How Late is Too Late to Switch Care Providers?

How Late is Too Late to Switch Care Providers?

Today's blog was written by birth doula Amy Reitz. She is tackling the hot topic of when, why, how you can change care providers in your pregnancy. Read on to find out more!


Second opinions. Switching providers. Change. SCARY….Our minds can jump to an anxious place so quickly when we are considering the health and safety of ourselves and our babies. I have seen quite a bit of activity in online groups lately related to switching providers. Sometimes people are looking for recommendations for a new provider, but a lot of the time their questions signal to me that people are looking for validation. They want to know if they are warranted in even considering making a change. Part of this is obviously because the thought of making the wrong decision can be overwhelming. Realistically though, making a change is entirely up to you.

A positive outcome is all about making informed choices with regard to your needs and the needs of your child(ren). So, how do you do it? Where do you even start? Let’s talk about what the process looks like when it becomes necessary to explore alternate care options during pregnancy.

How does the need to look for alternate care come about in the first place? Nashville has a constant influx of people, but switching providers because of relocation is not exactly what I’m talking about here.

We’re talking getting a second opinion or electively switching providers because of one of the following reasons:

  • a need to elevate your overall experience
  • a difference of opinion between you and your provider
  • your preference regarding location of delivery has changed
  • any other reason that does not fall in the medically necessary category.

Most often there is something brewing long before someone decides to take action. In my opinion, no one other than you needs to want a second opinion or change of scenery in order to explore it further. Trust your gut!

The most common misconception about switching providers is when someone believes it is too late to make a change. Preferably, a care provider does want to begin the process as soon as possible, but that still does not mean that a first trimester switch is the only time to change things up. I’ve seen a pregnant person reference 20 weeks as being “too late in the game”. My heart sank when I read it! I could sense the mix of feelings inside this person. Halfway through a pregnancy is absolutely not too late to make a change. Eventually the visits to the office/care provider are going to become more frequent, and if you already know halfway through that something isn’t clicking, go ahead and investigate making a change prior to the frequency of your visits increasing.

As the Office Manager of a home birth midwifery practice, I see people switch providers at various points throughout their pregnancy fairly often. I asked my boss and all around badass midwife Jennifer Vines for her thoughts on this topic:

“As a home birth midwife, we are open to transfers at any time. A pregnant person can change their mind about their birthing options for a number of reasons.  When we have inquiries of late transfers we sit down and talk about what they are looking for that is different than what they are currently receiving in care.

The biggest reasons we take late transfers are:

  • A provider indicating their discomfort with things on the birth plan that they previously agreed to earlier in the pregnancy.

  • The pregnant person learning that the facility she is planning to birth at does not support her birth plan. The provider may have indicated they approved but the facility will not support the parents wishes.

  • Deciding they really want a water birth.”

See?! Not too late. Theoretically, you could walk into any hospital you want in labor regardless of whether your provider delivers there. While I do not recommend doing this unless you are going to the closest hospital out of necessity/emergency, that doesn’t make it any less true. You could also potentially find a midwife with availability to be on call for a home birth. You never know unless you ask! Instincts and gut feelings are real things. Listen to them! Don’t know where to start? Ask a doula! For real. We’re well connected, we give great references, and we are always down to talk all things birth.

The East Nashville Doulas Birth Story

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The East Nashville Doulas Birth Story

Welcome to the newest doula agency in Nashville—East Nashville Doulas! We are so excited to offer professional labor support and education to families in the greater Nashville metro area. We are a group of dedicated and compassionate doulas who believe that all pregnant people and their families deserve to be supported no matter where or how they choose to give birth. 

I’m Andrea, and I’m the owner and founder of East Nashville Doulas. I chose the name because this is where I live—in this vibrant, progressive, expanding part of town. East Nashville draws people from all over the world to its fabulous restaurants, funky shops, famous music venues, and busy coffee shops. While we serve families all over the metro Nashville area, we carry the East Nashville spirit with us, and the heart of our work reflects these values—diversity, inclusivity, and support for all families.

Today, I thought I would share our East Nashville Doulas birth story with you! Like any parent, I’m very proud of the work that went into “birthing” this agency, but the story of its conception starts long ago.

I began my journey to birth work as a first-time mom searching for birth options over 25 years ago when I was pregnant with my daughter. Back then, I had never heard of the word "doula," but I knew that I wanted my birth to be the transformative experience I knew it could be. I also knew I wanted to birth my way on my terms. I chose a great OB who reflected my values, and I had an uncomplicated (and very fast!) hospital birth. Still, I was left wanting more for any subsequent births.

Fast forward to right after the birth of my second child at home, I had a much more empowering experience this time around as I felt more involved in the choices around this birth. It was in my research for my second birth that I heard the term “doula” for the first time. Aha! This was what was missing with my birth experiences—continuous and professional labor support. I decided that this was what I wanted to do with my life. I wanted to support families welcoming babies into their lives in a way that I had not been supported. 

I took a DONA-approved training around 1999, and ended up supporting the births of a few friends. I loved doing this work, but couldn’t figure out how to make it a sustainable career at that time.

I continued to work as a teacher and university administrator, eventually landing at Vanderbilt University in Nashville, TN. After working there for 12 years and raising my two children, I came back to the idea of returning to birth work when I was ready to make a change in my life. In 2015, I attended another DONA-approved training (with the fabulous Jessica English of Birth Kalamazoo), quit my job at Vanderbilt, and began my full-time solo doula practice. Within a few years, I built up my practice to become one of the busiest and most sought-after doulas in Nashville. I also mentored many new doulas by sharing my expertise with them.

