Navigating Relationships With Your Prenatal Providers

Pregnancy and birth truly are a one of a kind experience. There's nothing quite like it. Forty weeks of gestation followed by a birth of an unknown length and possible interventions can naturally spark a lot of questions and even fears for a soon to be mama. This is often especially true if this is your first pregnancy or you have had past pregnancies that sadly may not have had the outcomes you had hoped for. Cultivating a relationship of trust with your providers can be one of the best tools for overcoming any fears or anxieties that may pop up along the way. 

Here are my 5 tips for getting the most out of your relationships with your OB's and midwives right from the start. 

1. Treat your first visit like a business meeting and don't be afraid to interview them. 

Picking an OB, midwife or large practice to provide you with prenatal and birthing support is often one of the most overlooked parts of the birthing process. Many women will opt to stay with the OB they have always had, to avoid the hassle of a new relationship, or to avoid multiple appointments. While this may seem like it is saving you stress in the beginning of your pregnancy, doing your due diligence of researching and interviewing to find your perfect fit can save you anxiety in the long run. Asking your mom friends about their past experiences with providers can also tell you a lot. I urge you to consider interviewing a few different practices to find the one where you feel seen and heard. 

Many of us will simply opt for the first provider that comes up on our insurance coverage within a reasonable driving distance. Yes, finding a provider that is in your network or takes medicaid can be important, but chances are there are more than one in your area. Many of us have been conditioned to think that any doctor knows best, or that we should take the care we can get without question, especially if you live in a remote area. This conditioning is often the fractal for a poor relationship built on resentments and assumptions which are not the bedrock of stability in a therapeutic relationship. It's important to remember that regardless of how you pay your provider, whether that is insurance, cash, or medicaid ultimately YOU employ them! Without you as a patient, they wouldn't have a job.

You have the right to ask questions and to be treated with equality and compassion and you should never feel bad for seeking that out, right out of the gates. 

2. Know why you are there and express that up front to see if you are a good fit for their style of care. 

If you live in the US, you have probably had the experience of waiting to be seen by a provider for a longer period of time than you have actually had in their presence at the appointment. Many of us are all too aware that our medical providers are rushed and asked to see large numbers of patients in a day. This shouldn't mean that you don't ask questions because you don't want to take up extra time. This is not the time to be a people pleaser. You can be respectful of their busy schedules AND get your questions answered up front if you spend a little time preparing for your appointment. Spend some time considering these questions for yourself BEFORE heading to your appointment. 

What kind of birth do you envision? Natural, C-section, medicated, non-medicated, hospital setting, home birth, someone by your side at all times or as much privacy as possible? Knowing your heart's desires on these topics can help you find the provider that is a good fit. 

For instance, if you want as natural as possible, but suspect that you may want an epidural or that you have a pre-existing condition like a large fibroid that would invite a C-section, looking for a practice that has both midwives and OB's that deliver in a hospital would be your best bet. Asking how many providers and what types you will see can alleviate a lot of the unknown jitters.

If you are wanting a home birth, but are unsure of what would happen if you needed to be transferred to your local hospital for complications, you may be looking for a practice that agrees to be your physician of choice should that happen. Asking up front how they feel about this type of relationship is imperative. This can help to relieve any anxieties about the what ifs of a home birth. Often times, home birth midwives will also have an OB that they recommend to establish care with and are comfortable working along side with during your prenatal care for things like advanced ultrasounds or hospital transfers should they be needed.

If you know you want a C-section and in fact want it to be scheduled, ask your provider their thoughts on accommodating this request. Some OB's will be more than happy to do so while others will want to ensure that it is medically necessary first. 

If you know you want to avoid a C-section at all costs, but want to deliver in a hospital, a simple question about the C-section rates of the hospital you will be delivering at will provide a lot of information on the probability of that happening. The World Health Organization states that the acceptable rate of C-sections should be below 15%, however, the CDC states the US National average for a C-section in the US is 31.7% at the time of writing this article. This means that you have a 1 in 3 chance of having your baby via cesarian if you live in the US. Some providers C-section rates are as high as 70% which is exactly why it is a question worth asking.

