How can I tell my gynecologist I don't want her to be part of my pregnancy without hurting her feelings?

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Photo by *ejk*, used under Creative Commons license.
My husband and I just decided we wanted to start planning for a family (we are both 28 and healthy, active people). However, I have an IUD and my next gynecologist appointment isn't for four months, so we figure that is when we will start actually trying.

We moved to our current city three years ago and I basically picked a gynecologist at random for my annual exams. She is nice enough but I think I want to go with a midwife, home birth, or birthing center. I am the kind of person who doesn't like to hurt feelings and I am basically afraid that if I go to my regular doctor for the preconception checkup, I'll get talked into going through the whole pregnancy with her and end up doing the hospital thing.

Is it weird to see my regular doctor for a preconception checkup knowing I don't necessarily want her to be my OB? Do birthing centers do those kinds of checkups and should I find one prior to getting pregnant to avoid the above awkwardness? Do most couples pick an OB/midwife before getting pregnant, or am I putting the cart before the horse? — Andromeda22

  1. I think now is the perfect time to switch to a midwife. They are much more than "baby catchers" and will help you through all your pre-conception planning and post birth care. I have seen a midwife to insert my IUD, and for a breast infection.

    3 agree
    • I wanted to add that if you find a midwife who is in the same health care system as your regular OB, you may not even have to deal with transfering records.

    • This doesn't apply if you're in Canada, where midwives only do pregnancy, birth and postpartum (at least, that's how it is in Ontario, and most other provinces).

      However, even if you're in Canada, you do want to contact a midwife earlier rather than later, since there are not enough of them to meet the demands in most regions.

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      • I'm also in Canada and I've tried this but the response is that they won't see anyone until they're pregnant, but call them as soon as you are because they fill up fast. I got a naturopathic doctor, who can run all the same pre-conception stuff and provide mid-wife like support pre-conception. She's been great. I live in Victoria BC, by the way).

        Given how different jurisdictions are, I'd say to start calling around a bit and see what the clinics have to say. Some have open houses for potential clients.

        Even if you do go through your normal doctor for the pre-conception stuff, it might be really good practice for you to have to stand up for what you want out of your pregnancy – you're probably going to get pushed in a million directions anyways so this might be a good way to assert yourself – if she's professional, she's not going to cry or guilt trip you. The worst is that she might try to scare you into the western medical system instead, and the thing is that you don't even have to argue – just say "I'll take that into consideration. If we decide not to go with a midwife when I get pregnant, I will call you."

        1 agrees
        • I agree~~
          I'm also working with a fabulous naturopath in Brampton, ON and she's helping me get ready for conception and increasing my chances of ovulating through natural interventions. Plus, your gyn is a professional and you are entitled to care for your body the way YOU want! Good luck!

  2. Not sure if you've checked, but she might not even do OB- not all GYNs do. I imagine it's very normal for people to switch to a different medical provider once they are pregnant, the same way they do for any number of reasons (moving, insurance, etc). I wouldn't think you'd even need to explain it to her.

    7 agree
    • Very true – my GYN didn't, and although she was willing to refer me, I found someone on my own.

    • True, my GYN was only a GYN, but she just assumed I'd be staying within the practice when I told her the good news (I'd been seeing her for cycle problems that magically fixed themselves). So I still had to have that conversation. I just told her that I wasn't sure yet where I wanted to go for prenatal care. That was a lie, of course. But easy peasy, no hard feelings or awkward silences.

  3. I just had a water birth at a birthing center that supported me through the entire pregnancy. You'll enjoy your pregnancy and birth so much more! Don't get bullied into something you don't want! Its better to be a good parent than a good patient!

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    • Point of order – choosing a natural birth does not make you a better parent than someone who chooses a medically assisted birth.

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      • Hey Kim! Just wanted to chime in and say that Offbeat Mama's celebration of all kinds of births (check out our birth stories if you haven't) should show that we agree completely. This is a non-issue on Offbeat Mama. We don't judge birth choices or outcomes.

        You may enjoy a few of our wonderful hospital birth stories: http://offbeatmama.com/tag/hospital-birth

        3 agree
  4. Going with a certified nurse-midwife from the start might be best. Many even do well-woman care if you want to make a permanent switch. Don't feel bad about switching if you aren't 100%–your relationship with the person delivering your child is a very intimate one!

  5. Once you select a midwife you're comfortable with, they may ask you to see an obgyn for a couple of pre-natal visits anyway, in case you'd like an ultrasound, or in case there are complications with delivery, you may end up being rushed to hospital anyway. It's good that you have some type of relationship with an OB just in case.

