#13 | Is Your Provider Right For You? The First Three Questions to Ask.

Our society is always trying to turn the art of childbirth into a science. Now that's such a good, way to explain it. An analogy is, what if we had to turn sex into a science?

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.

So suddenly find out that you're pregnant and you're overjoyed with the news and then you have to think about the question of what Next, like who do I call? Where do I go?

I think most women start by default. I think this is the norm. You're going for your annual exams. And you find out you're pregnant. And I think the natural conclusion is Oh, I guess yeah, ob gyn. I've been using this person as a GYN and now I need an obstetrician. And that's it. decision made that so you you give your precious self to your precious business to your precious birth to most people put more thought and consideration research into finding a good real estate agent, then finding the best. That's so true. Yes.

We don't ask anything. It's like, Oh, that's an OB.

Okay, that'll do. Do you think that people feel bad changing providers, or they just don't I think in the beginning, they don't. I think they don't realize the choice they have. And in most parts of this country, we have a lot of choice. There are parts of this country where women are an hour from the nearest facility, but for most of us in very populated areas. You have so much choice and the variance and care is very great. It's you can't assume these people all practice similarly they did. They definitely don't. And that was what I did. I just said, Oh, I guess that doctor I see once a year, who keeps me waiting 90 minutes for every ATM first of the day appointment. Gosh, I guess I'm having the baby with her. Nope, I didn't. And it took me months to realize she was the wrong person for me. So how do you know how do you know if it's the right person? That's what we're going to talk about today.

Yeah, it's it's interesting, too. I really would be curious to know how many people stick with the provider that they started their gynecology with at age 18. Or is it a I think a lot of women find themselves in a family practice situation where there maybe was even their, their mothers ob and they're still going to the same family practice. When I found out I was pregnant, I went to the clinic that my university paid for you're married and graduate. Yeah, okay. Yes, but you were limited and limited, very limited. I had one practice to choose from. And that's how I ended up having a home birth.

So I think the first question for anyone out there is, how did I choose this provider? Was it by default? Did I ever consciously choose them at all? frequently, what I hear is, I love my doctor, I always want to stop there. You know, in the in the world of finance, there's always a warning, don't ever fall in love with a stock because that people make that mistake. They're like, I love that company. I believe in that company and the stock starts going down and people are emotionally attached. Right? Don't get emotionally attached stock is going down, like are you going to cut your losses or not? What are you going to do or capture your gains? And I sometimes viewed as this seems, I don't know why, but that's how I think about it. And my first thought is, provider. We all have our own worldview. And I obviously I've been influenced by mine, but honestly, my first thought is, does your provider love you? Do they love you? And I'm not saying they need to, but why do you use that language? You love your credit? No, you love your partner, you love your baby. I mean, let's think about who you love in this process. And even if you love your provider, even if they have this wonderful personality and you really enjoy being in their company, the hard news to accept is, that doesn't mean they're the right partner for you. When it comes to giving birth, they might have a completely different view as to what the ideal birth looks like, well, especially because if they've been only your gynecologist, that's a very different role than being your birth partner. Now, your birth provider. It's, it's not the same. It's not the same position and you don't really know anything about their how they think about birth, how they practice.

So you can always go have your baby with someone else and return to them if you liked them so much, or you can stay with a new provider. But here's what we're always looking for. And this is This is where it starts to get difficult. But having a good birth, the first step in having your best birth is taking a great degree of responsibility. That's there's just no way around that if you're prepared to take a lot of responsibility, that's the extent to which you're going to have a more satisfying birth according to your own terms of what that means to you. And here's where the work gets difficult. But this is really going to be the key. Before we get into little red flags and questions to ask them. The first step is figuring out what you want for your birth. And when you ask, most first time pregnant women that they don't even know how to answer that they just stammer they're like, I don't know. I'm just scared. I don't want to be pushed around or I don't want this and I don't want that. And I don't want an unnecessary c section. And they don't want to say what do you want is very hard. And it comes with education. It comes with maybe us presenting ideas to you, you discover yourself as you learn more you discover what's best for you. But then once you find Do that. Then the question is, what kind of birth does that provider attend? We don't say deliver. They're not delivering babies, you women are the ones delivering babies. What kind of births are they attending every day, when they show up at work? What is the norm for them? And what kind of gap is there between the kind of birth you want to have and the kind they're providing every day?

