Working Parent 411: Building an Open & Trusting Relationship: You and Your Pediatrician

Soutiens' Sarah Douglas recently had the opportunity to chat with Ariana Witkin, MD - a board-certified pediatrician and motherhood transition coach. Pulling on her experiences as a physician and a mom, Ariana shared thoughts on how to pick the right pediatrician, how to have open and honest conversations with your pediatrician even around difficult topics (hint: your "why" matters!), and shared how she's providing comprehensive support for expectant and new moms as a motherhood transition coach.

Ariana Witkin, M.D. is a board-certified pediatrician and motherhood transition coach. She helps expectant mamas feel equipped and empowered for the transition into the fourth trimester by providing expert, holistic education and support from pregnancy through postpartum. She works clinically as a newborn hospitalist outside of Boston. She received her bachelor's degree in Anthropology from Brown University prior to completing her M.D. at Mount Sinai School of Medicine. She did her pediatric residency at Seattle Children's Hospital, University of Washington. Her work has been published in Hospital Pediatrics and KevinMD. To learn more or to work with Dr. Witkin, visit her website, and follow her on IG @arianawitkinmd.

Audio Transcript

Sarah: Hi and welcome to our Parenting 411 video series where we’re bringing you interviews with experts that we think really contribute to the lives of working parents. I’m Sarah Douglas, and today I’m joined by Ariana Witkin. She is a board-certified pediatrician, and she’s also a motherhood transition coach where she helps expectant parents (mothers) feel equipped and empowered for the transition into the fourth trimester by providing expert, holistic education and support for pregnancy through postpartum. Ariana, I’m so glad you’re here with us today. I’m really excited to talk about this blending of pediatrician and motherhood coach and how that provides a completely holistic journey for new moms. So thanks for joining us today!

Ariana: Yeah, thank you. I’m super excited to be here.

Sarah: I first want to pick your brain as a pediatrician because for a lot of parents, choosing a pediatrician is a huge deal for them. It feels like a really daunting task, and they seek out all sorts of advice from friends and family, neighbors, and anybody in the community as to how to pick out the best pediatrician for them. So, from your perspective, what should parents take into consideration when going through this process?

Ariana: Absolutely. There are a few things. As you said, choosing a pediatrician can definitely be overwhelming. It’s really one of the first major decisions that you as a parent are making about the health of your child.

I think the first thing to know is that there is a national standard for pediatricians, and you want to choose a pediatrician who is board-certified by the American Academy of Pediatrics - by the AAP. The way you can tell if a pediatrician is board-certified is that they’ll have the letters “FAAP” - a Fellow of the American Academy of Pediatrics - after their name. And really what that means is that they’ve fulfilled the standard requirements for being a pediatrician and are still a member, which to me shows their commitment to continuing education, learning, and advocacy. So that’s thing number one - making sure they’re board certified.

Tip number two, I would say, in general, it matters less where someone went to medical school, and more what their practical experience has been. You touched on this a little bit, but I’m a huge fan of asking people who their pediatrician is. If you have a friend who has a similar parenting style as you, or you know their family values are similar to what yours are, ask them who their pediatrician is. The best test is if a family has a pediatrician who they love and that they’ve been pleased with their care. So that’s tip number two - getting referrals.

I had a mom actually last week who asked me for a recommendation for a new pediatrician. She had just given birth to twins. She had a c-section, and she was describing to me her first office visit with their pediatrician and she described how the office staff watched her struggle with getting in the door with her double stroller and taking out the babies and just the whole time feeling like they were not being attentive and aware that she had just had major surgery and trying to navigate these two babies. Something like that where it’s just not something you’re going to find Googling or even talking with a provider beforehand. So really asking someone what their experience has been like is key.

The third thing, I would say, is that practically speaking, you absolutely want the pediatrician to have a convenient office location. There are SO many visits that first year, that if it takes you 30 minutes to drive there or you can’t get there during rush hour because traffic is just insane, that’s not going to work. For my daughter, we chose a pediatrician we could walk to and I was so grateful that we did that. For anyone who has a baby already, you know that getting out of the house with a newborn is a process, so if you’re trying to get there for a sick visit, last minute, or running late, you want to be able to get there quickly. So convenience is definitely key. I think other practical considerations, like if they take your insurance, if they’re open on nights and weekends if that’s something that important to your schedule, is really important to consider.

