As doulas, we do not provide medical advice, clinical care, or catch babies. However, we are experts in helping families have positive birth experiences. Because we know just how important perinatal safety is, we support our clients in choosing or finding access to OB providers who provide safe, evidence-based care. We do not tell our clients who they should and should not seek care from. But we can provide clients with information and some OB provider red flags.
When we are working with clients as doulas or childbirth educators, we can help clients find providers who align with their birth goals. And most importantly, we can encourage clients to work with providers who practice evidence-based care.
Here are some OB Provider Red Flags
#1: Questions Are Dismissed or Called “Silly”
When person is having a prenatal visit, they deserve the opportunity to ask questions and receive evidence-based and compassionate answers. While OBs do this work day in and day out, parents do not experience these things every day.
Questions should not be dismissed or labeled as silly. Whether it is a question about common pregnancy symptoms or birth, parents deserve compassionate responses.
If a client expresses concerns about being dismissed, you can remind them that their provider’s role is to answer questions about their pregnancy and birth. Remind them they deserve appropriate care and can explore other options if they are not comfortable with their provider.
#2: They Do Not Clearly Explain Benefits and Risks
Every procedure, exam, and test has benefits and risks. Patients deserve the opportunity to provide true informed consent. To give informed consent (or to decline), patients must have the information to make a decision. Not explaining things to patients is a big OB provider red flag.
If a provider is reluctant to explain the benefits, risks, and alternatives to each procedure, this can be a red flag.
Wanting to know the benefits and risks does not mean a parent is likely to decline something. It means they want to make an informed decision and understand what is happening to their body. Even when something is medically indicated, knowing the benefits and risks is an important part of processing the experience and being prepared to navigate side effects.
If a provider does not want to fully explain something, this can be a concern. Because again, even if it is medically necessary, no one feels comfortable when things are just done to their body. If this occurs in office, are parents to expect a lack of communication and information when in labor too?
#3: Uses Fear Based Language Rather Than Clear Explanations – Big OB Provider Red Flag
Listen, we get it. Being an obstetrician is demanding work. You are responsible for the health and safety of two patients. And the way you practice tends to be impacted by the difficult cases which stick with you. Loss and complication are real risks in obstetrical care.
That said, fear-based language and overall fearmongering is not the way to manage care. Parents deserve accurate information to make informed decisions with a provider who practices evidence-based care.
For example, if you have a client hoping for a VBAC and all they are told is there is a risk of uterine rupture which is, “catastrophic and often fatal,” patients are not able to give true informed consent. Why? Because there is no risk-free way to birth.
ACOG even supports VBAC in many situations and recognizes the importance of offering a trial of labor after cesarean delivery (TOLAC). If an OB is saying, “I understand you want a VBAC but there’s a risk of uterine rupture which is often fatal whereas a c-section is scheduled,” patients cannot give true informed consent.
The risk of uterine rupture is real, but it is an overall low risk.
An OB providing accurate information without fearmongering might look like, “There is a risk of uterine rupture, but it is less than 1%. A repeat c-section does increase the risk of future placenta accreta, so you will want to consider the number of future pregnancies you desire. In your case, you have had one prior c-section, which was a low transverse incision. Here are the benefits and risks of a VBAC, and the benefits and risks of a repeat c-section. You have several months to decide what you think is best. We will monitor how your pregnancy and provide you with our suggestions based on how things are going.”
#4: Does Not Support Physiological Birth – Provides No Valid Explanation
There are circumstances where a physiological birth is not the safest option. For example, if a parent is 34 weeks and has preeclampsia, an induction typically becomes the safest option.
However, outside of medical indication, or a patient’s preference, there is no reason for a provider to refuse to support normal physiological birth.
If an OB says they only catch babies in the lithotomy position, that is a red flag because that is not an evidence-based practice. Any provider or hospital that says all patients must stay in bed when in active labor, says they require ongoing IV, they always break waters, etc., is a red flag.
Providers can have preferences around how they practice, hospitals may have policies, but it is not appropriate to refuse a patient’s right to autonomy in birth.
If there is a medical reason a physiological birth is not the safest option, parents deserve to understand exactly why that is. And upon receiving that explanation, they still have the right to informed consent or informed denial.
It is not that every birthing person needs or even personally desires a physiological birth. It is that providers and facilities need to practice evidence-based care which includes supporting physiological birth.
#5: Leaving Appointments Anxious or Feeling Silenced – An Important OB Red Flag
Overall, prenatal appointments should be exciting. Parents love hearing baby’s heartbeat and discussing birth plans. If patients aren’t leaving feeling good, that can be an OB provider red flag.
If their appointments leave them feeling anxious and unheard, it can ruin part of their pregnancy experience. It also means their birth could have extra unnecessary anxiety. People deserve to birth feeling safe and supported and not with extra anxiety about being silenced or unheard.
Take time to check in with clients after appointments. If they are consistently left feeling anxious, remind them they have options when it comes to working with an OB.
As doulas, we are not telling clients who they should or should not work with. We are not speaking badly about specific OBs or bad-mouthing facilities to clients. But we can and should provide clients with appropriate expectations for maternity care.
People only know what they know. When you are experiencing pregnancy for the first time, or even subsequent pregnancies but you are not in birth work, you do not always know what is and is not appropriate care. As doulas, we should share red flags and green flags, evidence-based information, and current guidelines (e.g., information from ACOG or ACNM).
Ultimately, your clients will choose their provider and as a doula you support them in having the best possible experience through evidence-based, continuous support.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...