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  6. Like people said above she may not even do OB, because it's pretty much a 24/7 job. If you don't wanna hurt her feeling just explain to her you would like to have a medically unassisted birth, she may be able to recommend a midwife to you. I'm sure she would understand that you have other options you would like to take advantage of. It's also a good idea to have a doctor monitoring your pregnancy along with the midwife. That way if there is an emergency there is a doctor that is familiar with you and your pregnancy. Trust me you don't want some random doctor you don't know making those decisions.

    1 agrees
    • I'm not sure about other midwife groups, but the one I worked with had an OB who backed them up in emergencies. That might be a question to ask when you are looking for a midwife. Who is backing you up? Can I meet this person?

      Another thing to look into is events to meet the midwives. In my area they have these once or twice a month, and host a Q and A at the end.

      1 agrees
    • We were switching insurance from Kaiser to PPO during my pregnancy so that I could go to a birth center and possibly get some money back (so much for that!), but in the meantime I had an OB/GYN with Kaiser and had to explain to her that I was going somewhere else. She was surprised but was totally fine with it. Then, at the last minute, the birth center rejected me because of high blood pressure, and while in labor I was sent to a hospital I had never been to before. I had visited what was supposed to be my back up hospital and was horrified, and in labor, I refused to go! I was worried about what the hospital experience would be like, and working with OB's and Midwifes (they had both at the hospital) I had never met. Turns out I had nothing to worry about. They were incredibly awesome, and I wish I had known about this hospital before I bothered with the birth center. So, you never know what's gonna happen!

      1 agrees
  7. Do you have to tell her that you don't want her involved?

    If it bothers you, can't you just not book another appointment with her after your next appointment?

    I have experienced a lot of times that people are afraid to hurt the feelings of hair stylists/doctors/ personal trainers etc, but they are professional and most often act like it. You don't have to explain yourself, but if you do, just give her a simpel " I have had good medical service from you, but I want to go a different route on my pregnancy".

    5 agree
    • I totally agree. It's her job as a doctor to care for her patients. Specifically NOT to let her emotions get in the way. If you'd be more comfortable getting your care elsewhere, the doctor should support you in that decision.

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      • And if she ISN'T comfortable with you checking out other options after you've explained your decision…it might be time to check out other OBGYNs to find someone who is more in line with your philosophy.

        1 agrees
  8. When my husband and I decided we wanted to start a family, I totally abandoned my old gynecologist and found a home birth midwife that did well woman exams. My previous gyno would not have been on board with a home birth so I made the best decision for my family, not for my gyno. I switched and got pregnant a year later. I am now 30 weeks pregnant and my midwife just found out that her license has been suspended by the nursing board because she had 3 transports in 2 months (because everyone knows transports make you a bad midwife) so I had to abandon all the plans I had meticulously set up and find a whole in midwife at 30 weeks! Big ordeal!

    All I can say is do not worry about hurting anyone's feelings. It is your body, your baby, and your birth. If you are uncomfortable with your current gyno, you should not feel guilty for switching.

    • You know, it never even occurred to me to check my midwife's current license status. I just did, and she's in the clear, but it's a good reminder when choosing a new practitioner!

      1 agrees
  9. You are definitely NOT putting the cart before the horse. I scoped out different birth centers and midwives (and daycare) about 6 months before we started trying to get pregnant. Because of waiting lists, I had a wellness visit/checkup with the practice of midwives I wanted to go with so we were guaranteed to have them as our midwives 3 months later when I did conceive.

  10. I wouldn't worry about hurting her feelings. When I told my doctor that I was going to see a midwife for my pregnancy, she said that I was the perfect candidate for a midwife birth. Being young and healthy, sounds like you are too and I'm sure your doctor will be understanding.

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  11. I switched from my OBGYN to a midwife/birthing center when I hit my second trimester. I wanted/needed to stay with a doctor for preconception and first trimester because it took a number of drugs to get pregnant and then stay pregnant through the first trimester (stupid PCOS.) Once we were sure that the baby was going to stick, I just made an appointment with the birthing center and had them call my doctor to get my records. I didn't ever actually talk to my doctor or even the office because I don't like confrontation and I didn't want to have to explain my choices. It was all very painless.
    If I end up needing to go back to a doctor because of risk factors popping up (I'm only 6 months pregnant now) or an emergency during the birth, my midwives have said they can recommend doctors that they work with often.

  12. My husband and I are trying to conceive. We haven't picked an OB yet – in the past I've done my yearly gyn checkups through my regular family doctor, who definitely doesn't do OB care, so I'll be choosing a new provider (hopefully!) soon. Keep in mind that this woman is your Doctor, not your friend. It's her job to care for you in a way you're most comfortable with, not get offended or take your decisions personally. Surely she's had the experience of a patient switching to another provider before – as a gynecologist (and esp. if she has kids of her own) she knows that birth and prep for it is a very special, personal process. Once you've conceived you can find an OB or midwife who really gels with you and your plans for pregnancy/birth and just tell your doctor to send over your records – you don't have to tell her why you chose someone different, and even if you decide to you can just tell her that you chose her as a doctor when it was just you who needed care, but now that it's you AND a baby, you wanted to plan for both your care.