In 2017, I became a certified Lamaze childbirth educator, and I’ve taught more than 100 couples in my classes over these last few years. With my lifelong background in education, I know how important solid, evidence-based information is for families as they navigate their birth choices. Knowledge is empowering, and it also reduces fears. 

In 2018, I decided that in order to serve even more families, I would open a doula agency. But I knew that I wanted to adopt a different agency model--one that provided the security families wanted by knowing who would be showing up for their birth. I had many families come to me because they wanted to know who their doula would be--they wanted a familiar face in their birth space. With us, you will know your doula, and that’s who will be at your birth.

I assembled a team of fabulous doulas who I met through networking and our mutual love of all things birth. They each bring amazing skills and talents to this work, and I'm so lucky to call them colleagues and friends! They are compassionate professionals who are eager to talk with you about how they can support your family during this transformational time.

And this is the East Nashville Doula difference! With our agency, our 3 foundational principles are: 

- It’s your birth (we provide nonjudgmental support)

- You create your birth vision (we are happy to provide great resources if you need them!)

- Your doula will be there supporting your birth and your vision every step of the way

I also hold a very strong belief that since no one can determine how long their labor will last, no East Nashville Doula family will ever be charged extra for a longer labor. Our agency has a structure in place to make sure that our families are well-supported, and our doulas are compensated for longer births. That’s just a no-brainer for us! Making our families and doulas happy is our number one priority.

I also believe in the power of education to transform people's lives. That's why we recommend childbirth education classes to all of our clients, and we offer both group and private classes to meet every family's schedule. Having the knowledge and tools you need for your birth can only lead to better outcomes.

Finally, what makes East Nashville great is community--diverse, inclusive, & accepting. I moved to East Nashville with my partner 5 years ago to find that accepting community, and it was the best decision ever! At East Nashville Doulas, we honor that spirit by proudly supporting all families who seek our services.

Support, education, community...these are the values that gave birth to East Nashville Doulas. Give us a call today if you’d like to find out more about how we can help you with your own birth story!

 

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Talking about...water breaking

Talking about...water breaking

Did you know that your water can break at any point in labor? It can happen before labor starts, during labor itself, or your baby can be born with the waters intact (called being born “en caul”). 

If we look at births on TV or in the movies, virtually 100% start with the water breaking. But that does not mirror reality! Research tells us that only about 8-10% of people (about 1 in 10) will have their waters break before labor starts. 

Many people report that they notice a difference in the strength of their contractions after the water breaks. In many cases, the water has been acting as a cushion for baby’s head, and with it gone, now the baby’s head is directly on your cervix. This is a good thing and helps your labor progress!

Did you notice a difference in your contractions before & after your water broke? Were you in the 10% of people whose labor started with waters breaking? Was your baby born “en caul?” Let me know in the comments!

"Are doulas the same as midwives?"

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"Are doulas the same as midwives?"

Probably the #1 comment I get when I say what I do: “oh, you’re a doula! Like a midwife?”

Nope! Well, we are “like midwives” in that we are both present at births. But midwives are direct care providers. More like OBs, but with a different model of care. 

Doulas are labor support professionals who are focused on providing physical, emotional, and informational support to families before, during, and after their births.

Sometimes I say: “Doulas are waist up, and midwives are waist down!” Though I’ve been known to hold a leg or massage a foot in labor :-)

Bottom line: doulas and midwives work together as valuable members of your birth team! Each has an important role to play. Contact me today if you are interested in adding a doula to your birth team!

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Talking about...early labor!

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Talking about...early labor!

My number one suggestion for my clients in early labor? R • E • S • T & IGNORE!

It’s the opposite of what you want to do, I know! “OMG, I’ve been waiting for labor to start FOREVER! Let’s start doing All The Things!” I get it. Really, I do!

Seriously, here are the facts to support this advice:

  1. Early labor is the most variable part of labor, and can last hours or days. Yes, days. So, saving up your energy is KEY to getting through this part of labor. 
  2. Like preparing for an endurance event, going out too hard & fast will trip you up later on when you need that energy for the super physical stages like pushing. Pace yourself well and it will pay off in the end!
  3. Distraction with an easy labor project like making a freezer meal for your postpartum time, or watching your favorite show on Netflix can help you to ignore your early labor until it becomes active. When you can no longer rest & ignore, THAT’S when it’s time to start your labor coping & comfort measures!

What did your early labor look like? Did you rest & ignore, or did you do something different? Let us know in the comments!

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Why you don't need a doula (but you should want one!)

Why you don't need a doula (but you should want one!)

You may be asking, "Why is a doula telling me that I don't need her services??" 

Well, the operative word there is "need." Women have been having babies since the dawn of time, and for 99% of that time, they've been giving birth with no medical help. Even if they had a midwife or other birth helper in the past, the real work of birthing a baby was done by the mama herself, in most cases.

No one "needs" a doula to have a baby. But here are 6 results from a 2012 study drawn from over 15,000 births that illustrate why you should definitely want one:

  • 31% decrease in the use of Pitocin
  • 28% decrease in the risk of C-section
  • 12% increase in the likelihood of a spontaneous vaginal birth
  • 9% decrease in the use of any medications for pain relief
  • 14% decrease in the risk of newborns being admitted to a special care nursery
  • 34% decrease in the risk of being dissatisfied with the birth experience

Did those numbers catch your eye? They definitely caught mine! In today's hospital birth setting especially, the doula plays an important role of holding space and empowering families to create the births they want.

Doulas provide the support, experience, and non-judgmental compassion that birthing families need.


Your birth story is something you will remember for the rest of your life! If you want to increase the likelihood of being satisfied with your birth experience, then you want to hire a doula. And this doula will look forward to hearing from you soon.