I think it's interesting, because I think a lot of women really do feel that they love their provider, they want to stay with their provider, they don't want to really think about these things too much. They just want to trust their provider. And if everything goes smoothly throughout the pregnancy and the birth, they end up feeling really satisfied with that choice. But the problem arises when suddenly something happens in your pregnancy or your birth that you didn't expect and you don't you don't necessarily feel about your providers hearing you or listening to you and now you're so late in the game and you look back on this experience as a negative one that you don't feel satisfied with, when really the work, like you said, has to begin in the beginning. And you really have to get clear with yourself that like, do you actually feel really trusting of this person? Do you really feel heard, seen safe, because birth is unpredictable, and you have enough confidence in that provider? That if things do go off course, you really do trust their course of action.

Well, one suggestion that comes to me, as you're saying, This is, has that doctor, we're assuming it's an OB, we're not getting into other options yet, but has that provider during any prenatal visit? First of all, how much time are they spending with you? Because some women say 10 minutes and some say 5560 minutes. And so I have five minutes and some say five minutes. Have they ever looked you in the eye and said, How are you feeling about this? Do you have any anxiety They checking in with you?

Or have you? Have you ever even been asked the question? What do you want out of this birth experience? What does your ideal birth look like? Usually it begins with, here's how birth looks to me. Here's how, right from the providers perspective, here's how this will go A, B and C will happen if this this and that occur,

And it's a red flag. If they have the tone of voice like, well, we'll have to see what happens. That's fine. Oh, you want to try for that kind of birth? That's fine. We'll see how it goes. And that is definitely in my opinion, a red flag. It's um, it's a weak response. It's them not taking much responsibility and it's not that provider holding you very responsible.

So when a woman goes in for her very first prenatal visit, this is the one time where she might actually get a 20 or 30 minute visit. This is her time to get a real feeling if this person that she's been working with before is the is the right person for her through this pregnancy and birth experience. So Try to give our listeners some examples of questions they can ask.

One of the most important questions to ask is what is the scissoring rate for this group? The unfortunate thing is, all we can do is hope that they tell you the truth. Because there's really no audit, there's no way they have to publicize those numbers or that data. I wish they had to. I think maternity care would improve immensely if those data points were public, but you can hope that they tell you the truth. The World Health Organization said in the 80s, after this worldwide study of hundreds, like couple hundred countries, I think that the tipping point is like 10 to 15%. So it should be in that range. And to the extent that you're in a country with good access to healthcare and food and water, you should err on the lower side of that. I think I would also want to know if their sectarian rate is improving over The recent years is your seryan rate going down, because with all the new information we have and the known risks of higher Sicilian rates, I would want to choose an OB, who was top of their game with that and working toward lower sectarian rates, meaning that they're working toward evidence based birth practices and lower intervention birth.

Yeah, I mean, when I asked my doctor, she was like, Oh, why are you even asking? But then when I asked the midwives that I switched to, they pulled out records from a file cabinet and right next to her, right, where she was sitting and said, Okay, these were a statistics last year. So Oh, wow, you care about this, too. I'm not the only one who cares about this. So their response to it? Are they defensive? Do they respect that you're asking? I would certainly respect it. If I were the provider that you were asking, because it indicates you're taking responsibility for your health care that I would want you to interview me carefully. But the more telling question is What are some of the reasons you give cenarion sections? Because when you get more informed, you know, the good reasons that are evidence based and you know, the reasons that are red flags.

Before we even get into that, is there a number in your mind a percentage that a ob, if you were going to have a baby today and interviewing ob, is there a percentage that you would feel safe with? What would that be?