The rate of C-sections since the 1970's has increased 500%, though the risk of having a child has not increased which begs the question, "Why would there be such an increase?". Often times hospital procedures and intervention cascades, bias of surgeons to operate, increased reimbursement rates for C-section vs. vaginal delivery, and lack of support persons during labor all coincide to increase the possibility of a C-section. Simply asking your OB their thoughts on C-sections and your hospitals C-section rates at your first visit can give you a better understanding if they are the right provider for you.

3. Don't be afraid to ask questions and write down their answers. 

If you have specific fears about your pregnancy due to your past history like miscarriage or spotting during pregnancy, that first visit can be a good place to ask about their policy on monitoring the pregnancy. How many visits and ultrasounds will you have throughout your pregnancy? How do you get in touch with them if you are spotting or suspect a miscarriage? Will you be seeing the same provider for all your visits to establish rapport or rotating through all of the providers? 

When we get nervous, our memories don't always function at peak capacity. Writing down their answers can be helpful so that you can convey their answers to your partner if they are unable to attend the visit with you. If you forget a pen and paper, use the notepad function on your phone. It's always courteous in this day and age to ask them if they mind if you write down their answers in your phone so they don't think you are checked out texting or recording them without their consent. This also helps them to know you are taking their answers to heart and considering what they have to say in your decision making process. 

4. Ask how you can get in touch with them if something comes up outside of your appointments. 

Different offices have different procedures for connecting with your provider outside of normally scheduled appointments. Establishing the ground rules for this right out of the gate can again save you a lot of possible frustration later if a stressful situation presents itself. Ask if they have an on call number for after hours, if there is a direct extension during business hours where you can reach them or their nurse with your questions, or if they have a concierge style digital care available like the GoMo Health app for Prenatal and Maternal care? Often times home birth midwives will be connecting with you via email and text in these events. Be sure to ask what their policy is for returning your messages. 

5. Ask them their opinion in a way that "humanizes" your care. 

If you have asked a question about your pregnancy or birth and don't feel you have gotten an adequate response as to what to do, sometimes wording the question in this way can help to soften the provider's response by subconsciously reminding them of your humanity. Picking the identifier that seems most appropriate based on your ages, asking "If I were your partner, mother, or daughter what would you advise me to do in this situation?" can help to get you a more candid answer over a text book answer. It may also invite a deeper conversation about your feelings of the situation as they see how dedicated you are to finding the right answer for your personal situation and all that is coming up for you as you navigate these decisions of care. 

I hope the insights provided in this article help you to learn how to advocate for yourself and baby on this miraculous journey to becoming a parent, and to build a prenatal and birthing team you are confident and trusting of. 

References encouraged for further research

https://www.ariadnelabs.org/resources/articles/news/keynote-to-american-ob-gyns-c-section-rates-linked-to-hospital-complexities/

https://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_eng.pdf?sequence=1

https://www.cmaj.ca/content/191/13/E352

https://www.cdc.gov/nchs/fastats/delivery.htm

https://www.cesareanrates.org/state-dashboards

https://gomohealth.com/maternal-child-health/

Acupuncture for Breech Presentation- Myth or Very Possible???

With an all time high rate of 32.8% for cesarian birth in our country, Acupuncture has recently gained popularity as a method of turning a breech baby or inducing labor naturally.  This article seeks to demystify this ancient approach as I have seen it work time and time again. Traditionally, the point named Zhi Yin or UB-67, located on the lateral side of the pinky toe is used to turn a baby in breech presentation. Zhi Yin translates to “Reaching Yin.”  For those of you with some working knowledge of traditional Chinese medicine, one can understand how a fetus would be the utmost Yin (fluid, soft tissue, or very center) of a woman’s body as the fetus does not obtain its own Yang energy until it takes its first breath outside of the womb.

