#118 | Your First Trimester: Provider Red Flags

You can almost bet that your provider, especially if it's an obstetrician knows absolutely nothing about nutrition, nothing about health. And for us it is a major red flag if your provider is fixated on your due date.

So if they say that you're asked for now in the first trimester, what is your C section rate? What's the C section rate for this practice? See if they keep track? See how they respond? Do they seem touchy and defensive? How do you feel having that conversation with them? What's your intuition telling you?

Any provider that is calling you geriatric is a red flag for us

I wouldn't call a geriatric person, geriatric.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Okay, hi, everyone. Welcome back to another episode of down to birth. Trisha and I are really excited today to talk about one of our ongoing conversations we're always having with you. But we're organizing a little bit this time provider red flags. So today we're going to talk about some of the biggest red flags that you can start to identify in your first trimester. And you can look forward to subsequent episodes coming out on the second and third trimester as well. So we have a whole bunch of red flags we want to talk with you about but today Trisha,

we're obviously always talking about you having the you know, best possible birth experience a birth experience that you feel satisfied with at peace with. And so much of that has to do with your provider and the provider you choose. And we talk a lot about how to choose the best provider. So we're going to give you today some of the most common red flags to look out for in the first trimester so that you can know whether you are with the right provider, or if you need to make a change before it's too late. Not that it's ever really too late. But it does get harder.

Alright, so let's start with language. When you're sitting with your provider, starting from your very first prenatal appointment, start to pay very close attention to their language, what you're looking for is either language that is elevating them and putting you down in any way. So an example would be if they were to use language like the word let or allow like, I can't let you go past 40 weeks, or we don't allow women to give birth in this hospital without an IV. that language is an absolute red flag. But what you also want to start developing is the ability to recognize rhetoric, when you hear it medical rhetoric like, Well, look, we just have to see how it goes. Or look I get worried about Frankly, I get concerned if we go past the due date, that's just rhetoric that's not giving you any data.

or big babies, you know, usually have problems at birth, big babies get stuck Exactly. Or gaining too much weight in pregnancy, you know, requires a C section or the placenta stops functioning after this point. That's a very common trend right now.

Or who didn't somebody say something recently about a placenta?

A client of mine told me in class that was a first I've had a lot of couples be subjected to fear tactics with comments about the placenta when they're all having completely healthy pregnancies, no sign of anything being wrong providers just talking about things that can happen with the placenta. I don't even want to give it. I don't even want to talk about it, because it's such bad information. But yeah, yesterday was the first time anyone shared it was a dad in class who shared that they were told, be careful after the due date, the placenta can fin and I was like, that's a first I've heard of calcify. I've heard of fail but thin. And you said, Trisha, that's a first for you to

I haven't seen a thin placenta or heard about one. I mean, it can change yet the placenta definitely changes but then is not we'll have to look that up and see if that's the thing. All right. So here's something that I think is really an easy trap to fall into. The very nice provider. We don't want to just choose our provider because they're nice. It's great to have a nice provider. It's great to walk into your providers office and have it feel like it's a you know, really well we'll design a friendly, functioning clean, warm, welcoming environment. That is excellent. We want that But it is not enough. Do you remember Dr. Stu Fischbein had a great line in the episode we recently did with him where he said, you don't want the nice pilot, right? Right doesn't matter if your pilot is nice, you want your pilot to be able to fly right plane. It is good if they're nice, but nice is not nice, doesn't cut it point here. Nice doesn't cut it nice doesn't get you the birth that you want the safe and dignified, well, you know, respectful birth that you want.

Yeah, I mean, along those lines, there are a lot of women who say, well, I've been with this ob for 10 years, okay, that's great, but they were a gynecologist for you up until now, now that you're pregnant, right, and you don't know them in the obstetrician role. And we don't need to be sentimental about this relationship. You can go have your baby elsewhere and return to them afterwards, if you find that another place might be more suited for you, or change altogether. You know, I for those of you who know my birth story, Episode 10, or if you've read it, I've my daughter was really charming and nice. And I say that now looking back at her and she has continued to serve women in this area. And I've had a lot of clients with her, most of whom fired her and found other providers. But when I think of her, I always have this vision of her peeling off this nice mask and like this scary frightening monster underneath it, because that's how I came to see her. But she was really charming, and had a sense of humor. I mean, she gave me five minutes per appointment. We'll get into all that. But I nice isn't enough, you are looking for someone who's on the same page. In your first trimester, you don't yet know what you'll want for your birth. That's okay. But keep in mind, you haven't made your decision yet about this provider because you haven't formed your vision of your birth yet. Once you do and that will come once you do your job is not to determine whether they're nice enough, it's to determine is the kind of birth I want. In line with the kind of birth they typically attend on a regular day at work. Is it their standard? Or will I be the anomaly in their work? Because if you're going to be the anomaly, it's going to be an uphill battle. If it's just the default, then it's going to be a much smoother fit regardless of their personality.

