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!
- 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
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 by a midwife or doctor, 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.
or
Woman: I am afraid of tearing during birth. Could we use warm compresses instead of perineal massage when baby is crowning?
OB: I’ve been doing this for years. I’ll take care of you. You can trust me.
or
Woman: I really want to have a natural childbirth, but I’m feeling really nervous about the pain of labor.
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.
or
Woman: I read about the difference between delayed cord clamping and umbilical cord stripping after baby is born. Is umbilical cord stripping something you do routinely?
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?
or
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.
Woman: …
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 a birth plan or preferences with the medical team 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
Birth plans are an excellent tool for expectant parents.
Birth plans
- 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
Leave a Comment
What about you? How did you know when it was time to fire your OB or midwife? What questions did you ask your OB or midwife initially to see if they were a good fit? Leave a comment and share your story. I’d love to hear from you!
Mykaela
Tuesday 6th of April 2021
I switched from hospital to home birth at 37 weeks because of the pathetic and overbearing Covid restrictions. I am SO HAPPY I did!! I’m pregnant with my second now and so looking forward to another home birth, Lord willing! I loved how gentle, quiet, personal, and free it felt to give birth in my own space, surrounded by people I love. :)
Melissa m
Wednesday 30th of September 2020
Hello I’m 38 weeks and on my last ultrasound I was told I have low lying placenta and my placenta was 1.8cm away from my cervix and if it does not move up I will end up having a C-section, this will be my 4th baby, my other 3 were vaginal delivery and I’m 37 years old, I’m really confused I have not had any bleeding through out my whole pregnancy, and the little research I find on the internet has really no answers just really basic stuff , I spoke to my OB and she basically answered me back with a question “well since you’re getting a C-section wouldn’t you just want to get operated to not have more kids?” I have not been back to her office for the past 2 weeks I don’t want to see her face, I feel fine and still no bleeding at all but I will be going to ER tomorrow just to make sure my baby is doing well and hopefully they will do an vaginal ultrasound and give me some good updates. If any one has gone through this situation please let me know, any thoughts thank you
Tejaunee
Friday 24th of January 2020
Im going through this now. I’m 38 weeks, and should have fired my OB weeks ago. He refuses a VBAC, even though my specialist suggested I’m a great candidate for one. When I brought it up he became irate, and used scare tactics. He said, “ Oh yeah, well if the specialist thinks that, you can just tell her to come take care of you! And guarantee she won’t! And what if I have an ectopic pregnancy to deal with, and you go into labor and blow out your uterus and there’s no one to take care of you?!!! You’re a 2% risk!! We don’t do that!” At my last appointment I asked about the gentle c section. I asked if my baby were healthy would they please put him on my chest before taking him away. He replied, “ Oh yeah they love to do stuff like that, but there’s no room for that kind of thing in a surgical room. You’ll have a drape up to here, and you can have one person in the room, and they will get to see the baby but you won’t. “ I’m angry. Outraged. My c section is scheduled for next week, 39 weeks on the nose. I don’t want to look at this guy again, much less let him cut me open , pull my baby out, toss him to the nurse and start a conversation with the anesthesiologist about where they got good sushi from last week as he staples me up and glues me back together. I don’t want to itch all over from the duramorph and have freezing chill shakes. All the while not knowing how my little one is. Childbirth should be looked forward to with elation, and great expectation! It’s a gift from God. Doctors should not be allowed to steal that wonderful experience to satisfy their own convenience.
Lindsey VanAlstyne
Friday 24th of January 2020
I'm sorry this is happening to you. It's not ok. I hope you find support. Do you have a local ICAN chapter in your area?
Aly
Monday 21st of January 2019
It’s important to know that in some areas it’s not possible to change providers after 16 weeks. We found out our hospital had a 2 support people maximum, I tried to change to a hospital that would allow 3 and there was only one Doc in Manhattan (NY) that would take me for that hospital. And he had many many of the red flags in this list. I decided to stay with my doctor that is wonderful and just hope that my Doula is able to find a way to switch out to support me.