To offer assistance with breech presentation, often only one acupuncture appointment is needed. Typically the mother is instructed to continue using a technique called moxabustionat home for 10-20 minutes a day until her next sonogram or physical examination. Moxabustion is a technique that involves burning of an herb called mugwort to gently stimulate an acupuncture point. Exceptions to this treatment are when there are structural hindrances in the mother’s body, low levels of amniotic fluid, dehydration or what we sometimes call blood deficiency in Traditional Chinese Medicine.  Points and techniques are chosen to address the blocks first before attempting to needle or moxa the point that coerce the baby to turn into the proper head down position.  When the mother is properly hydrated it increases the volume of amniotic fluid allowing the baby to turn with ease.  When the mother is properly nourished, the blood supply in the uterus is ample allowing the baby to turn and calmly remain in the head down position instead of becoming what we refer to as “restless” and moving in and out of position.  Helpful food choices that prime a pregnant woman’s body for optimal conditions for a fetus to turn can include coconut water, fruits high in water content, eggs, avocados, red meat, red raspberry leaf tea, and fatty fishes that are high in omega-3 like salmon and tuna.

Although babies can be successfully relocated to the proper position up to the moment before birth, it is optimal to seek out treatment around week 33-34 of your pregnancy if you know your baby is not in the correct position. This ensures that all significant blocks to turning are addressed and allows more time with the baby’s head against the cervix to help release proper hormones needed for a smooth birth.

Natural Labor Induction- does it really exist?

It’s all too often that I get a phone call from a frantic Mom-to-be or Father for that matter, desperate for labor to start. Reasons range from fear of the impending doom of a forced induction with pharmaceuticals to a scheduled C-section because they are overdue or high-risk, to just simply being ready to get the show on the road.  Many people are under the assumption that by taking a few herbs or doing a couple acupuncture points that are traditionally contraindicated during pregnancy, that you can make labor happen instantly.  This couldn’t be further from the truth! The fact of the matter is that there is very little known about the mechanism of birth or what makes a baby decide that it is in fact time to make his or her grand introduction into the world.  Here are a few of the most commonly asked questions I get on the phone. Can acupuncture cause contractions? Yes sometimes. Can it help to make contractions more regular if they are already randomly occurring? Yes. Can you cause someone’s water to break? Probably not! Will you leave my office in labor? Highly unlikely, although the chance for naturally going into labor in the next 48 hours seems to jump significantly after you are over 40 weeks of gestation.

When I’m asked if I perform labor inductions, my answer is, “No, but I do offer the service of Labor Prep.” Labor Prep usually begins around week 37-38 depending on the woman, but can be started as late as week 41.  Just like any other patient, your complete medical history is discussed; emphasis is placed on the pregnancy and any prior pregnancies, to gain a better understanding of you how your body reacts physically and emotionally.  Any repetitive patterns of disharmony are noted and checked against pulse and tongue diagnosis and channel palpation. Appropriate points are then needled to help you feel your best going into labor. All fears or concerns about birth are addressed during your appointment. This is commonly a cause to delayed labor. Sometimes its “stuff” you didn’t even realize was an issue (like not wanting a relative in the room during your magic moment, but not wanting to hurt their feelings by saying no or the impending feeling of immense responsibility for the rest of your life).  As with all acupuncture treatments, typically the biggest side effect is relaxation which is always helpful when trying to initiate birth. As your due date draws closer and your body is in a strong enough state to thrive in labor, points that may help to initiate descent of the fetus, dilation and softening of the cervix, or for coercion of contractions are then used.  Sometimes you may be instructed to perform acupressure on yourself in between appointments to help further things along.  Herbs are sometimes employed depending on the health, needs and wishes of the parents.  Appointments are typically once a week from weeks 37-40 and then treatments are given in rapid succession three times in a row anywhere in the range of weeks 40-42 depending on the mother’s health and fetal measurements.

Lastly, if your partner is available, they are encouraged to attend at least one of your appointments. They will be instructed on how to perform acupressure on you during labor to help you progress in a timely manner.  This is often helpful so that they feel like an active participant in the event of birth instead of standing helpless in a corner as the woman they love screams in pain. Acupressure during labor can help to ensure that contractions are strong and getting you somewhere instead of wearing you and baby out, while providing a slow release of natural endorphins that help you to manage the discomfort while remaining as relaxed as possible.  Your brain has spent the last 10 months saving up endorphins for this occasion and has a finite amount to release during the labor and birth. Acupressure is a safe and non-invasive way to encourage your brain to release the appropriate amount in conjunction with the stage of labor you are in.  PDF manuals and demonstration videos can also be emailed to the interested and tech-savvy partner so that they have a simple way to retrieve a short, to the point reminder during the event.  No pun intended!

Click for video of acupressure points to help bring on labor.

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