Tuesday, November 1, 2011

Doctor Swapping

As a doula, most of the women I talk to are interested in having a good birth. They may or may not want to go completely natural, but they want to feel empowered and respected throughout the process. Most are taking some kind of prepared childbirth class and do lots of reading too.

One problem is that a lot of these women decide they want a natural birth long after they have chosen a care provider, and their care provider's style and workplace may not mesh well with what they now want for their birth. Some women report feeling increasingly uneasy with their doctor or midwife, but are hesitant to do something about it. They may feel that it is too late to change, or that they won't be able to find a care provider they like on their plan, or that they have no choices at all due to managed care or Medi-Cal. Let's go through these one at a time.

1. It is too late for me to change care providers.

While many OBs prefer to take clients before 32 weeks, there is no rule against switching doctors as late in pregnancy as you need to. I have personally known women who switched at 39 weeks, but generally you will have the easiest time finding a new practice if you make the switch earlier.

2. I won't be able to find a doctor I like on my plan.

Check over your options carefully. Often, there may be doctors you overlooked because they don't practice at your first-choice hospital that are great, and living in a big city like LA, you have so many choices of birth place and providers. Sometimes the prettiest, shiniest hospitals aren't the most supportive of natural birth. I have had great experiences with clients at some of LA's smaller hospitals and teaching hospitals. Ask around and see what you can do.

3. I don't have any choices - I'm with Kaiser or Medi-Cal!

It is true that with Kaiser, you get whatever doctor is on call, but you often can choose which Kaiser location you will deliver at and whether you will be working with an OB or Midwife. Kaiser is generally very supportive of natural birth (let me put my cynical hat on) because natural birth costs less, and they don't have the luxury of passing on expensive bills to you and your insurance company.

With Medi-Cal, you just have to shop around and find a good doctor. There are great OBs and terrible ones that accept Medi-Cal. Similarly, there are hospitals that will treat you well and ones that will not be as nice. Don't stay with anyone who doesn't make you feel that you and your baby are of value. Ask your friends or ask your doula for recommendations and find someone who will respect your birth.

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