The final thing I would say is that it’s really important to pay attention to your gut. So what do I mean by that? Maybe you’ve chosen an office close to your house, it’s your best friend’s pediatrician who has similar values to you, the pediatrician they love, and it’s someone that’s board-certified. That’s a great start, but that doesn’t necessarily mean that they’re going to be the right fit for you and your family.

Okay, so how are you going to figure that out? Call the office. When you call the office before your baby is born, before you have your baby, how does the person who answers the phone answer the phone? Is it a person that answers the phone or is it an automated answering service? When you do finally get ahold of someone, ask if you can schedule a “meet & greet” with the doctor. A lot of practices will do this where the pediatrician will meet with you ahead of time so you can see if you might be a good fit. If your practice doesn’t offer that, ask if you can schedule a time to speak with the provider on the phone. If you can’t schedule a time or you’re kind of getting the runaround, pay attention to that. That might be a sign of what it will be like to try to get ahold of the provider after you do have the baby.

If you are able to meet with them or talk with them on the phone, ask questions that matter to you. So, for example, if you know that you want to breastfeed, ask your pediatrician what their breastfeeding or feeding philosophy is. In-depth breastfeeding education is not actually a standard part of pediatric training. So if that’s something that’s important to you, ask your provider what their experience has been, if they’ve sought out continuing education on this topic, or whatever your question is. Just pay attention to how they’re answering your questions. Does the doctor seem rushed? Does she answer all of your questions? Does she make you feel heard? Do you feel validated?

After I had my own baby, I wanted to call every patient I’ve ever had and apologize. It’s so different to work with other peoples’ children as a pediatrician and learn things from a textbook than to have your own. So you really want to work with someone who gets that, and I think the only way to suss that out ahead of time is by meeting with them or talking to them.

So, to summarize, the four tips that I would give are you want someone who is board-certified by the American Academy of Pediatrics; you want a convenient office location and other practical things, like insurance, to consider; you’re going to ask people for referrals, and really trust in your gut.

Sarah: Perfect, absolutely perfect. I think it’s really helpful to have that in a step-by-step process of things parents should be considering. Because there is a lot and you want to make sure that you have a pediatrician that you can be open and honest with, and that you can have those hard conversations with. Even if you don’t anticipate needing to have them, at some point, something is going to come up and you’re going to need to feel really confident that you’re working with someone that has the best interests of your family in mind. So, what a wonderful way to start off. Thank you, that was absolutely great.

Ariana: Good, I’m glad it’s useful.

Sarah: In continuing in that line of thinking about listening to your gut and having open and honest conversations, there are definitely some conversations that are hard to talk about, either because we feel like we’re stigmatized by them or we don’t have the “right” answer or we’re doing something that goes against conventional wisdom. So things like cosleeping, extended breastfeeding, circumcision, immunization schedules, and things like that. What’s the best way to go about talking about these topics with your pediatrician so that you are able to maintain that open and honest relationship?

Ariana: Yeah, so this is a great question. I think it’s really important to highlight for people that these things do come up and they are definitely things that they should be discussing with their pediatrician. As with most things, I think the best way to communicate with your pediatrician is by being direct, open, and honest.

So let’s take your example of cosleeping. I had a (coaching) client recently who was a physician herself, who was cosleeping with her baby. She was telling me she disclosed this to her pediatrician and that the doctor was horrified and surprised and did not hide the fact that this is how she felt. She had all these feelings that she had this patient who was a doctor who was cosleeping. And when the client was telling me about this, she was crying. She was so upset. She was exhausted. She has a newborn, and when I started asking her questions it came up that her baby just would not sleep alone in the bassinet, so that meant the baby wouldn’t’ sleep, she wouldn’t sleep, her partner wouldn’t sleep, nobody was getting sleep, and the only way for any of them to get rest was to cosleep. So in my opinion, her pediatrician really missed an opportunity there. She missed the opportunity to share how to make cosleeping as safe as possible. It’s not that my client didn’t know the safe sleep recommendations, which are that newborns should have their own sleep space, separate from their caregivers. It was just that that was not working in practicality for her family.

So whatever your hard question is, cosleeping or something else, ask it.

Remember it is our job as pediatricians to hold that space between what the research says, what the recommendations are, and what is practical.