I would, it's interesting that you ask because the World Health Organization put out there look for no more than 10 to 15%. So that's the first thing I look at, but I have to say, Take enemy Gaskin is one example of a midwife who has been practicing for whatever 4550 years or something now, she has carefully kept those statistics of her group at the farm in Tennessee. She's always had, I think, seven, eight or nine midwives at a time. they've kept very careful statistics every single year for all these decades. And they didn't have a single year where this is airing rate exceeded 2% in their aggregates is Aaron rate and a All these decades is 1.4%. That is 14 women out of 1000. In a country where it's more like 330 out of 1000. So if one person in the same country with the same population, who's probably attracting high risk clients in the first place, who traveled down there to birth with her because they can't find a better option, if one person can provide such good statistics, what I conclude from that is, first of all, that's how much you can believe in your body. When you're with the right provider. That's how low your true risk of a Syrian section could be. Because she has this enormous population where it's only 14 women out of 1000. And the second thing is, if she can pull off statistics like that, Why can't anyone else why aren't others pulling it off? What does she know? And what is she doing that all the other mainstream providers like my former doctor, we're not doing?

I would love to hear from anyone out there who has a certain rate under 5%

I don't know that that exists, it probably does somewhere.

I would love to hear that. And I would love to hear how they do that. I think what are they doing differently? Yeah, what are they doing differently? But I mean, I, I do I am a and the farm is going to attract a small percent of small percentage of women who are high risk, but the vast majority of those are very low risk normal birthing women. So is it fair to compare those statistics I think it's more than fair because she is attracting higher risk my couple of clients who almost birthday with her couldn't find it. The few clients I've had who almost birth with her and I can't wait till my first couple days. I haven't had that couple yet who traveled quite that far. And went to live in Tennessee until the baby came. They were about to go there because they couldn't find another option. The first one I'm thinking of how to a breech baby and they really wanted a battle breech birth and they almost went there for it. She's attractive People like that. every set of twins on the farm. last set of statistics I looked at, right who knows when it's changing and if it ever has every single set of twins were birth family, and in this country 90% of twins are born by C section. So, just looking at that alone, what is she doing differently my own friend and mentor Nancy Waner, who coined the acronym v back in the 80s in her book silent knife VBC vaginal birth after cenarion hurt. She became a home birth midwife after her own traumatic first birth, which was a C section, her own second birth that was in a hospital VBAC. But they took her baby away, which was unacceptable to her. And then her third birth was at home so she became a home birth midwife and an author. She's still practicing today and she's had many of my own clients but in her first 400 births, only two head c sections. And she attracts very high risk clients VBAC women for one multiple, multiple Syrians and she turns in went away. No one. So what are these people doing differently? So when you ask me back to the question, what statistics are we looking at? I have all this floating in my head. Like if anyone has a really low searing weight, why doesn't everyone, right? Look at the variety in care in the same population of women, American women?

Well, this brings us back to the conversation we were having in the evidence based birth episode about how the difference between how a midwife is trained and how an OB is trained. So much of it comes from the education. rubies are not given that information. They're not given that training in metal. in medical school, they don't talk about physiologic birth. Yeah, whereas the midwifery model of care. That's the that's the foundation. That's the premise of how we practice. It is really, really tough to find an OB practice where you're going to have As a provider who has that low of a C section rate, because they don't even they aren't even equipped with the tools to prevent some of those Syrian sections with these other techniques that a midwife may have more experience with.

So the first question is, what's your scissoring rate and interpret their body language? Their response to that, that's going to tell you maybe even more than the answer they give you since you just have to go by what they mean? Are they even really keeping those statistics? Probably not. I know, I sure would be if I were in that field, but that's the first thing second, which is much more telling once you're educated, this is very, they have to be keeping those statistics, that's all and so they don't have to. They don't have to share them with you. They're keeping them Oh, yeah, they have it's all in I mean, it's all in their insurance number. No, I mean, they have the data, but are they keeping the status? Do they themselves know I found spouse asked them at night. What's your salary? I don't think they know data's there. But the question is, yeah, how aware are they of it? How much are they paying attention to it and are they willing to share it? Maybe they're not proud of it.