    You could certainly start your search for an OB/GYN before conception. But if you and your husband are both healthy and expect no problems getting pregnant you could also probably wait, as Himself and I have.

  13. I think this is a great question! I did a lot of research when I moved to my current city. I knew I wanted a homebirth with CNMs who were connected to a hospital and credentialed there (just in case). I knew I wanted a practice where they did well woman care and fertility management as well as baby catching. I started seeing my current midwives almost 3 years before I became pregnant. That said, I have a primary care doc who I LOVE. He is wonderful and I trust him implicitly. But, alas, he does not do homebirth nor is he a provider at the only hospital in town that does breech birth (again, just incase). Thus, I told him how much I appreciate his care but informed him I was going with the midwives and I hoped he would still be my doctor for everything not related to "lady land". He laughed and said of course. He has been VERY helpful thoughout this pregnancy as I have had some odd heart rhythms and he was able to evaluate me without my having to go to a cardiologist but at a higher level than the midwives could.

    I know this is a bit different because you are talking about your current OB/GYN. I don't think you need to explain yourself to her at all. People change providers all the time for many reasons. Most providers have pretty thick skin, if it even registers at all. I would say, take the time to shop for a midwife or a practice that covers the things that are important to you. If you are really feeling stuck, even planned parenthood will remove your IUD. If you are headed down the homebirth/natural birth path you are really going to want to find a provider that feels good. Take your partner with you so that he can get a sense of the vibe too. My husband LOVEs our midwives. This is a big evolution in your life and you deserve and have the responsibility to be in the care of a team you trust with your and your baby's life.

    Also just an FYI. Some women do not take long to get back into regular cycles, and get pregnant right away after IUD removal. My husband and I were SURE we would have 6-12 m of trying before we got pregnant….we had 5 weeks. It was overwhelming and a bit of a hard start for us so just be warned. Everyone had told us it would take a long time but it was lightning fast. Best wishes!

  14. Seriously I think you're over thinking this. Unless she were a family friend or something I can't imagine her being put out that you want to go elsewhere. It's pretty normal, especially when you want a midwife. Don't worry about it. Have your IUD removed, ask her if she can recommend any midwives. She might surprise you.

    5 agree
  15. I saw an OB-GYN for my 8-week pregnancy checkup and then a midwife for the rest of my pregnancy. Granted the doctor wasn't someone I'd known for years or anything, but she was COMPLETELY on board with me going with a midwife.

    What you have to remember is that you have LOTS of reasons to choose a midwife-assisted birth that have nothing to do with how you feel about your current doctor. Her feelings wouldn't be hurt if you went to an optometrist instead of her to get glasses, right? You're looking for a service she doesn't provide.

    If she is a jerk about it and tries to convince you to do a hospital birth, you can always avoid the issue afterwards. 😉

    1 agrees
  16. I'm the type of person who goes out her way to avoid hurting other people's feelings, so I get where you're coming from. The thing to remember though is that she is not your friend; she is a professional providing a service to you. And if she's a good professional, she won't take it personally. You've decided that you want to go the midwife/homebirth or birth center route, which is not what she's providing, so it's reasonable that you'd want to switch to a different provider. She may even be able to recommend some resources or midwives to you. If she is not respectful and supportive of your choice, then take that as a sign that she's the wrong OB/GYN for you.

  17. I haven't read the other comments, so sorry if I am repeating, but this is not the sort of thing that doctors get too upset about. In fact, if I was you, if I respected her as my gyn, I would ask her for a referral to a good midwife/birth center. Chances are good that she has much experience with other local providers.

    This will be good practice for you in being a parent. You will often need to be direct with people – doctors, teachers, etc. to advocate for your child and getting all worked up over hurting someone's feelings seems to make it worse. I think most people appreciate when you are honest and direct.

    Good luck finding the best provider for your family!

    6 agree
  18. I know that you're trying to avoid confrontation, but your current OB can probably help you here. Especially if she is open to home births and midwives, she may be able to refer you to a midwife in the area who she trusts. Plus, like others have said, it would be beneficial to have someone you know as a back-up OB (assuming she is an OB) in case of a breech birth, etc. in the off-chance that you'd have to be transferred to a hospital.

    1 agrees
  19. As a doctor (anesthesiologist)I can say that you should just switch and not waste any energy worrying about it. You can even switch now and have a midwife pull your IUD (an extremely simple procedure, by the way) and not worry about seeing your GYN again. If you've only seen your GYN once or twice, there's a good chance that your GYN doesn't even remember who you are without looking at your chart because she probably has a couple of hundred patients. Good luck getting pregnant!