Yes, so right from the get go. If you are looking to have a VBAC birth and your provider is unsupportive from day one don't think that you're going to convince your provider to become supportive over time. Anything that isn't 100%? Absolutely. If a VBAC is what you desire, we will support making that happen, then I would choose a different provider at that point.

Yeah, I think we can do a red flags episode on VBAC alone. And we did do a VBAC episode last November, but I think it was Episode 63. But um, yeah, if they even use the term uterine rupture, red flag, absolutely unnecessary. And you know, it is kind of a rule of thumb with V backs not to have your your V back with the doctor who performed a cesarean section because it can be very triggering, even subconsciously,

if what and also if they're not totally, if you're not sure where they stand on VBAC, if it sort of seems like they're supportive, but they're not really as supportive as you'd like them to be asked their feedback rate 80% of vbacs are successful. So if they tell you that when you know they have a VBAC mom, it works about half the time, I'd be looking for a stronger provider.

Next, we have checking in with your intuition. And so when you show up at that appointment, before you get out of your car, just ask yourself how you feel? Are you excited to check on the baby? Are you happy that you have a prenatal that day? Walking in, you know, excited to see that everything is okay, maybe you have questions you want to ask them. When you're walking out going back to your car a little while later. How do you feel? Do you feel calmer? Do you feel more trust in yourself? Or do you feel anxious? Are you praying that everything is okay? Do you have new thoughts and concerns you didn't have before that weren't rooted in any evidence of any feedback from your appointment? But just from the conversations from the rhetoric from the stories from the examples your provider gave? Do you feel better or worse, having had that encounter with them? That is a very valuable bit of information for you. If you're feeling worse, it's a red flag.

That's probably the that's probably the number one thing you can always go back to again, I mean, that works. Wherever you are in the pregnancy is like the top red flag. How do you feel when you leave your appointment better or worse? Yep. Yep. Here's one that really I think is super important. Does your provider make eye contact with you? It seems so simple, but it's surprising how many just people in general that you're speaking to, don't make eye contact and eye contact is the basis of trust. So if you can't have good eye contact with your provider, then what does that say about the trust between you and your provider and trust is essential. For you to have the birth experience that you want. And does it feel genuine? Is it? Is it a, you know, does it feel safe?

Yeah, I think the absence of eye contact would be a red flag. If you have eye contact, I don't think it means you're in the clear. Because I know some providers have good eye contact. But yeah, I think the absence is a big red flag.

You know, that's

so true. It was a there was one midwife who never looked me in the eye. And I've always said that was one of the things that just never made me feel safe with her. She was, well, she was always in a bad mood. I never liked that either. But she never looked at me, she would be writing. And then when I would, she would answer questions, she would glance off to the side. Like she had to think about what she was saying, but she wouldn't look at me. It's really awkward.

I mean, I think it's, you know, I think it's rare, probably the provider make zero eye contact with you. And that is a massive red flag. But, I mean, that's kind of like, like a provider who doesn't speak to you from that. Yeah, I mean, that's kind of the same thing. But I think there's a degree to how does the eye contact feel? Is it genuine? Is it is it as brief moments, and then looking away when you when you're asking a hard question, are they looking you in the eye and giving you a sincere, thoughtful response? Can they keep their gaze? I mean, we're talking about relationship building here. I mean, you wouldn't want to be with someone who couldn't have healthy eye contact with you.

Yeah, I think you're right. And body language in general. I think Trisha is such a good one that you're bringing up? Because I've so often heard couples say things like, Well, you know, we asked this question, and the provider got really defensive. Yes, like, Oh, that's a major red flag. If their ego is involved, and they're getting defensive. They are definitely, in my in my opinion, they're in the wrong line of work. If they look defensive and act defensive, all it tells you so much, right.

So pay attention to eye contact. Here's kind of a silly one, but I think it actually is very telling. If your provider suggests that you take a gummy or flinstone prenatal vitamin. I've never heard of that.

That's like that. Talk about infantilizing. Take a Flintstone prenatal vitamin.