Well, yeah, that's are they defensive? How do they respond to that? Or do they respect that you're asking one of the most important questions you can be asking them? And then the next question was, what are some of the reasons that you give scenarios, which tells you much more, but you have to be pretty informed to know how to interpret those. What are the red flags? You know, if it's because baby is too big? Or is it because failure to progress? Those are red flags.

And that is such an important question to ask it is it's not enough to ask, What is your C-section rate because that's really not telling you anything?

No, but some are noticed, like my own doctors would be just run like hell, if you have a doctor who says it's 50% it's like, goodbye. Nobody should be having a 50% cset. Nobody will agree with that. But that's that that's safe or good practice. It's really unethical practice. But if you get a number, more in the median range, I mean, if you Get a 20% or 25% or even if you get 10 or 15%, which would be awesome to hear. You really need the follow up question. In order to really understand. You must ask that question what are the most common reasons.

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So following along the same lines as reasons to go to C section, I would want to ask my ob the question of duration of labor and expectations for progress of labor. So there are many OBS, who will state that they expect you to dilate at a certain rate. That's our that is so I was in that my doctor said, I want to see you daily to send me an hour. It's just like, first of all, I don't care what you want. That somewhere along the way, this, you know, data was out there that became known as the Freedman curve. And this was the expectation that the majority of women will dilate at this rate at this pace, and that became the standard of practice and it hurt women Everywhere for decades and misinformed doctors, and they, they expected this one thing I said in one of my articles, and I don't remember which one but I, I like this, I say this a lot. Our society is always trying to turn the art of childbirth into a science. Now that's such a good, that's such a good way to explain it. And analogy is what if we had to turn sex into a science? This is how sex has to go. This is how long this is how long foreplay last lap. This is how long it should take him to get aroused. This is how long it should take her to get around. This is definitely when the orgasm should occur, like and it should be on this level of the scale. That's right. It should be. This is unbelie. And tell me that wouldn't ruin sex? Because now we're coming out of this natural bodily experience and we're in our heads. What's the timing? How long did that last? Oh my gosh, what are we doing here? If this isn't working? This is exactly what we're doing with childbirth. It is an art. It's quick. For some women, it's long. For some women, it's all okay. There are medical indications we always want to look for, right? We're not talking about that which Talking just the art of a normal birth, the art of birth was definitely lost when birth, moved into hospital institution and into medical school. I mean, it's, we like predictability, we like control as humans. That's what makes us feel safe, it makes us feel safe. Birth is just, it's just the opposite of that. That's right. Either the whole way to feel safe and birth is to let go of that control to relinquish it being predictable to surrender to the process. And it's interesting because we we talk a lot about evidence based birth, and that isn't the science we need that science to support certain things that we do or don't do, but it is also the thing that has gotten us into, you know, difficult places with birth. Oh, for sure.

When you remember what I talked about in the I think, again, was in the evidence based birth episode maybe or somewhere else where we talked about the circle Safety.

I think that was in our first episodes in our first episode. I don't remember, maybe not. We've talked about it before. Yeah, but this is where there is, you know, we do need these parameters for, for where things need to be where we need to intervene, we do need these points where things become outside of the scope of normal. But the real difference is in choosing a provider who has a very narrow circle of safety, because then many of the things that occur in a narrow circle of safety, many of the things that occur are still going to be completely normal and you're going to have unnecessary intervention for normal things. If you choose a provider who has a wider circle of safety. All of these variants like a 36 hour labor or a four hour pushing stage, are still going to be deemed safe and they are normal. They're just on the outs, you know a little bit more on the outside of the bell curve, but they're still normal.

And they didn't, if they don't provide a medical indication, that's all you need to know. If there's no medical indication, then you keep at it. As long as the mom is comfortable and happy going about her labor on her terms, there's no reason to intervene without it.

So of course, when we are in that moment of birth, and when we're talking about, you know, our baby is at stake, women are so vulnerable and it's so hard, it can be so hard to speak up for yourself in that moment, and that's why this work of talking to your provider early on and really believing in that person for your care is so important.

