When you’re pregnant after a loss, you may find you want a new doctor or midwife. Maybe you lost trust in your previous doctor due to the circumstances of your loss. Or maybe you are now classified as high-risk and your previous midwife won’t be able to take you on. Maybe you have moved to a new city, or your doctor has since retired. If you’re one of the many people who would like to find someone new to work with this time around, here are some tips on finding a doctor or midwife for pregnancy after loss.
First, remember that the doctor-patient relationship is just that: a relationship!
There are some wonderful, kind, caring, knowledgeable providers who simply are not a good fit for your needs. This isn’t a reflection on either you, or their skills. It is simply a matter of difference in personality. Just like when going on a first date, meeting with your practitioner is a chance to get to know them and determine if things will work out. They shouldn’t be offended if you choose someone else.
If you have a good relationship with your family doctor, you might want to start there for a recommendation. You can be open and honest about your fears and they will probably have heard through the grapevine who is going to be the better fit for your needs, either because they are known for their sympathetic ear and patience with emotional anxieties, or because they are specialists in caring for people with your medical condition. Hopefully, they should have an idea about your personality and needs and can help you find a good match. Asking friends and family may be helpful too, but chances are they haven’t experienced a loss like yours, so their needs may be very different.
If you’ve decided that you want or need an obstetrician, you can go online.
In the United States, you can get a list of obstetricians from the American Congress of Obstetricians and Gynecologists web page. Unfortunately, there is often little information about their particular area of expertise, but unless you’ve had additional complications (eg. you’re a cancer survivor), you’ll be looking for a Maternal-Fetal Medicine expert.
You may be interested in choosing midwifery care instead.
Midwives may be a better choice for you, because they often have time for longer appointments. They may come to your home, rather than you having to go to a clinic. Midwives also deliver postpartum care. Current practice indicates that “most women should be offered midwife-led models of care, although caution should be exercised in applying this advice to women with substantial medical or obstetric complications.” (italics mine).1
Many people who’ve experienced a stillbirth, early neonatal death or multiple miscarriages are considered high risk, whether the cause was found or not. So, depending on your circumstances, a midwife may not accept you as a patient. However, if this is something that interests you, it doesn’t hurt to ask. Even if you are not a good candidate for midwifery care, just like your family doctor, a midwife will have insider knowledge about which obstetricians are good to work with and can make a recommendation. Just as you would when choosing a doctor, you’ll want to ensure that your personalities work well together, and you can ask for recommendations from family and friends. In the United States, you can find a midwife through the American College of Nurse-Midwives, or through your state association.
In some instances, family doctors also do obstetrical care.
The positives are that these are people you’ve likely already built a strong relationship with. Like midwives, they likely have time for longer appointments and are located in small towns and rural areas, not just large hospitals. Fewer and fewer doctors are willing to do obstetrical care, but again it is worth asking if you think this might be right for you.
When arranging for an appointment, let the administrative assistant know that you’ve had a loss and will need a slightly longer appointment time. This will both give the doctor or midwife the heads up that you aren’t a typical patient, and ensure you’ve got time to have all your questions answered. Remember, this initial consultation is your chance to determine if you’re a good fit, so don’t be afraid to ask questions and don’t be offended if things don’t work out the first time. You may have to meet with a couple providers before you find the one that’s right for you. If possible, bring someone with you. Your spouse, your sister, anyone you can trust who can help you get a sense of whether this is a good fit for you.
Whether you choose a doctor or midwife, they should be taking three things into consideration when making decisions related to your care:
- The best available research evidence related to your issue.
- Their own expertise and knowledge
- Your values and preferences.
When you meet with your practitioner, they should be familiar with the latest research and be willing to investigate answers to your questions, no matter how obscure. The second element, their experience as a practitioner, is important too. Their education, and knowledge of local circumstances, can make a difference in your care. Lastly, the third issue is understanding your needs and desires. They should listen to your concerns, understand them, and work with you to find a solution. They should be able to explain their decision making in a way you can understand and help put you at ease. If you feel your questions are dismissed, or if they are not explaining the tests and procedures in a way you can understand, as well as any risks and benefits of these procedures, then it is okay to walk away and find someone else.
Lastly, whether you choose a doctor or a midwife, they should also be someone who works well with others. My obstetrician was quick to refer me to a Nurse Practitioner and a Social Worker for additional emotional support. If you have additional medical concerns, they may need to work with other specialists. Ask what other professionals they will be working with to ensure you get the care you need.
Doctors and midwives are there to help guide you through your pregnancy. You’ll want to be sure that your partner on this journey is someone you can trust.
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1. Hatem M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care for childbearing women. Cochrane Database Syst Rev. 2008(4):004667.