by Kimberly Ambrose

of Open To Birth

 

Not all doctors are in it just for the money, and not all midwives are old-world, hunched-back women with tinctures and buckets full of towels. Most health-care providers are very intelligent, capable and highly dedicated people who love helping others to be their healthiest. However, we’re also talking about the American Healthcare System, which as we currently know it, is not its healthiest. From limited insurance to inadequate care, we’ve all been through it. How many of us have experienced or know someone who has experienced mistreatment in a hospital or a doctor’s office? How many people feel like their caregivers are not really listening to them or are not searching for alternative care methods outside of drug prescriptions? How many people have fantastic doctors, but their insurance is putting limits on what decisions they make for their health? People often come away from a doctor’s visit or a trip to the hospital feeling frustrated, dissatisfied and only half-cared for. Part of that is also because, when you don’t feel well, you yourself are not the most enjoyable to deal with, but we’re not talking about a broken bone or an illness. We’re talking about the normal human process of childbirth. When it comes to the medical treatment you receive from the beginning of pregnancy throughout the delivery and postpartum period, trusting your caregiver is one of the most important parts of your experience. Not only do you have the right to feel safe and respected in the hands of medical professionals, but you are also trusting your life and the life of your child to your caregivers. I don’t want to be overly dramatic, but this really is a life or death situation. If you don’t think your doctor or midwife has your well-being at the top of their priority list, you could be in a dangerous situation. From unnecessary interventions to unnecessary surgery, as a consumer of healthcare services, it’s your job to advocate for yourself, find the best healthcare provider for you and express your needs to your care team.

The saying throughout capitalism is, “the customer is always right. Well, if you’ve ever worked behind a desk, behind a register, or at the side of a table, then you know that the customer is most definitely not always right, but more often than not, they get their way. When it comes to medical care, it’s not as easy to give the customer exactly what they want. If a trained obstetrician tells you that you need to have a cesarean due to a medical issue, even though that is not how you wanted to give birth, you still have to go through with the cesarean, because it is medically necessary. If you planned on getting an epidural, but your labor goes faster than you had planned and you miss the window to get the epidural, the doctor’s job is to tell you that you have to deliver without it. Not having the birth that you want is a possibility, and you want to trust your care-provider like you trust your closest friend, to be able to tell you what you don’t want to hear when it’s necessary and because it’s what’s best for you. No obstetrician, gynecologist or midwife can give you the birth that you want. That’s not really the issue. The bigger problem is when you don’t have a positive or safe birth experience because the care-provider did not have your best interests in mind.

When an obstetrician, a nurse, a midwife, an anesthesiologist or a birth doula puts themselves, their policies or their income before your wellness and your family’s wellness, they have stepped over the boundaries of a professional medical interaction and have abused their client. I know a couple who’s birthing doula left their birth before the mother had delivered because she had somewhere else she needed to be. The doula did not send a backup and neglected the couple, breaking the contract of doula services. I know a woman who delivered in a hospital, but had her baby caught by her own mom, because the doctor and nurses did not show up for the actual delivery. I know a woman who was held down by nurses after her husband had left the room to go to the bathroom so someone could check her cervix without her consent. I’ve heard stories of cruel anesthesiologists, insensitive surgeons, judgmental nurses, improperly trained midwives and unprofessional doulas. All birth professionals are just people, and people make mistakes. Highly trained or not, sometimes a person’s best intentions get derailed by fatigue, money troubles, inability to balance life, etc., but there’s no excuse for any birth professional to go outside the boundaries of the Hippocratic Oath to Do No Harm.  It’s your job as the patient and as the customer to protect yourself by speaking up for yourself and making your wishes for your birth be heard. You should have confidence in your care-provider and trust their judgment. It’s your responsibility to find a doctor or midwife you trust so that, if they do need to make a medical decision, you’ll be able to trust them in that moment that what needs to happen is what’s best for you. If possible, you should feel included in the decision-making when it comes to your birth, your body, and your baby.

How do you know if you can trust your maternal care-provider? By asking your OB or midwife questions when you first meet with them, you can understand their personal style of care. Does the hospital you’re going to birth at have a high cesarean rate or a low cesarean rate? Does the midwife you’re interviewing have privileges at a nearby hospital so you can transfer to a hospital if something goes wrong? What are the hospital’s policies? Do you have to be hooked up to a fetal monitor? Will you be allowed to get out of bed and move? Does the obstetrician perform routine episiotomies on every mother? Will you be allowed to eat or drink something other than water? Getting to know hospital policies and a midwife’s protocols for labor and delivery are very important for figuring out if birthing at a certain location or with a certain care-provider is going to be best for you. If you choose to give birth at a facility that has a rotating staff, like a hospital or a midwife group, you may not know who you will be working with on the day of your delivery. This is a good reason to come up with a written birth plan that you can hand to your nursing staff so they can communicate your preferences for your labor and delivery to the OB assigned to your case. If you are working with a doctor or midwife that you know for sure will be attending your birth, a birth plan is still a good idea, so you can present your preferences when you have your first interview with them. When you get the chance to interview and choose a care-provider, you get the opportunity to make sure that their style of care matches up with your personal preferences for how your birth is handled. Birth plans should be simple, with the most important information presented first and in a manner that is easy to read. The most favorable birth plan is only about one to two pages. You can also simplify your birth plan by simply stating what your preferences are to your care team.

Many people see doctors as authority figures. They went to medical school, and they know the human body better than anyone, so whatever they say goes. Some people even think they’ll get in trouble with a doctor if they don’t do what they’re told. A doctor is not the health police. A doctor is a guide for healthy living. No one should bully or pressure you into making decisions that you are uncomfortable with when it comes to your health. You can ask as many questions as you need to in order to feel confident. You can ask for a second opinion. You can ask to wait a few minutes before agreeing to anything. There’s a difference between being stubborn and advocating for yourself. It’s okay to say that you are not okay with something. Either what your care-provider is suggesting is absolutely necessary, or it’s not, and you could always try other alternatives. You should trust your care provider, whether it’s an obstetrician, a certified doula or a midwife. You should trust that they know what they’re doing, that they have your best interest in mind, that they will take your individuality and personal requests for your birth into account, that they will be honest with you and that they will be there when you need them.

As the patient or customer, you’re responsibility is to ask the questions you need answered and not assume your caregiver is going to automatically know your needs. It’s also up to you to understand that, if your doctor or midwife thinks something is necessary and you’ve worked together to take every step to avoid it, you may have to do something you don’t want to do, like have a cesarean section or give birth with or without an epidural. In the same way that it takes a village to raise a child, it takes teamwork and a dedicated net of support to bring a child through a woman. By working with a birth team that you trust, you can relax and leave the medical care up to them, while you do what you need to do to bring your baby into the world.