OBs play very influential roles in women’s lives during pregnancy, childbirth, and postpartum. Having the right or wrong person at your birth can make or break your vagina. Literally. Unfortunately, sometimes the doctor or midwife a woman chooses in the first trimester turns out not to be such a great fit as pregnancy progresses. But how should you know when it’s time to fire your OB or midwife? Glad you asked.
Parents, pay attention! The following are 15 tell-tale signs that it’s time to fire your OB, midwife, or other care provider.
15 Signs That It’s Time to Fire Your OB
If you experience 2-3 of the following signs, never mind a solid majority, it’s time to fire your OB or midwife and find a better suited care provider. No matter what type of birth is planned (hospital birth, water birth, cesarean birth, etc.) it’s crucial to have a solid birth team. Every woman, partner, and baby deserves high quality, competent, and compassionate care. We are worth it!
1. A Gut Feeling
Many women that switched care providers during pregnancy, or wish they had, report having a “gut feeling” that something just wasn’t right.
Some of us, however, don’t have enough experience with hearing, listening to, and acknowledging what our inner knowing is telling us. For some it can be a bit trickier to have an accurate awareness of the situation.
If you find yourself thinking about something that happened at a prenatal appointment that didn’t feel good or sit right in your gut, pay attention. If you find yourself making excuses and dismissing your feelings, pay attention. Excuses may be covering up the obvious – it’s time to fire your OB or midwife.
Journal about what’s happening, talk it out with 2-3 trusted safe people, sit with it for awhile, and see what comes up. There’s no need to make any rash decisions, but there’s also no need for indecision. You can do this!
2. Rushed Prenatal Visits
Another warning sign that it may be time to fire your OB or midwife is when routine prenatal appointments are rushed. Rushed appointments severely limit personal interaction with the person or people that will be at your birth.
In many OB offices, women tend to spend lots of time in waiting rooms and with nurses, but with no-one that will influence her birth in any way. What a disservice!
Prenatal appointments should be a time to develop a relationship with care providers, get questions answered, learn new things, and of course, monitor the health and wellbeing of mom and baby. If you are feeling like “just a number” or that they’re just “checking off the boxes”, it may be time to fire your OB or midwife.
3. Dismisses and Belittles Patients
Another red flag that many women experience is that their desires and concerns are dismissed and/or belittled. Even when this situation is difficult to pinpoint, and it often is, doesn’t mean it’s not happening or a concern. To give some clarity, here are a few examples of an OB dismissing or belittling a woman’s concerns and desires.
Woman: I want to hire a doula for my birth. What are your thoughts about that?
OB: Oh you don’t need to do that, I’ll hold your hand through the whole thing.
Woman: I am afraid of tearing during birth. Could we use warm compresses when baby is crowning?
OB: I’ve been doing this for years. I’ll take care of you. You can trust me.
OB: Why would you want to be in pain when you don’t have to? There’s no shame in getting an epidural. You don’t need to be a hero.
OB: Oh, did you read that on the internet? Just because you read it on the internet doesn’t mean it’s true.
4. Makes Minimal Eye Contact
Another disconcerting behavior that may indicate it’s time to fire your OB or midwife, is that your care provider makes minimal eye contact during prenatal visits. This behavior is typically coupled with rushed office visits, and a sign of a lack of desire to foster a relationship with patients.
Sure, sometimes, just like all of us, care providers have their off days. But if minimal eye contact is the rule and not the exception, this is completely unacceptable. If a care provider does not have the time or energy to cultivate a healthy relationship with a pregnant woman, perhaps they’re in the wrong line of work.
5. Speaks Mainly to Partner
Another sign that it’s time to fire your OB or midwife is when conversation is directed mainly at a woman’s partner, and not the pregnant lady herself. Generally speaking, I think it’s wonderful when partners are included in the entire process, but it’s quite another thing when a woman is ignored, overlooked, or completely left out.
