to get in the way of making an honest assessment and possibly better decision the next time.

So what is my ultimate point in sharing this?
Not that all OBs are evil (as I said above, there are some wonderful doctors and midwives doing beautiful work) or that it's necessarily bad to have some sort of loyalty to your doctor or midwife.  My point is rather that we should take all of this into account when making our decisions for a provider.  That loyalty to our doctor or midwife should never trump doing what is best for us or our babies and that if something is telling us to switch, then we need to listen to that.

::A few things to remember::

Your provider and their philosophies on birth are one of the utmost factors in how your birth goes.  Choose well.

We are choosing them.  Not the other way around.  If you aren't happy with their care and you can't discuss things openly with them, switch.  It is okay and good to "shop" for your provider.  Being "nice" is not enough to qualify them to be chosen.  You are likely not going to hurt their feelings by switching (and if you do, they'll get over it and maybe learn something from it).

It is never too late to switch.  Whether you're 39 and a half weeks or have already birthed children with that provider, you can still switch.  I just heard a story about a mother who fired her OB while in the delivery room because he was doing the well-known switcharoo with regard to her birth plan and dismissing her reasonable requests.  Good for her.

It is okay and JUST to expect that your provider treat you with respect, dignity, and listens well to your concerns.  If they dismiss you or will not work with you to have the birth that you want or if you feel rushed or like another number during appointments, then switch.  If they mock you for having too many children or for using Natural Family Planning, then switch.  The more women begin to demand better, the more we will see a safer and more dignified birth model in our country.  (And if you do switch, consider writing a letter to let them know why.)

Birth rape, trauma, and abuse are actual things.  Simply because someone has the title of doctor or midwife or because you have developed a relationship with them does NOT give them the authority to do something to you without your permission.  If your provider tries to pressure you into procedures or violates your body without your consent, it is NOT okay.

Encourage your husband to have a role in the birth.  Hold that baby right away if possible.  Let that oxytocin work for you and your family.

I would love for you to share.

What have your experiences been with woman care and birth providers?

Feel free, too, to think I'm crazy and disagree with me and my theories...I'd love to hear what you have to say either way.

*image source*

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  1. This is so interesting! I have used the same ob three times and I like and trust him, so I have no reason to change. However I have "broken up" with a pediatrician and that was so very hard and stressful. There were several small instances that happened over a year or so that made us question if we should use him (nothing too major - giving us the wrong prescription, promising to fix a wrong bill himself and never doing so). My husband really wanted to switch after the wrong prescription deal. But I liked him and felt bad, so we stuck it out. When my second son was four months old, he misdiagnosed him and we ended up in the hospital and every Dr that we saw pretty much did not understand how our Dr couldve missed what he did. We switched after that. It was hard and the Dr actually called me several times and left messages politely wanting to know why I switched. I have seen him a couple times since and it is awkward. But I am very glad we switched and I didn't even realize how bad he was until I started dealing with a competent doctor! :)

    1. Wow, yes that is such a great reminder that the ones who pass at the bottom of their class STILL PASS and get the same title as the one who graduates at the top. I think of that often. Doctors are people. THere are good ones and bad ones, uncharitable ones and loving ones, and each one should be judged (as worthy of your business) according to their merits and witness not because of their title.

  2. I've had a hard time getting over the wanting to be a "good" patient thing: just going with the flow because it makes things go smoothly (you, know, until you've suddenly got too many drugs being pumped into you or are being wheeled to the OR). Your reminder that we are the customers is so important. And we're paying some serious money at that! I wouldn't hesitate to take my business elsewhere if anyone treated me like the anesthesiologist for my c-section did if I was at, say, a restaurant. Our vulnerability and fear and lack of experience with birth can make it more like taking your car to a mechanic where it's easier to judge his helpfulness by how nice he is than how well or safely he repaired your car because what the heck do you know about cars anyway? Add in urgent worries about baby's safety and you're signing up for all kinds of things you want or need.

    I've been thinking a lot about how to deal with situations where you want to stand up for yourself but don't want an adversarial relationship with someone who, as you said, will be treating you in a very intimate and vulnerable situation. Like, asking a nurse (or anesthesiologist I guess) to do something differently or not do something routine or whatever. In some (urgent) cases, navigating that will be unavoidable, but I think you're right on that we can avoid a lot of those situations by finding another care provider with whom we're already on the same page ahead of time.

    Or by not being afraid to fire your OB in L&D! Good for that mom!

    1. I agree. It makes me sad that women DO feel they are in this position so often during their pregnancy and they have to walk on eggshells or ask the "correct" way in order to have their providers respect them. It's true but it's a shame.

  3. Interesting theory. Probably a lot of truth to it. I also think that when we look to people as 'experts' we forget that we know ourselves/our bodies/our children pretty darn well, and experts are there to help lead us. Weirdly enough, I LOVE my obgyn, but I HATE that she doesn't come from a Catholic/Christian perspective. With John Paul, I switched, thinking I would feel more comfortable with a doctor more 'open' to our mentality. We met with her once. In her office she had literature about the sinful nature of premarital sex and birth control, etc... but we felt really uncomfortable with her. In our initial meeting she told us she wouldn't be doing any blood work and only one ultrasound at 20 weeks. Because of my history, and my concerns, I felt super weird about her approach. We never went back. We returned to my original doctor (who I always loved) and she was super psyched we were having a third (repeat customers). She was incredibly proactive with my pregnancy. I ended up I had severe iron/blood issues and needed iron infusions for 8 weeks leading up to the surgery. I ended up hemorrhaging with John Paul and losing a crud ton of blood. It was very VERY scary (not to mention the most pain I have felt in my life). I was so glad I listened to the little voice in my head who told me to go back to my original doctor even if she didn't match all of my beliefs. I also think Aaron and I have been a pretty big witness to the whole office because of our choices/attitude/etc...(several the of the nurses/doctors made comments about our family- positive ones). Any future children will be delivered by my current doc, I really feel like she protected both JP and I.

