Three Different Care Provider Relationships

This is a post from our archive, written by Sheridan. It’s a great resource for helping women determine the type of relationship they want to have with their maternity care providers. -Lani

There are three types of care provider relationships.

Often when a mom thinks about choosing a care provider for her birth she thinks about two things: what kind of care provider she wants and where she wants to give birth. I think it is equally important to look at the type of relationship* you have with your care provider.

Here are the three types of relationships:

Authoritative – In this relationship the Care Provider (CP) is in charge. CP tells the mom what will happen. If the mom has any questions or concerns about it, CP may not even take the time to address them. Instead, because CP is not used to being challenged, CP will try to scare her or shame her into doing what CP wants.

Partnership – In this relationship the Care Provider sees him/herself as a partner with the mom. CP may tell the mom what s/he would like to happen or what CP’s normal routines are. If mom has any questions or concerns about it, CP takes the time to listen and answer questions. S/he treats the mom with respect, and s/he is open to doing things outside of his normal routine if it is what mom wants. (CP may have restrictions within the bounds of a certain framework- for example if mom is having a hospital birth, her care provider may be bound by certain hospital rules, etc)

Mother-Led – In this relationship the Care Provider takes his/her lead from the mother. She tells CP what she would like and CP provides it. If mom has questions or concerns CP is happy to discuss them with her and will support and trust her intuition as she finds a solution. CP is a resource for mom to go to for support.

What might this look like?

Let’s look at what this may look like in a hospital setting with a mom discovering her baby is breech at 36 weeks.

Authoritative – Mom discovers baby is breech. Care Provider says, “We will have to do a cesarean.” Mom questions if there are any other options? Care Provider says, “The baby is breech and can not be born this way. Do you want your baby to die? The safest thing to do is have a cesarean.” If mom does research and finds out about External Version and brings that idea to her Care Provider, CP may get angry that she did research about it and may or may not help her try external version. If baby doesn’t turn CP will force her to have a cesarean, by using scare tactics instead of treating her respectfully. (If you think I am exaggerating about this, just go read some of the quotes from “My OB said WHAT?”)

Partnership – Mom discovers baby is breech. Care Provider says, ‘We may need to do a cesarean.” Mom questions if there are any other options. Care Provider says, “There are some different things you can try at home. We could try External Version, there are some pros and cons to that.” He then explains those and lets moms choose what she feels is best for her. If baby does not turn they have more discussions, if mom really wants to try a vaginal breech birth, the care provider may not be able to attend mom due to hospital restrictions, or lack of training. CP will be honest about the situation, “15 years ago you would have been a good candidate for vaginal breech birth, but today our hospital is not comfortable with that risk.” Mom is left with little choice and has a cesarean. She hopefully feels respected through the process and this helps her adjust to and accept her cesarean.

Mother-Led – Mom discovers baby is breech. Care Provider says, “What would you like to know about breech babies?” Mom asks her questions and does some additional research and lets her Care Provider know what she wants to do. If baby does not turn they have more discussions. If mom still wants to try a vaginal breech birth, her Care Provider will help her to do so. CP may not be able to personally attend (due to hospital restrictions, or lack of training), but will help her find a care provider that can help her have a vaginal breech birth.

What affect could this have?

Can you see how these different relationships could affect a mom’s birth experience? Will her birth be a positive experience for her, or a negative one? Will it empower her or break her down?

We read in Proverbs 12:18:

“There is one whose rash words are like sword thrusts, but the tongue of the wise brings healing.”

Care providers should bring healing, starting with their words, which will greatly affect the kind of relationships they have with the women they care for.

What kind of relationship do you have?

Interestingly enough, many people assume that OBs have authoritative or partnership relationships with their patients and midwives have partnership or mother-led relationships. However, that is an incorrect assumption. You need to look at your relationship with whatever care provider you have. There are authoritative midwives out there, so don’t assume because you have a midwife you will have great support. There are also OBs out there who are mother-led.

It is important to figure out what kind of relationship you want with your Care Provider and then determine which kind you have! Ask questions and follow your intuition to determine if the relationship you have is a good fit for you. If you are not happy with it, you can change to a new Care Provider that will give you the type of caring relationship you want and deserve.

***I did not come up with this idea, however I did change the names of the three types of relationships – you can read a 21 page paper on the Technocratic, Humanistic and Holistic Paradigms of Childbirth, by Robbie Davis-Floyd or a simpler version about the Philosophical Options of Birth.