We have a local hospital in fact, the one that I left where I didn't birth, my baby, my either my babies but that hospital has a large digital clock in every room. And when a woman enters they push the button and start a digital clock and the women are told you have 10 hours, 10 hours. And I have said to my clients, I mean, I try to have them really think about where they're giving birth, because depending on what kind of birth you want, if that isn't the kind of birth they're providing on a daily basis, then you have more work to do during your labor. It's just such a smooth fit. When you find a place that typically provides the kind of births you're looking to have. So there was a dad who kept covering with the sheet and the nurse that got most people really end up loving their nurses and most I think are really, really loving, supportive people. But you never know. It's like any other thing. egos get involved. And the nurse kept coming in and yanking down the sheet. I would keep restarting the clock, but who wants to give birth under clock and here's the thing and a bunch of doulas that I work with stress response, Oh, my God. And a few doulas I went to after that I didn't know about this. They said Oh yeah. And then they said, Well, look what happens when she gets to send 10 centimeters if she's so lucky to have gotten to the hospital late enough and get to 10 centimeters before this ridiculous clock runs out. They really push the button and the language that the doulas here is two hours till c section. This is just come on, we don't we deserve better than this. This is unacceptable. They should be losing business left and right for treating people this way. And none of it is evidence based.

It's so hard for me to believe that these things are still like right here in our backyard in practice that way when all this evidence is out there to oppose it and in even, even the ache hug speaks up about this. I mean, they're they're not supporting that. No, not at all. So how can practitioners still be practicing that way? Well, same as like depriving them of food and labor. You know, you you just take so long for these things to be implemented. One major red flag I want to bring up right now the word let is a red flag. If anyone speaks to you with that language, frankly, if your partner does, I would say get rid of a red flag for anyone, for any adult who should be viewing you As an equal and they're emotionally equal to use that language with you. That's a red flag. So if they say, Oh, I wouldn't let you go that long. Excuse me, it's not for you to let me do anything doctor, it's for me to let you handle me treat me take care of me support me. They tend to me. Language says a lot about a person because it's we speak subconsciously, so much of the time and it's a reflection of how we think. And when words slip out. It's it's a little window into the belief dynamic and yeah, into the how that person views their their role. It says a lot. But I will say this, the morning you have a prenatal visit. Do you feel excited to check on your baby? Do you feel curious about questions you're going to ask? Do you find yourself waking up? Excited on those days? How do you feel walking into that? doctor visit? And then when you're leaving, how do you feel because some of us show up happy and excited, and we leave praying, let the baby be okay. Oh my god, I'm worried. So many women get in the car and they call me crying they call their partners crying. That tells you a lot because when you're with the right provider, you might show up with some anxiety and you leave like, everything's gonna be okay. That's such an important point right there. If, there's anything you get out of this conversation, even if you don't know how to ask these questions to your provider, or you never asked them, How do you feel when you leave that appointment? And if you can really tune in to that inner feeling, and you notice that you feel agitated, uncomfortable, worried there's a higher level of anxiety than there is peace? Then you should probably consider alternative providers.

Another high level question you can ask is once the baby is born, What is the typical default procedure that happens from them?

You mean, do you put my baby's skin to skin? Or am I separated?

That's right. Do you put my baby on me skin to skin? We can get into delayed cord clamping and all those things another another time because they're deeper topics

but, but most importantly, what's happening to my baby as soon as my baby is birthed?