They don't even make it really common. Do they make prenatal vitamins? Yeah, yeah, they do. They make prenatals Oh, no, no, no, no, they're kid vitamins. But But a lot of times, I've seen this happen a lot providers will recommend it because they're more they're, they're more tolerable. They're eat other chewable only tastes, but they don't trigger nausea in lemon goodness. But the reason I think it's a little bit of a red flag is because I don't think a Flintstone vitamin has any nutritional value. And so if they're just throwing that at you, it's like, have the conversation about diet,

you know, you can almost bet that your provider, especially if it's an obstetrician knows absolutely nothing about nutrition, nothing about health. So you might be better off finding a naturopath or finding someone else to build into your birth team. Because honestly, I would always say when you want to learn about health and nutrition, do not go to a doctor for that you go to them when you need intervention, you need medicine, but they don't study the avoidance of of illness. They don't study nutrition whatsoever whatsoever.

Well in pregnancy is a really important time for nutrition. So

whatever midwives it is a big part of what they do. Yeah, for midwives, I know that it is

much, much more so but but not always. But I always for me, it's more about like, it's like a band aid for a problem that's much deeper than what a band aid can do. Like a Flintstone vitamin isn't going to do anything for them. I

can't believe you've heard that I've never heard I have to find out kind of my clients if that's common. Yeah. So I what I would say we're it's a little side point that I think is going to be valuable. But I personally, in my first pregnancy was prescribed a prenatal and by my second pregnancy learned that that was just a complete junk, fancy thing that really wasn't very digestible because it's all a chemical. So anyway, for my second pregnancy, I went to Whole Foods and bought food based vitamins.

Yeah, I mean, I don't think anyone's going to have a I think the I think the idea is that vitamins are prescribed a lot in pregnancy is because insurance will cover them, and then people will possibly take them.

I don't think they're covered for that reason, personally, but I'm maybe more of a cynic on this topic. I think that they're prescribed in pregnancy because pharmaceuticals and doctors have the relationship they do and it's a homogenous moneymaker for pharmaceuticals, but they can't make a vitamin that's as good as a 100% food based vitamin.

So for food, they're skipping the nutrition conversation, and they're trying to prescribe something or throw a little kid vitamin at you to just check the box.

That's it, and then it gives women the impression that they've had their nutrition for the day rather than that they need to actually eat a healthy diet. That's what you're saying.

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And I don't think we can have a provider red flag discussion without talking about due dates in the first trimester. Even though I know we will talk a lot more about this and our red flags in third trimester, it's still the first trimester your first prenatal visit is going to be when you get assigned your due date. And for us, it is a major red flag if your provider is fixated on your due date. So if they say that your baby is due on August 30.

And there's very little flexibility around going past your due date that is a red flag. We know. You know babies can come two weeks before babies can come two weeks after it's really a month of time around that guest date as what we prefer to call it. Yeah, it's much easier to have that conversation in the beginning and make a change in your provider in your first trimester, second trimester than it is when you get to 39 and a half weeks, and they're talking about induction because your due dates in a few days.

Right? Not evidence based. Okay, so the next one is what is their c section rate? Here's the problem with this one. They don't have to report those numbers to you, they probably don't care to keep track of those numbers. And it they might answer as though they know exactly what the percentage is. And you'll have no way of knowing if that's actually true. But it is a very good way to start to get to know them. So when you ask them their c section rate for that practice, it's also interesting to see how often doctors threw their colleagues under the bus. And it also covers themselves in the process. A really common responses, while mine is 17%. But like, you know, with these guys, there's is way higher, Well, okay, red flag because you very well could get one of those people. But I think the I just don't trust that kind of conversation at all. That doesn't sound authentic to me at all. But there's no way to know when it's true, which is the real challenge. What's going to end up happening as you inform yourself through your pregnancy and get educated is later in pregnancy, you can start asking more meaningful questions such as What are some of the most common reasons you give c sections? And by then you'll know which reasons for a C section are red flags, failure to progress being the number one reason in the country? And it's not a medical indication? It's a matter of duration of the labor. So ask for now in the first trimester, what is your C section rate? What's the C section rate for this practice? See if they keep track? See how they respond? Do they seem touchy and defensive? How do you feel having that conversation with them? What's your intuition telling you? If they're saying Why are you asking c sections are great there. Anything they say pay attention to it's going to tell you a lot. If they're nonchalant about C sections. If they tell you that you can schedule a C section, I would personally consider that a red flag because that points to a less safe birth for mother and baby. C sections are the most wonderful thing in this entire field of childbirth when they're needed. And we want to avoid unnecessary sagittarians because of vaginal birth, all things equal is significantly safer for you and the baby and the World Health Organization has plenty of data on that information, if you're ever so inclined to want to read about it. But if they're nonchalant about it, if they mentioned scheduling, oh, it's easy. Why not? That's a red flag.