    1. I think if anyone would make a good witness to life and faith in a secular environment like that, it would be you guys! Some of the best providers I know are those who don't share our faith...and, sad to say, vice versa. I feel that way about our situation, too.

  4. I have a long story that I won't get into, but as a pro-life community we should be pro-life about our doctors, as well. I found out, too late sadly, that my former ob/gyn was (maybe still is) a medical director of a Planned parenthood facility. I switched immediately and when I made an appointment with a new doctor I told the receptionist that I wanted to talk with the doctor before my appointment, so she could book some more time. At my appointment (across her desk, not in the stirrups), I asked "do you, or have you ever done, abortions?" She answered me very frankly (no) and was very understanding of why I would ask, as she is also a devout Catholic.

    It's easy to just pretend that your caregiver (the ob/gyn) is who you want him, or her, to be. But some things you can't just hope for, you have to know. How any doctor can welcome life on one day and destroy it on another is beyond me, but that is the intellectual dishonesty behind abortion.

    1. Just for clarity, I didn't see my ob/gyn at a PP facility, obviously. I saw her at her "nice" office on the days she was there, and one or two days a week she was at a PP.

    2. Wow, that must've been such a shock. I agree that providers have an ethical obligation to be honest and willing to answer patient's questions whether that's their beliefs on birth and abortion or whether it's their c-section rate. I tell clients that if a provider is unwilling to do that, then you know everything you need to know about how they will treat their patients and should run. I pray for a day when all pro-life doctors will also be the same doctors who treat the birth process itself as well as their women in labor and afterwards with dignity and respect. It's a shame and unacceptable that so many women have to compromise one way or the other.

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  6. Wow...this is so, so, so true. All my children have been born in different states so I've used different care providers for all of them.

    I definitely agree that flood of oxytocin and hormones present at birth "bonds" you with that doctor or midwife in a unique way. I can remember feeling "sad" at all my 6 week check-ups that I wasn't going to see that dr. or midwife again. It really is a very unique situation.....such an emotionally charged situation.

    I think because we see doctors and midwifes at our most vulnerable states...we are trusting them with ourselves and our children. It does make for a strange bond....becuase it is for the most part very one-sided. We end up feeling attached or bonded to the dr. or midwife, but it's all one-sided....they don't share that same vulnerability with us. I think the one-sideness of the whole vulnerability part *can* make for weird feelings and feelings of "power play" with the doctor.

    I 1000% agree that choosing the right provider is so important. I've driven longer distances to find a doctor or midwife or pediatrican that I trusted and that would respect my wishes. It's definitely worth a longer drive and a bit of a search to find someone who respects you and your wishes and plans.

    1. I agree. Knowing what I know now, I would make a longer drive or pay more in a heartbeat to find a good provider.

  7. I had to delete my first reply as it was just too personal to share. I agree with your post 100%! I've heard so many women say they can't change their doctor even after receiving horrific care. Your reasoning could explain why. I feel more educated now and wish I had the information I have now 14 years ago.

    1. Cassie, I am so sorry for the experience you had. I hope good comes out of it somehow, if only that you can share with other women the importance of selecting a provider well and not accepting anything but respect and being treated with dignity throughout their pregnancy and birth.

  8. My MIL and I got into a "discussion" about how I felt about our new ped. My old ped made some comments about breastfeeding when I mentioned I was still breastfeeding our toddler and the practice missed mono for 4 solid months and kept telling us he had ear infections. We have only seen the new ped 1x and when I mentioned our son's constipation, he gave vague directions to give him fakalax and that even though it says only for 7 days, people have been using it daily for years (though I do know that the FDA is looking at issues with older adults and neuropyschological issues and I worry about the effect on young minds). I would rather try to discover if there is a root cause for a symptom before medicating the symptom. My MIL asked if I thought I was smarter than the doctor....I just think that I have a lot more time to be concerned about my family than my doctor does.

    1. You're exactly right (but don't exclude the possibility that you may indeed just BE smarter than him...). Doctors are trained to treat x with y and don't always look at all the other factors surrounding why x is happening. Moms do.

  9. You make some very valid points, We need to remember our bodies our choices, tests etc. I was most impressed when my new OB (old one retired) actually confirmed that:) my first female OB btw, my previous one was male, pretty flexible but still I was very excited with my new one. I think midwifery here in Australia is more about empowering women than it seems to be in America. Certainly here in my country city, they are excellent, always respectful of following my birth plan, non intervention as much as possible.

    1. Out of all the industrialized countries in the world, the U.S. actually has the worst maternal and baby mortality rate and the maternal death rate is rising. Completely unacceptable when we know better but are stuck in this crazy OB/hospital model.

  10. That's why I looooove that we have a pro-life, Catholic OB office that we've used for all our births! I know some people who've had bad experiences with the same practice, and I have to wonder how that happens with the same doctors...

    1. Yeah, women definitely accept different things and have different preferences so sometimes one person's "that practice is awesome" is another person's "I hated that practice." I do wish that pro-life Catholic OB office equated respectful and evidence-based birth practices but sadly, it doesn't...I'm thrilled when it does, though!


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