Sure, maybe there are situations when speaking to a support person a little more than usual makes sense (teen pregnancies, language barriers, etc.). However, leaving the pregnant woman out of the conversation speaks volumes. This behavior may feel patriarchal, dismissive, and belittling.
If your care provider mainly speaks to your partner and not you, it may be time to fire your OB or midwife.
“I knew it was time to find a new care provider when the nurse asked my husband to sign the circumcision consent form while I was out of the room.” Logan B.
6. Uses Fear-Based Tactics
Another red flag to watch out for is when care providers operate and communicate in fear. This often presents itself in the context of discussing options and making decisions for pregnancy and birth. Instead of using plain, non-emotional language to discuss the pros and cons of a particular choice, a care provider uses fear to manipulate parents to make certain decisions.
Here’s an example.
OB: You’re 41 weeks. I would like to schedule your induction for tomorrow morning.
Woman: I really don’t want to have an induction. I want to go into labor naturally.
OB: As your baby gets closer to 42 weeks the chances of stillbirth increase. Is that something you’re comfortable with? Do you want your baby to die?
Woman: I would prefer to have intermittent monitoring during my labor, assuming everyone is safe and healthy.
OB: My policy is to have women on the monitors during their entire labor. I once had a woman take herself off the monitors and spent too much time in the bathroom. Her baby died and we didn’t realize what happened until it was too late.
In the OB’s defense, who knows, maybe they did experience a recent tragedy that is haunting them. The weight and responsibility care provider’s have on their shoulders is incredible. However, despite what happened last week at the hospital, it’s important for all care providers to facilitate evidence based decision making without fear tactics or manipulation.
(By the way, these scenarios were not fabricated by me. They’re the real deal. Let that sink in for a moment.)
7. Not Current with Best Practices
When it comes to obstetrics, there’s a strange phenomenon I’ve noticed, which apparently has been happening for years. Many obstetricians do not stay up to date with and/or follow best practices, but operate out of convenience, what was taught in medical school, and/or “what we’ve always done”. It’s the strangest thing.
Couple that phenomenon with the ego that accompanies many physicians, and what you get is a recipe for disaster. If your care provider is faced with facts backed by evidence, but refuses to operate differently, it is likely time to fire your OB.
There’s this OB in my community and I really like her. However, years ago, moments after my client gave birth, I witnessed her arguing about how delayed cord clamping had no real benefit and “the blood was going back and forth anyways”. I think my client’s baby experienced delayed cord clamping, but it was discouraging that she had to push for it at a moment where mama/baby bonding should have taken precedent.
The thing is, years later there was a big push for delayed cord clamping, especially from the AAP. In response to this shift, this particular OB adjusted, changed how she operated, and now facilitates delayed cord clamping with her patients. What this told me was that she had the vulnerability to recognize an area of improvement, and the courage to change how she practices.
When looking for an OB, find someone of high character that stays current with best practices, but also vulnerable and courageous with a willingness to try new things.
8. Doesn’t Value Informed Consent
Informed consent happens when a care provider communicates with a patient regarding a medical procedure, intervention, or condition in a manor that leaves the patient fully comprehending to what they are saying yes or no.
I don’t know if the medical model of care just doesn’t value informed consent or that care providers think certain information is beyond a woman’s ability to grasp, but informed consent happens inconsistently at best.
However, research has shown that the more a woman is part of the decision-making process during birth, she will be happier about the outcome, no matter what happens.
“It is also suggested that active involvement of pregnant woman in decision-making process for the delivery method will increase the rate of vaginal birth after c-section and decrease c-section rate and improve the degree of maternal satisfaction after delivery.” (SOURCE)
Plain and simple, if a woman is ignored she will be unhappy about her experience giving birth, which can have long lasting consequences in the way she mothers, her self-esteem and future pregnancies (among other things).