Also, try to remember that you’re likely not the first person to be asking your questions, so if you feel shy or embarrassed, try to keep that in mind. If your pediatrician can’t live in that gray area with you and acknowledge that some recommendations aren’t right for every family, don’t be afraid to seek out a new pediatrician. That might seem like a hard and daunting task, but absolutely if you feel like the relationship is not working for you, seek out somebody else. You want someone who can speak not only from their medical expertise but from the practical perspective as well.

The second thing I would say is that it’s also really important to share your why.

People have many different reasons for making certain decisions for their family, and if you share your why you’re giving your provider that much more insight into your particular values and family dynamics, which is only going to help them better tailor the recommendations to your specific situation.

So, again, if we take the cosleeping example, maybe it’s because like my client, your baby cries all night, and the only way for anyone to get any sleep is for the baby to sleep in your bed, or maybe it’s because you’re doing Attachment Parenting. Those would be two very different reasons that would lead you to make the same choice, and reason that you’re telling your provider will really help them better understand and guide you going forward.

Lastly, the most important thing is that your pediatrician should listen to you. They shouldn’t interrupt you and they should let you get out your thoughts. They should be respectful. They should ask you follow up questions, and they should not be judgemental in any way.

Sarah: I think even just hearing that parents should be trusting their gut and should be seeking an outside perspective if things don’t feel right - just the permission to be able to do that is freeing. I feel like sometimes parents get so stuck with a provider that they don’t really like but they’re so afraid of offending that person by moving to someone else or by questioning their pediatrician’s attitude toward a certain or particular issue. I think it’s just enlightening to hear that from a pediatrician to say “it’s okay, go find someone else to listen to”.

Ariana: Yeah, absolutely. Don’t be afraid of hurting anyone’s feelings. This is your child. You should make the decision that is best for your family.

Sarah: So I’m wondering if we can transition a little bit now because I know you also do this motherhood coaching, and I feel like that’s an amazing thing to be able to offer to people to help provide that continuity of care but in a slightly different way. Can you tell me a little bit about the services you provide, why those services are important, and what gap you’re filling?

Ariana: Yes, thank you. As you said, I am a motherhood transition coach and consultant. I help expectant women feel equipped and empowered for the transition to the fourth trimester. In our culture, women and mothers are undervalued. That’s just a fact. So at its core, what I do is about elevating motherhood in our society and illuminating the value in giving women, in particular, the tools they need to recover postpartum, bond with their newborn and thrive as they make this huge transition.

I solve two problems for my clients. The first is that there’s no one person that supports women from pregnancy through their postpartum journey. In the traditional medical system, pregnancy, the postpartum period, and newborn care is fragmented. I have an 18-month old daughter, and when I was pregnant and going through my own postpartum I had an OB, a doula, a lactation consultant, a night-nurse, a pediatrician. So that’s 5 people. On the surface, I had a lot of support. But it wasn’t coordinated. There were all these individuals coming in, telling me different things. No one was thinking about the big picture and holding it all together. Which meant I had to hold it all together and hold that uncertainty and anxiety and it was too much. It was overwhelming.

The second problem is that clinical pediatricians will not talk to parents, other than these “meet & greets” that I mentioned earlier, they will not answer questions about your baby before your baby is born. I’ve had many clients who have tried. Recently I had a client who contacted her pediatrician because she had questions about her mom maybe visiting from across the country when the baby was born, and she wanted to talk through some different scenarios in terms of what the risk would be to the baby if she were to have visitors. So a great question, super relevant, really important to have that information before the baby is here. But she was told by the doctor’s office that the doctor could not speak with her or answer her questions until there was an actual baby. So, again, what a huge missed opportunity! What a disservice. She called me instead and we talked through what the actual risks are, in terms of the baby getting sick, what would happen if the baby did get sick or get a fever in those first few weeks, but also her very real need for support postpartum and what she was comfortable with in terms of reconciling those two things and those risks.

So really I combine my lived experience as a momma myself and my professional training and expertise as a physician to empower my clients to make the decisions that are best for them and for their families.

I started my company because throughout my medical training I witnessed a lack of humanity, really. I’ve seen mothers be terribly mistreated, but I also have countless stories of moms who are the most unbelievable advocates for their children.