    2 agree
  20. I think it's a great time to switch! Also, if your IUD has slowed or stopped your cycle, you might want to get it out sooner, if timing of your pregnancy is an issue. I had the mirena IUD and it stopped my cycle altogether. I was otherwise totally healthy, but it took 10 cycles to conceive, and I suspect it was because my body was slowly getting back it its groove after the IUD.

  21. You have one OB but your OB has hundreds of patients. If she is offended (which I doubt) then she'll get over it. You PAY her to do your exams, unless you two are friends outside of the office I wouldn't worry.

    also, I switched providers at 22 weeks pregnant because I didn't like how I was being treated. Best choice I could have made!

  22. I began going to my midwife (a CNM) long before I got pregnant. There are three women in the practice and I saw them for "well-woman care" starting when I was eighteen.

    Make the switch– you won't regret it.

  23. Remember this throughout your preconception, pregnancy, birth and postpartum: Those who mind, don't matter. Those who matter, don't mind.

  24. I'm speaking from the point of view of someone who works in the medical system: you should have an honest talk with your GYN and explain what you want. She won't feel hurt, it's her job to make sure that her patients receive the care they need and want.

    1 agrees
  25. I switched after my obgyn did the first check up to confirm conception. It wasn't a big deal (except that I could have avoided the unneccesary genetic testing she does for everyone what an expensive pain in the ass) iUD was removed in her office and my pregnancy in the midwifes office has been treated vastly different and I'm beyond thrilled that I switched. I'm much more comfortable and they really go put of their way to help….. Anyways I love my birth center and although my Obgyn was nice her high tech low touch philosophy was not in line with what I needed, I never once felt guilty didn't feel like I needed to tell her.

  26. I'm not sure if this was mentioned before but it doesn't hurt to continue seeing a doctor for a few appts during your pregnancy whilst seeing your midwife regularly. I was going to discontinue care with my obgyn after 20 weeks and solely see my midwife but was advised that it might be wise to continue (infrequent) care at the hospital. That way if for any reason a transport is necessary ( or pre-term labor etc) then they have more of a medical history for me on file. It's completely up to you but it might be nice to have both kinds of care if you can swing it financially so you feel fully prepared for any outcome. But definitely make sure your obgyn is on board with your medically unassisted birth…you want extra support, not someone you need to convince of your choices.

    1 agrees
  27. I interviewed and settled on a homebirth CNM (nurse midwife) before we even started trying to conceive our 3rd baby. After my first two miserable OB experiences, I wanted to make absolutely certain that I was going to find a provider that I gelled with before we got pregnant (and railroaded) again. My midwife does all the well-woman care I'd need as a low-risk mom, so I didn't feel the need to see an OB at all. She ordered labs, ordered ultrasounds, etc, etc. Unless I need gynecological surgery, I can't imagine needing an obstetrician for the rest of my life.

    I have known lots of moms who use a midwife for prenatal care, and also keep their OB as a backup just-in-case. Unfortunately, in all of those cases I've always seen the OB wag their finger at them for using midwifery care at all. If you can find an OB who's not a douche (and knows they work for YOU, and not the other way around) then by all means, use both when necessary.

  28. I did this exact thing. Actually, my IUD removal ended up being with the nurse practitioner in the practice so I didn't have to see my regular OB before switching. Once I became pregnant, I made appointments with two hospitals with midwifery practices affiliated and one birth center. I was planning a (successful!) VBAC so I went with the hospital. The records were transferred and I was all setup with midwifery care for my prenatal visits. Unfortunately, my water broke at 35 weeks so the midwives had to hand me off to the OBs at that hospital at the last minute, but they still checked in on me to make sure I was being treated nicely and they are doing my post-partum care and IUD insertion.

    Just know that it really shouldn't be a problem as long as your new care provider takes your insurance and stuff. Good luck finding a care provider that you love! And I hope you have a healthy and awesome pregnancy!

    Can I also interject- look into hiring a doula in case you do have to transfer care to an OB, mine was really awesome, especially considering the huge change in plans. I also lucked out on getting a really awesome nurse who totally respected my wishes to go au naturel as much as the preterm labor situation would allow. She never asked once about my pain level or epidural desires during active labor, she asked my preference when we first met and knew i wasn't into that.

  29. I agree with lots of previous comments- this is the perfect time to switch to a midwife. MOST midwives do well-woman care (in the US) and a certified midwife is certified to do well-woman care. Plus, it can be super-awesome for your prenatal care for your care provider (midwife) to know you before you become pregnant. Lots of benefits. Plus, a certified midwife has a relationship with a hospital in case of emergencies. That is part of their job.

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