Annmarie
Monday 15th of October 2018
I had a lot of red flags with our first OB, thankfully we did switch and our second has been amazing. Here’s some fun things we were treated to from the first one: 1) very first appt at 8 weeks. I went in, told them I thought I was about 8 weeks along which meant I had gotten pregnant around Valentine’s Day. The woman didn’t even look up from my chart and said “when was your last period?” I told her January, but I have PCOS, my periods are irregular at best and not a good indicator. I know I wasn’t pregnant in January. So, she writes 12 weeks on all of my charts, doesn’t acknowledge that I said anything, and bumbles me down to ultrasound talking about how they had to work me in because despite the first appt being scheduled, for some reason the ultrasound tech wasn’t. Go figure - the baby measured at 8 weeks. The woman didn’t even apologize to me, just changed it on the paperwork with a sigh commenting on how everything’s going to be messy on the chart now. Now, my husband and I were not physically in the same city for most of January - which is how I knew I didn’t get pregnant in January. 2) that same appt I was already upset over gain to argue about when I got pregnant and got ignored, as things were wrapping up my husband and I both said this is our first. We don’t have our parents or people who have gone through this already. What can we expect is normal during the first trimester? Is the car sick normal? And were told “if you start bleeding badly go to the Er” and shoved out the door. 3) a couple weeks later I get a call from a specialist clinic in downtown (probably a good 30-40 mins away from us) to schedule my appt. I had never heard of them, and asked what was going on. To be told that we were referred to them by my OB. I called the OB, who told me sending me to a specialist for extra ultrasounds (plus another $100 out of pocket for each appt) was standard for women with PCOS, due to miscarriage rates of PCOS women. This is after not even acknowledging that I had said I had PCOS. I was livid. So, I schedule with the specialist and we went a few times to them as well as to the regular OB another time. 4) when I did go back to the OB and flat out asked who they were scheduling me for a specialist after not talking to me about it, my husband and I both got looked at and told “we’ll its in her notes that she told you, maybe you don’t remember” to which my husband got mad at them because he was with me at all appts and knew how upset I was after having to say I have pcos and it being ignored. Now I felt like I was being called a liar. When I got into the room with the OB and flat out asked her, she told me a completely different story. That she had gone to her boss after and mentioned it, and her boss told her to schedule the specialist for me after the fact, that they didn’t have to call me about it. At this point I wanted a new OB. I was angry. I was done. I felt lied to. I felt like I didn’t matter and I had no earthly clue what was normal because - again - we don’t have older family to help us. But I felt guilty for wanting things different and kept getting told by other people or the internet that this was completely normal and I was just being a baby about it. 5) at the end of this all, I was around 15 weeks. I suddenly couldn’t lay down at night without a whole bunch of terrible, awful itching happening everywhere. So what did I do? I looked it up to see if that was normal. I know the doctors tell you not to do that - but I don’t exactly have a mom to call and say “how is this normal?” And it was 1 am. After reading online and not finding anything saying it was normal, the next day I called the OB. They had me come in right away for a blood draw to check everything out. I mentioned what I had found online and she goes “yeah, that happens. But don’t worry, I’m sure it’s not happening to you. Everything’s fine.” And just walks out the door. I call back 2 weeks later to ask about results- who hadn’t anyone called me? Is everything ok? Is my baby ok? And was promptly told they only call about results if there’s something wrong, not just to say that everything is fine. That was my final straw. I had been left to worry about my baby being hurt by my own liver for 2 weeks because no one bothered to tell me that they weren’t going to call me. I asked for all of my paperwork to be copied and released to me totake where I so pleased, and to cancel my next scheduled appt because I would not be coming back. Which also took a week for no particular reason. When I came back in to get my paperwork, the head nurse took me aside and asked me to justify why I was leaving the practice altogether and not just switching to their new midwife. It took me an hour to explain it so that she’d Let me leave. A week after that, I ended up in the ER due to an asymptomatic UTI that had turned into a very symptomatic kidney infection and was now in my bloodstream. I was doubled over with localized back pain and couldn’t stop vomiting in the second trimester. I knew something was wrong. But I didn’t have a new OB yet because everyone we called was not available for another month or so. After a week of not being able to walk or keep anything down, we went to ER. The nurses were amazing. They pinned the dehydration in a second, had me in fluid, took a ton of blood. The ER doctor came in and suggested that I was just not as far along as I thought and still had morning sickness. To which I started crying as soon as he left. He also suggested the back pain was just a pregnancy thing (even though I’d found nothing online about localized back pain around the kidney being a pregnancy thing) and generally treated me like a hysterical pregnant woman wanting attention until the nurse came back with the bloodwork and found this awful infection. The nurse had to advocate for me to stay there long enough to get 2 full IV bags of fluid because I was so dehudrated from constantly throwing up (I was throwing up sugar free jello, if that tells you anything) and they put me on heavy antibiotics to knock it our of my blood while still being safe for the baby. A month after that, I went to my current OB, told him everything, and he’s amazing. Appts are still rushed (5 minutes unless I request more time with the front desk when I’m scheduling) but he’s been wonderful. He looks me in the eye, talks to me, educates me on terms I don’t know (like the Rh shot since I’m A-) and answers all my questions. I got a well deserved lecture for not calling them at 3 am after having 5 hours of contractions and only mentioning it 2 days later at my appt. everything’s fine, he immediately did a cervical check and an ultrasound to make sure everything was good. I’m a 3 on the Bishops scale as of 34 weeks, but nothing to be concerned about. I’m so glad I switched. But I know it took being pushed really far and having to work through years of guilt and a lack of willingness to stand up for myself that I think the first OB was counting on.
Lindsey
Monday 15th of October 2018
Thank you for sharing!! It's so good to hear your story.