I had this one patient in training with a rare disease and she had a life-expectancy of less than a year. When I was working with her she was already two. Her mom was an amazing advocate. She discovered that CBD oil actually was very helpful to the pain crises that were associated with her child’s particular illness. At the time, in the hospital that I worked, it was against the policy to use CBD. So every time this patient came in, her mother had to push and push to get us to use the one thing that she knew would help her. Through her tireless advocacy, her research, her knowing her child - it comes back to knowing your child - we were eventually able to incorporate CBD into her child’s care plan. So that’s just one example of many, but this lack of humanity in the traditional medical system combined with my own experience as a mom, which has been hard and really overwhelming, is really what motivated me to shine a light on the lack of support on this motherhood transition period.

So to go back to your question of how I work with clients, I generally start working with clients in the last month of pregnancy. I know you have children. Imagine the month before you’re having a baby, so you’re 8-months pregnant, you’re anxious, you’re overwhelmed, you’re excited. There’s probably a stack of pregnancy and parenting books next to your bed. I think for me, I had everything from the Mayo Clinic Guide to Pregnancy to all of Emily Oster’s books. I took notes in the margins. I folded over pages. You have all this advice, not just from books but from friends and family. Suddenly everyone you know that has a baby is an expert in parenting. So you have all these ideas and philosophies, but how are you going to choose what’s right for you? Maybe you think you know what your parenting values are, but what does that mean for you in practice? Oh, also, your nipples are giant and dark, and you want to breastfeed, but you don’t know how to be successful. Who do you ask about all of this? Is this normal? Where is your tribe of these mommas? You know they’re out there, these smart, drive women that are undergoing these massive transitions. So that’s where I come in.

Imagine having someone you can go to not only for questions about your baby but a space to explore your parenting choices in a nonjudgemental and practical way. So imagine you don’t just have a birth plan but a postpartum plan for after the baby is here. What strategies and resources do you have? How are you going to utilize them? If you’re postpartum and your baby is crying all the time, won’t sleep in her bassinet, breastfeeding is painful, you’re exhausted, you’re lost, you don’t have time to do that thing that grounds you - whether it’s exercising or cooking or knitting or whatever it was - you’re probably fighting with your partner because everyone fights with their partner when they have a new baby, how are you going to get through that? So now we’re talking every week, not only answering your questions about your baby but we’re addressing how we can utilize this plan that we crafted before the baby was born.

You’re really navigating your transition to motherhood in an empowered way and prioritizing caring for yourself in addition to your family.

Sarah: I think that’s an amazing service. I know that I get frustrated with childbirth education classes that end with birth because it doesn’t end there. That’s an outcome, but that’s really just the beginning of everything else. So I think what you’re providing for new moms is an incredibly valuable service.

I have to imagine that you are a well of information for new families, and you probably have more advice to give than anybody else. And you are certainly well qualified, probably more qualified than the rest of us, to give any sort of advice. But what’s your favorite piece of advice, as we close here, to share with expectant moms as they’re headed to this amazing journey?

Ariana: I love this question. I believe that you are the expert in your baby from the moment that they’re born. You’re going to encounter a host of “experts”, right - doctors, nurses, friends with kids, your own parents - they’re all going to tell you lots of things may seem right for kids in general and may or may not be right for your child. So yes, it is the pediatrician’s job to be an expert on development and medicine and illness, but you know your child best. And that’s my biggest piece of advice. So if something your pediatrician says doesn’t sit well with you, if it feels like it doesn’t really align with your values or your parenting style or it just not great for your family, listen to that feeling. This goes back to listening to your gut. Speak up. Ask questions. Seek out a second opinion. Talk to other parents about their experiences.

In a world where there is no shortage of parenting resources, it is so important to trust yourself as the expert in your child.

You can find conflicting opinions about anything, right? From sleep to feeding to childcare. You need to tap into your knowing. If you’re the birth parent, you’ve known this child every day for nine months, if you’re not the birth parent - if you’re the partner or you’re adopting - you have spent time and energy invested in and thinking about your child, and you really are the expert.

Sarah: I think that’s an amazing way to close out. I know we often tell expectant parents that you have both the honor and the responsibility to make the decisions that are right for your family, but only you alone can make those decisions. You have to honor who you are as an individual and how your family works together in order to make those decisions that are right.

So, as we close today, thank you so much for your time. I really appreciate it. I think this is really helpful for expectant parents everywhere.

Ariana: Thank you.