Maybe you could ask the question. Do you ever perform unnecessary c sections and see how they respond? Do you

know what I once heard that a doctor said, I don't know if I told you this? This is nuts. The quote was women were never meant to give birth vaginally. How can anyone say that? Who do they think they are to say that they create this whole story around how evolution messed up as if evolution messes up? evolution messed up that is an it's arrogant to that's an oxymoron. Yeah, it is. It is like an oxymoron. It actually is. It actually is like liable. It's right. Like by definition, its mission is going to be the safer way to birth because nature is always going for survival. So we're always going to evolve toward what's going to drive up the likelihood of survival. And that is not c section birth. No, because that's not possible. Right? Without intervention.

That's so crazy. Yeah, we shocking, just shocking. Okay. All right. So of course, we'll be talking a lot about C section as these conversations go on in further episodes. Another one for me that's really important as if in the first trimester, your providers talking about routine ultrasound? Oh, yeah, I see no benefit to routine ultrasound,

many, many potential risks, especially in the third trimester,

we really don't know even in the first trimester, we do not know the impact of the cavitation of cells in that high temperature. That is, we have results from early ultrasound,

we don't know well, that no one cares to study it knows how to search it. Right. To the extent that there's any debate and question around the safety of ultrasound. I think that it's known by now it's not linked to any macro deformations of any kind. But the question is, whether it can influence neuro processing disorders and the like. And we know that intra uterine ultrasounds are the strongest. The ultrasounds are really helpful when we need to get information and if you, you know, the anatomy scan can be really useful for people. I think we start to question when they're routine. And that's really the key word routine routine. What are we looking ultrasound is the question, why are we doing it? And you're not going to be quick to say no, because it is awesome to see your baby. It's the most exciting thing in your life, no doubt. So you're not going to be the one to say no, they're not going to be the one to say no to they bill for that too. Oh, yeah. Yeah, of course. But do give thought to avoiding routine ultrasound and certainly not doing one at every appointment. That is the trend. Okay,

let's touch on age. Because obviously, when you go for your first prenatal visit, your age is going to be right up there on the screen. First thing, your due date and your age. So any provider that is calling you, geriatric is a red flag for us.

That's that is the I wouldn't call it geriatric person. geriatric. No, I mean, okay, just a terrible word. Let's look it up. The definition of geriatric is relating to old people, especially in regard to their health care. So, or an old person who is receiving special care. It's ludicrous. To call a woman who's overthrown, you're 35 and pregnant. It is ludicrous and getting special care. You know what, it's terrible to do that. And you know what, the other thing, the other reason that's often derogatory, it feels it's not evidence based. It's fear inducing. It's, it's just absolutely terrible. But here's just what your common sense can tell you. You know, and only you know how you've cared for yourself your whole life. If a woman has smoked for decades, her cells will be older, her body will be different from a woman who's 42 and has never smoked. You can't put all people into one category. You can't just say the risk of heart disease goes up at this age, because how we've all lived our lives drives up or down those rates, but there's no other way to manage things, then in aggregate. Yes, there are risks of genetic things that can happen that doesn't have to do with your birth.

real problem here is that if your provider is unwilling to look at the holistic picture, if they're if they're going to use terms like geriatric and label you and categorize you and not be more open minded about your, your holistic scenario, that's to me the concern,

if blood pressure can go up with age, that's fair, right? Then check then check the woman's blood pressure, because that's a medical indication. But to lump them all if her blood pressure is normal, and to still treat her differently, because she's 35

take the whole picture into the scenario. So if they are going to just pigeonhole you into a category of ama, and call you geriatric, and not be willing to consider your lifestyle that is a red flag for me.

So these are some good starting red flags, go to your first few appointments in your prenatal visits. Start off with these, you can always write to us with questions for our q&a episodes if you want to share any of these experiences with us, but just take it step by step in your pregnancy by second and third trimester. We're going to bring up other questions, topics and potential red flags for you to consider with your provider. But remember, the most important thing is to really see how you feel about them where you feel safest is that birthing facility, what feels right to you. And is this the right person to be with you to attend your birth when you're in labor. Stay tuned for the next red flag episode on the second trimester in the coming weeks.

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It's a bit meant to be that way in the early postpartum. I mean a woman's brain is biologically hardwired to be extra attention to extra attention. Extra 10 so go ahead. I have so many good new words to say.