Communicating with care providers is a two way street and sometimes both parties lack the skills to come to the desired outcome. Hop on over to this post to learn how to ask your care provider questions to get good information in order to make the best decisions.
“It’s time to fire your OB when they don’t ask permission to touch you before doing so. A woman in my birth group actually argued that showing up to an appointment was consenting to a vaginal exam and there was no reason to ask.” Heather H.
9. Unsupportive of VBACs
After a woman has a first cesarean, she is often told that for subsequent births she’ll need to deliver by cesarean as well. For many women, this statement is simply not true. However, what typically happens is that without questioning anything, she’ll goes back to the same OB, and agree to a repeat cesarean.
For whatever reason, some OBs or midwives do not attend vaginal births after cesareans (VBACs). In an attempt to keep their clientele, I’ve heard of some care providers sharing with patients that VBAC is dangerous and that “there aren’t any OBs that do VBACs around here”.
Again, this is simply not true.
Others that dig a little deeper often come to the conclusion that a VBAC is a reasonable and safe option for most women. They’ll also conclude that it’s a deal breaker if an OB doesn’t attend VBACs.
10. Pushes Cesareans for Big Babies
Did you know that a suspected big baby in and of itself is not cause enough to schedule a cesarean?
For non-diabetic women:
- If a care provider predicts a big baby based on an ultrasound or physical exam, they will be wrong about half the time. Ultrasound weight results at the end of pregnancy can fall anywhere from 15% above or below the baby’s actual weight. (SOURCE)
- If a care provider thinks that you are going to have a big baby, this thought can be more harmful than the actual big baby itself. The suspicion of a big baby leads many care providers to manage a woman’s care in a way that increases the risk of cesarean and complications. (SOURCE)
If your care provider is concerned about a suspected big baby (or too small of a pelvis) and wants to schedule an induction or cesarean, it’s time to for further discussion or to move on.
“It’s time to fire your OB when before labor they say baby is probably too big to deliver naturally. Even worse is when it’s your third and your other 2 were almost 10 lbs and delivered without complications. This happened to a close friend of mine and they gave her a c-section. Baby turned out to be smaller and had a smaller head than her other son.” Jacquelyn S.
11. Talks About Induction Too Early
Inductions are very convenient for birth attendants. Believe me, they are for me too! As a doula, it’s definitely helpful when attending an induction because it’s easier to plan ahead, schedule childcare, etc. Being on call is HARD!
However, the convenience of care providers and other birth attendants should not be valued as high as the health and well-being of a mother and her unborn baby. You see, medically unnecessary inductions increase their risk for no good reason.
If your care provider repeatedly brings up induction, especially in the second and early to mid-third trimesters, they may be grooming you for an induction come 39 weeks. This is a pretty messed up scenario, in my opinion, because the 39+ week pregnant lady is D.O.N.E. and prone to agree to whatever makes her misery come to an end.
It’s best to hire a care provider that agrees that labor progresses best with hands off, watchful care (for healthy moms and babies, of course).
12. Unsupportive of Birth Choices
- help parents explore and become educated about their options
- facilitate communication with care providers during pregnancy and birth
- encourage parents to be a part of the decision making process
Many care providers do not like or encourage parents to make birth plans. I think one of the big reasons for this is that sometimes parents pigeon hole themselves into a very narrow view of how their birth should unfold and don’t make room for the unexpected. However, I think a better response is for care providers to see this as an opportunity for patient education and communication.
On the other hand, another reason care providers do not like birth plans is because some OBs are unsupportive of their patients requesting preferences that diverge from “the way things are done around here“. If this is the case, pay attention. If your care provider is unsupportive and inflexible in regards to your birth choices and plans, it may be time to fire your OB or midwife.
13. Dislikes Doulas
Imagine you’re pregnant and at a prenatal appointment with your care provider. You really like this person! However, after sharing your intentions of hiring a doula, they say a doula is unnecessary and not to hire one. What would you do?
