Pregnancy is full of changes. Your body changes, your emotions are all over the place, and even your house changes to accommodate all of the "necessary" baby accessories. One of the less common changes – but one with potentially big impact – is changing your doctor or midwife. If the prenatal care you're receiving isn't meeting your needs or if your care provider doesn't support your preferences for birth, consider switching to a new practice. Changing Ob-Gyns during pregnancy, even if you're in your third trimester, isn't as difficult as you may think.
"There is no rule that says you need to switch by a certain number of weeks of gestation," says John E. White, MD, of Mount Auburn Ob/Gyn Associates, Inc., in Cincinnati, who will take patients anytime as long as he can meet them face-to-face at least once before their baby arrives. "If you have that 'uh-oh!' feeling about the doctor, the office, the staff, or whatever, and you have a legitimate reason to switch, then you should."
Your choice of care provider has a significant impact on your birth, affecting both the health and safety of you and your baby, as well as the satisfaction and enjoyment of your experience. While there is a standard code of ethics and guidelines in obstetrical care, care providers practice differently. Some have unusually high rates of induction and cesarean; some are more experienced in supporting natural or low-intervention birth, and others prefer a more medicalized management of birth; some do a wonderful job of involving you in your care while others do not. Choosing one care provider over another could mean the difference in having a vaginal birth or having a cesarean birth, despite the same set of circumstances.
Below are some reasons why you might consider choosing a new Ob-Gyn or midwife:
Questions are dismissed or unanswered during prenatal appointments
You feel uncertain about a suggested treatment or course of action
You want a water birth and your practice doesn't allow it
You dislike being in a group practice
Your provider will not deliver twins or breech baby vaginally
Doulas are not encouraged or allowed at birth with the care provider
You feel like a "number"
Preferences on your birth plan are not allowed or encouraged
You move to a new town – or to a new healthcare plan
Your pregnancy suddenly grows more complicated
If you attend a group practice where several doctors rotate being on call for births, be sure to meet with and talk to each doctor in the practice. If you're happy with your primary doctor's care, ask her if the other doctors or midwives have a similar philosophy and style – and find out for yourself. If you meet another provider in the practice who doesn't align with your preferences for birth, understand that there is a chance this doctor will be at your birth. Even practices with one doctor or midwife on staff contract with a back-up provider in case of illness or emergency. Ask about their back-up and find out if you can meet him.
"Always follow your gut," says Sharon Muza, BS, CD(DONA), BDT(DONA) LCCE, FACCE, a Seattle, WA, area doula and childbirth educator at New Moon Birth. "If you aren't 'feeling the love' then it is at least worth exploring switching to someone who is a better match." Renowned author and doula Penny Simkin always tells women that if they don't like their doctor or midwife during pregnancy, it won't change during labor and birth.
Heather Moody Gantenbein, a work-at-home mom in Denver, CO, changed her care provider three times with her first pregnancy. "Everyone thought I was crazy for switching so much, but it was the best thing for my baby and I'm so glad I did! My second doctor scheduled me for a C-section before mid-October, but I ended up delivering vaginally on November 29. The right doctor made a huge difference for me."
Changing your care provider is usually as easy as calling the new office, asking if they accept your insurance, and making an appointment. Before you make a call, however, do your due diligence to narrow down the field of available doctors or midwives. Ask friends, family, your doula, and your local birth network for recommendations. Be specific about what you're seeking (more time spent during appointments, water birth, a more natural-minded provider, etc.).
"Moms choose to switch providers all the time," says Muza. "It can be done rather easily and you shouldn't be concerned about making your 'old' doctor or midwife feel bad. No one will fault you for making a decision that's best for you and your baby. Your new provider can request transfer of your medical records and you don't need to have any awkward conversations."
Even if you do have to call your former practice, the request is usually handled without questions or hassle. If front office staff does ask why you're leaving, you don't have to share your reasons, but doing so may help the practice improve.
"Many people want to avoid a confrontation, so they just have their records transferred with no explanation," says Susan Keane Baker, author of Managing Patient Expectations (Jossey-Bass). "That's like someone's breaking up with you without giving a reason. You should give the doctor a chance to make amends." Or at least do better in the future with other patients.
Dr. White and other experts suggest that women examine their reasons for wanting to change doctors and try to resolve problems first before seeking a new practice. Then, if you still need to switch, do it as early as possible to ensure your new doctor becomes familiar with you and your case.
Some women mistakenly believe they cannot change care providers late into their pregnancy. While many practices stop taking new patients between 36-38 weeks pregnant, it is not unheard of to switch care providers at 39 or 40 weeks pregnant, or even while in labor (though this is rare). If you're beyond 38 weeks, call the practice you want to get into and explain your situation. They may be willing to make an exception. If you can't get past the scheduler, visit the office in person – even without an appointment. With your sweetest smile, let the person at the front desk know your situation and that you're willing to wait in person for some time with a provider in the practice.
If you're running into dead ends on your own, reach out to your doula or childbirth educator. "An experienced doula or childbirth educator knows your area's care providers," says Tracy Cuneo, CD(DONA), LCCE, an Atlanta, GA, area doula and childbirth educator at Graceful Birthing Doula Services, and student midwife. "More than likely, she has a close connection with a few Ob-Gyns or midwives who she can call directly on your behalf." Even if you're working with a newer doula, chances are good that she is connected with other doulas who may be able to help.
Sometimes, limitations within your health insurance leave you with few choices for prenatal care providers. If you are unable to find a care provider who best matches your needs, there are things you can do to increase your chances of having a safe, healthy, and enjoyable birth. The following suggestions are good practice regardless of your care provider choice.
Be your own advocate. This is sometimes easier said than done, especially for first-time mothers and especially with care providers who are intimidating or aggressive. But the more you and your partner are able to speak up – especially during your birth – the more likely you will get what you want. Remember, your doctor works for you.
Attend a childbirth class. Being your own best advocate is easier when you have the education and information to back it up. By attending a childbirth class, you'll be better equipped to make decisions and feel more confident about your choices.
Hire a doula. A doula is an awesome partner and knowledge source who can help you advocate for yourself. A doula does not speak to your care provider on your behalf, but she can help provide you with evidence-based information to make a decision and remind you of your birth preferences during labor.
Make friends with your labor nurse. Labor and delivery nurses are integral to your birth experience. They will not overstep a doctor's orders, confront a doctor for you, or go against hospital protocol (their license is at stake), but they may have tips and tricks to help you achieve the birth you want. If you're planning for a natural/pain medicine-free birth, request a nurse who enjoys assisting natural births when you check in.