What Good Care Feels Like, and What It Doesn’t

Two pregnancies, side by side

Good care can be hard to name until you’ve had it. This comparison, mostly from my own two pregnancies, helps you recognize it and name what’s missing when it isn’t there.

What changed

In my second pregnancy, after the high-risk practice that had cared for me in my first pregnancy cancelled my care, I wasn’t searching for prestige anymore. I needed a doctor, fast. I found an OB in private practice out of state: a middle-aged white doctor who delivers at a hospital I would never have chosen from a ranking. I had low expectations.

My OB was professional, observant and kind. Not chatty, and not trying to be my friend. I still brought my questions and my research. I no longer felt that asking all of them was the only way to make sure the next step happened.

I have complicated feelings about who made me feel safe. In my first pregnancy, I chose a doctor who looked like me. In my second, a doctor who didn’t look like me gave me care that helped me feel much more at ease. Shared identity still matters to me. It doesn’t replace being taken seriously.

Key points

In a 2023 CDC survey, 1 in 5 people reported mistreatment during maternity care, including 30% of Black respondents. The most common form was being ignored or having requests for help refused. If that happens, write down what you asked for and when, and send it to the practice in writing.
A 2012 review of older U.S. outpatient studies found wide variation in missed follow-up of abnormal test results. It does not tell us how often this happens in a particular practice today. At each visit, ask: “How and when will I hear about these results?”
Patients judge care by how attentive it feels, more than by minutes on the clock. At the end of every visit, ask: “What happens next, who arranges it and when should I hear?”

The comparison

Items marked (me) come from my own records and experience. Items marked (research) come from published studies.

Next steps arrive before you ask. After my first infection this pregnancy, my OB scheduled a follow-up urine test to confirm it had cleared. I hadn’t asked. (me)
- Instead: You chase every next step. In my first pregnancy, I asked for the hematology referral myself. IV iron came into the plan at 35 weeks, and I gave birth before hematology could see me. (me)
A treatment that isn’t working gets changed. When iron shots didn’t raise my levels, my OB referred me to hematology for infusions. (me)
- Instead: More of the same. In my first pregnancy, my iron tablets were doubled. (me)
The referral works. It’s made, the receiving office has what it needs and someone checks that you can be seen. My OB referred me to a cardiologist they knew well, and I was seen quickly. (me)
- Instead: You get a phone number. When my appointments were cancelled, a scheduler sent me a number for booking scans at another location. (me)
Results and referrals come to you. In my second pregnancy, tests and referrals arrived as notifications, not as replies to my requests. (me)
- Instead: You find out on your own, or not at all. One study found practices failed to inform patients of 7.1% of clinically significant results, up to 26% at some practices. (research)
You understand the plan between visits. My OB gave me suggestions on supplements and on tracking my baby’s movements until the next visit. (me)
- Instead: You have the numbers but not what they mean. When I asked whether my baby’s growth percentile was dropping, I got the measurements and a follow-up scan in two weeks. I still didn’t know what change would concern my doctor. (me)
You aren’t rushed. In my second pregnancy, I was never rushed out the door, and I was far more relaxed. (me)
- Instead: You get less and less time with your doctor. In my first pregnancy, I saw my specialist less and less and didn’t understand how responsibility was shared with the physician assistant. My portal messages grew longer. (me)
You feel comfortable asking questions and declining care. These are items researchers use to measure respect in maternity care. (research)
- Instead: You hold back. 44.7% of people in the CDC survey held back questions or concerns. My own questions were recorded in my chart as too extensive. (research and me)
One named physician is responsible for you. (me)
- Instead: You can’t find out who is. After my care was cancelled, I spent weeks asking, in writing, who was responsible for my pregnancy. (me)
Your loss is acknowledged. Women who lost a twin said they wanted “acknowledgement of the vanished twin by the professional.” (research)
- Instead: It’s one line in the chart. My consultation note covers screening in detail; the loss of my twin gets one line. (me)
You’re treated with dignity, whoever you are. That’s the World Health Organization’s standard for respectful maternity care. (research)
- Instead: You aren’t. In the Giving Voice to Mothers study, 23.8% of women of color reported mistreatment, against 14.1% of white women. (research)
You relax between visits. I really enjoyed my out-of-state OB’s practice. When I needed to move back, I cried. (me)
- Instead: You brace for every visit. In my first pregnancy, I steeled myself before appointments. (me)

Take this back

To discuss with your care team:

What would you normally order next for someone with my history?
If you refer me to a specialist, who do you trust?
How will I hear about results and next steps?

To discuss with the people in your life: Have you noticed how I am before and after my appointments?

Next in the series: “Working With Your Doctor”