First off, I would want more information. In this situation it may be helpful to do a backwards B.R.A.I.N. exercise to better understand where they’re coming from. (Hop on over here to learn the B.R.A.I.N. acronym.)
Using this tool, parents may ask their care providers the following questions.
- Knowing who I am and what I’m hoping for at the birth, how would not hiring a doula be helpful for us?
- How would we be at a disadvantage by not hiring a doula?
- What would you recommend us to do instead of hiring a doula?
Statistically, a doula that provides continuous labor support is a key player in creating excellent outcomes for mothers and their babies. According to a 2012 Cochrane Review, women who received continuous labor support were:
- more likely to give birth spontaneously
- less likely to give birth via caesarean or with a vacuum or forceps
- less likely to use pain medications
- more likely to be satisfied
- had slightly shorter labors
After gathering information, do a little soul searching and gut checking to see where you stand. If you still want to hire a doula, but your OB disagrees, it may be time to find someone new.
14. Not Forthcoming or Transparent
Honesty and transparency are critical in any relationship, and the doctor/patient relationship is no exception. Parents need to trust their care providers with big things like their lives and well-being. Trust should be earned. One way to develop trust between parents and their care providers is to answer questions honestly and with transparency. When that can’t happen, parents have every reason to be concerned.
If you ask your OB about their cesarean or induction rates and they skirt around the issue, that’s a red flag. If you ask them how they would handle a patient going past their due date, and they refuse to discuss the issue, that’s another red flag.
When a care provider is not forthcoming, it may be time to move on.
15. Uses Bait-and-Switch Tactics
There’s an OB practice in my community that has an unfavorable reputation among childbirth educators and doulas. One of the reasons for this is because of their bait-and-switch tactics. Over and over again, women go to their practice in the first trimester and have conversations that go a little something like this.
Woman: I want to have a natural childbirth. How do you feel about that?
OB: I’m totally supportive of natural childbirth! You can do whatever you want. No problem!
The thing is, once these women get to 39-40 weeks everything changes. All of the sudden the belief that a woman is capable of birthing her child without medical intervention flies out the window. Ultrasounds, inductions, and cesareans are scheduled, and new mothers are left feeling traumatized, among other things.
I know how this practice operates, but most women don’t find out until it’s too late. So, what’s a woman to do? A little reconnaissance, perhaps? Keep reading to find out more.
How to Find a New Care Provider During Pregnancy
After reading this article you likely came to one of two conclusions – your care provider needs to stay or go. If you find yourself needing a new care provider, don’t worry, it’s not too late.
“I switched a week before the birth of my first kiddo. There’s no such thing as “too late to switch”. Being embarrassed of “switching too late” isn’t as bad as going into something as important as birth with someone you don’t trust.” Lois A.
Here’s a good story about how one woman made the switch from one care provider to another, but also birthing venue as well.
A good way to find a new care provider is to ask a variety of women who they chose, but also why they liked them. Pay attention, however, because what is important to one woman may not be important to you.
TIP: A good way to find women to talk to, quickly, is in local Facebook groups.
TIP: If you’re looking for a new care provider pay extra attention to who the doulas in your community are using. Ask them why they got picked, and what they ended up liking and disliking about their OB. I imagine a conversation like that would be very telling.
15 Signs That It’s Time to Fire Your OB
To recap, use these 15 signs to know when it’s time to fire your OB or midwife and find someone new.
- A Gut Feeling
- Rushed Prenatal Visits
- Dismisses and Belittles Patients
- Makes Minimal Eye Contact
- Speaks Mainly to Partner
- Uses Fear-Based Tactics
- Not Current with Best Practices
- Doesn’t Value Informed Consent
- Unsupportive of VBACs
- Pushes Cesareans for Big Babies
- Talks About Induction Too Early
- Unsupportive of Birth Choices
- Dislikes Doulas
- Not Forthcoming or Transparent
- Uses Bait-and-Switch Tactics
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