Help! I Want to Change My Care Provider! Is it too late?

So you have discovered that your first (or second, or maybe third) choice of care providers isn't right for you. Don't sweat it! I've been there too.

I'm going to be really vulnerable with you here. I teach childbirth classes, and a big component of our curriculum is helping students, parents just like you and me, learn what mother-friendly care is, and understand the importance of choosing the right birth team. And as a doula, I help parents formulate questions to pick the right care provider for their birth.

Despite all of this, I apparently struggle at choosing the right care provider for myself.

I try not to share my personal stories with clients and students while I'm helping them prepare for their own personal journeys, but truly, I have garnered a lot of knowledge from my experiences, and I think now is the time to share some of that. Consumer power is a real thing in maternity care, and more and more families are realizing that and using their power as consumers to advocate for themselves and their babies. I am daring to demystify the idea of changing care providers late in the game. I'm not saying it's always easy,  and I'm certainly not implying your experience will be the same as mine. But for whatever it's worth, I'm going to leave my experiences here; take from it what you may.

My first pregnancy was an easy one; healthy and free from common discomforts. I lived in a small town, didn't know about midwifery care, and would have never thought twice about birthing anywhere but the closest hospital. I never noticed the red flags from my care provider. At 36 weeks, my provider began suggesting I schedule a cesarean because I was a very small girl and this baby looked big. I believed in the process of birth, and desired to have a natural birth, so he "agreed to let me try." I ended up getting pressured into an induction, and I didn't have the slightest inkling, at the time, the emotional and physical toll it would have on me years later. 

Fast forward to my second pregnancy, four, almost five years later, I very quickly realized the frustration of finding a provider who would support my birth wishes. I gave up, sometime in my first trimester, on my desire to birth in a birth center, and I assumed that I would never find a home birth midwife willing to accept me. Eventually I found a group midwifery practice, and planned for a hospital birth about an hour and a half away from my home. History has a funny way of repeating itself, and once again, I found myself being told I should have a cesarean at 36 weeks; this time because my baby was breech, but this time, I knew enough to change providers. This would be my first act of exercising my power as a consumer. Despite being told, "you have no options." This would be my first act of exercising my power as a consumer. Despite being told, "you won't find a provider anywhere in the United States who will let you VBAC a breech baby," and "you can't have an ECV." This would be my first act of exercising my power as a consumer. We were sure to let this practice know exactly why we were leaving, right after finding a new provider - a midwife/OB team - just down the block.

We had taken a childbirth class with this pregnancy, and I had a doula, and once we transferred care at 37 weeks, I had a midwife I could trust. At 40 weeks I elected for an external cephalic version, (ECV) with a breech friendly provider who worked alongside my midwife. The version was successful, and I was offered the choice of induction or simply waiting. I knew waiting for baby to pick his or her birthday was the right choice, and so we waited. I was uncomfortable in the summer heat, but I knew that it was worth it to wait. I was, like most women, a bit impatient as the days wore on, and as I approached the 42 week mark, I began to get nervous. As much as I liked the OB who who worked with my midwife, I had elected the ECV in hopes to birth with the midwife. So, to encourage labor, we tried some “natural induction” methods at 41+6. They worked, or perhaps the time was right, and I went on to have a fast and furious labor with baby number two! I attribute the loss of my luxurious early labor to these natural induction methods. 

During my third pregnancy, I knew the kind of birth I desired, and I was fully aware of the steps I needed to take to obtain it.

changing care providers in pregnancy

I was prepared to carry my baby to 42 + weeks. I was prepared for a baby who would pick their own position(s) in utero (baby number two had changed positions again and again after my ECV, prior to being head down for his birthday - but at the time that had been my little secret) and I had confidence this baby would also be vertex at the time of birth. And above all, I was not going anywhere unless medically necessary. I had this ideal image in my head a nice, long, easy, early labor, followed by enjoying dinner with my family, in the comfort of my own home.

Choosing a care provider was a struggle for me. I was still daunted by the VBAC label and didn’t have the emotional stamina to deal with providers who would “let me” birth a certain way. I knew now that negotiating allowances for my birth was not ok. I received prenatal care from a few different providers, and once again found myself at 36 weeks looking for a provider. It was important for me that the provider I chose graciously accept and respect my body and birth, and after narrowing it down and deliberating between two midwives, I thought things were finally ready for birth. I had to do the dreaded 1.5hr drive to my required weekly appointments, but it was worth it I thought. I had a birth attendant who would respect my pregnancy, support my birth, and I wasn’t going to have to go anywhere, not for the birth, nor for postpartum. Totally one of the best parts of home birth, am I right?! My baby flipped positions often, just like I knew she would. I carried to 42 weeks, just like I knew I would. (I had received a late second trimester ultrasound that dated my EDD 4 days later than my LMP.)

I agreed to a BPP to help satisfy my midwife’s paperwork. I had no concerns, baby moved plenty, and I trusted that my body and my baby knew what to do, but I figured, what could the harm be. I was 42+1 (or 41+4 according to paperwork) and my midwife called to say the specialist thought my baby was too small – more along the lines of a 37 week baby. They guessed baby’s weight to be 7lb 14oz, (the midwife’s palpated guess was 7lbs). Baby had passed the BPP with flying colors, my placenta was a grade 3, as it should be, but I was being handed another label – IUGR. I was told I needed to drive to the city where I birthed my second baby and be induced that night. I did some research on risks & benefits, and what criteria were needed to diagnose IUGR. What I learned, was the information we had was not enough to warrant a diagnosis. I chose to call around and get a couple of second opinions. Neither of the providers I spoke to agreed with the midwife’s recommendation. I returned her call, requested my paper work, and planned - as a precautionary measure - to receive another ultrasound that would measure the diastolic umbilical artery flow. The ultrasound I planned to receive the next day, would help me decide if I should give concern to the matter, or simply continue to respect my body and baby, and wait for my baby to pick the right day to be born – surely it would be any moment! And oh, it was!

As anyone versed in birth would know, you gotta have more than one plan. So, I met and hired yet another new birth attendant that very night. As we drove home from consulting with her, I called my doula to update her. I had to put her on hold a few times during our conversation “cuz this baby keeps stretching, and it’s quite uncomfortable.”

Eventually, I recognized those “stretches” for the labor pattern that they were, and tucked into bed around 11pm.

My birth stories are largely made up of the journeys I took to get there, and this one is no different. My third birth is my favorite, and as it would turn out, My Day Was Not Measured In Centimeters.