That's right. And I remember my doctor saying to me, Hey, you we let you have the baby for a bit. I mean, you can have the, you know, let you Yep. And she said, Yeah, I mean, at first, and she had this language and this is what I mean listening carefully. She used the word At first, she said for a bit and I remember thinking, what does that mean? What like what is your idea? And really now what I know is that baby never needs to be separated from you again, without a medical indication. If they're born a little blue, they get sure go that by all means hand the baby over and get them oxygen or if there's a little meconium in the lungs or something then that would warrant suctioning. But the baby otherwise never has to be off of you. And when we're pregnant, we think so much about the birth because we're thinking so much about ourselves and our anxiety and oh my god, what am I going to be feeling? And how is this going to go? But your story later, when you tell your story later, a very significant part of your story is going to be what happened after the baby came out. So a great degree of your satisfaction with this is going to be around that and how you retreated in that moment, how you how you felt about that first moment, you saw your baby, were you treated in a respectful way that you know, here's your baby is here for you? Or was it you know, it's our, our baby to manage first and you know, wipe down and check out and evaluate and now here now, here's your beautiful wrapped up, baby that's been all swaddled and had a hat on and all you can see is just their little face. Right? And that's a really different experience. That's it's a it's one is super empowering and one is really disempowering.

Think about the baby's experience, we don't want to put too much pressure on ourselves here. This because we sensitive moms can be really hard on ourselves and things don't have to go perfectly for this baby to know he or she is utterly loved and safe in this family. But do think about the baby's experience. We don't consciously remember birth. But that baby comes out and has every expectation again, it's not a conscious expectation of going right to you, the baby is comforted by you the baby's temperature restores. When on your skin restores to the ideal temperature, the baby knows your voice, your heartbeat, your skin, your baby knows your partner's voice.

Well, the baby has never been separated from you and Damn it if it's the Doctor Who does that the first time, right?

And if you don't want that, then you don't do that. You don't accept that if the baby needs medical and vention in a serious way, which is certainly rare that you'll be the first person to hand your baby over, you're not going to be demanding that when you know your baby needs help, you will happily relinquish your baby and say, please go help my baby and bring my baby to me after. But in a normal birth, they shouldn't be taking your baby away from you because it isn't good for the baby. And it isn't good for you, your body and your breasts are expecting that contact, that special hour that that you get this hormones, but the hormone cocktail, the golden, the golden hour, that perfect, beautiful time, that young baby had to bond.

And that's something we're going to talk about in detail in detail. Because that's important.

It is from both both sides. It's important to talk about so

these are high level questions to ask your provider when you start considering who you're going to give the privilege of supporting you and you're giving birth.

Yeah, how are they going to handle your baby? It's your baby. How are they managing that moment?

Trisha remember during my home birth and I tell people this in my class I already had one wonderful birth at the birthing center. And I almost thought I don't think anything could really top that. But a home birth was another level for me. And one of the most memorable moments for me was when I came out of the tub with Vanessa and I got in the bed, Amy was checking me to make sure I didn't tear and she was awaiting the placenta, and you were on your knees on the floor. Next to me as I was in the bed, and my husband was on the other side of me. And Vanessa was starting the breast crawl, you were just saying, Okay, keep her in the middle. You're whispering. Okay, put her there. I was thinking, should I be whispering? What's going on? You kept whispering that whole time. And were guiding me and letting her find her way to the breast. And finally, I said to you, why are you whispering? And you said, Well, I want the baby to bond with your voice. It's not mine. And I was so moved by that. And I had to have a home birth for anyone to even make that suggestion to me. It had never come up before. Yeah. What a beautiful thing. Now here's what I really want to say. Did anything we say touch you? Did you get choked up at all? Did you feel a sense of protection or anger at anything I said, like when I told you that the doctor said, well, we'll we'll let you have your baby for a while. Did you feel an emotion because this is the most important thing that we can do for you. We can help you recognize your emotions. So when you feel any emotion spike, while we're talking, take a little camera like a snapshot and say, What am I feeling and what did I just hear them say? Because I'll tell you this, whatever you felt, that matters to you, if you're listening and you're indifferent, you're like, oh, whatever, they don't care if they take the baby or put the baby on me, okay? Then that won't be linked to your satisfaction in this birth. We know that. But if you hear something and you feel that sense of injustice, or you feel inspired and moved and choked up, pay attention, because that's a little window into you and what you care about. And that's what matters. This is your birth. This has to be satisfying to you. That's so well said What matters is that in the end, you have a birth that you feel at peace with and that is safe and satisfying. And this is how we get there.

We listen. We learn, we see where we're triggered, and then we adjust and adapt.

It's a choice.

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