Recently, a study was released that found women are more afraid of childbirth than previously thought. As a doula and childbirth educator, I opened the linked article with interest, expecting to find that women were scared of pain or fearful that they or their babies may not be healthy. Instead, their greatest fears included being abandoned by their provider or that their providers wouldn’t treat them with respect or listen to their concerns. They also feared being “expected to bear the brunt of decision-making responsibility.” The article called the findings “a lukewarm endorsement at best of the maternity care given to mothers in the United States.”
One of the first choices you will make when you become pregnant – before you find out the sex or choose the nursery theme or plan your shower or hire a maternity photographer – will be the care provider who sees you through your pregnancy. Here’s a list of red flags that may indicate your provider is not the best fit for you.
- You have different goals for your birth. Are you planning to go into labor naturally? Find out your provider’s policies about induction. Is a Cesarean birth something you want to avoid? Inquire about your provider’s Cesarean rate and the reasons he/she most often performs this surgery. Are you planning an unmedicated birth? Ask your provider what percentage of her patients birth without epidurals or narcotic pain relief. This goes the other way too – I recently met a woman who planned an epidural, only to discover that her provider doesn’t “allow” them after a certain dilation (see number 2). She was unaware of this policy until she was already in active labor. She left the hospital traumatized by her birth.
- Your provider doesn’t practice client-centered care. He may use words or phrases like “allow” or “try” or “we’ll see.” An ideal client-provider relationship will revolve around shared decision-making. Are you hoping for a VBAC with this new pregnancy? How did your provider respond? A supportive provider might say: “I’ve looked at your history and think you’re a great candidate for VBAC. I love supporting women seeking a VBAC, and my success rate is high. Let’s do everything possible to help you reach your goal and still have a healthy mom and baby.” Consider it a red flag if the response is something similar to, “Well… Let’s see how things go and perhaps I’ll let you try for a VBAC.” With a trusted provider, you will come to decisions together about what is best for your baby and for you.
- Short appointment times or lack of personalized care. Are you peeing in a cup, waiting for a nurse to take your vitals and weight, and then sitting in an exam room waiting again for a provider who then spends 5-10 minutes with you, checking items off a list on his or her computer? Are you given the time to ask questions, to discuss concerns and fears, and to get to know your provider? Do you feel rushed? It is impossible to provide personalized care in such a short amount of time. Avoid cookie-cutter care that is the same for every patient.
- Dismissive of your concerns. It is frighteningly common to hear about pregnant women who brought concerns to their providers, only to have them dismissed with the response, “Well, that’s normal.” It’s true. Pregnancy DOES often bring with it a variety of odd ailments and afflictions. They may in fact be “normal.” But your concerns or discomfort should not be dismissed. A supportive provider will take the time to explain why you are experiencing the symptom and help you find ways to alleviate it. When you ask questions, you shouldn’t feel demeaned or unintelligent. The response should be in layman’s terms and absent of medical jargon. It should be compassionate. You should feel like you are being heard.
- Poor communication. Is it easy to reach your provider outside of your appointments when you have a concern? Is there an on-call number for you to reach him/her directly? If not, how quickly do you get a phone call back? It should be easy to reach your provider 24 hours a day, and this communication should be welcome and encouraged.
- Lack of evidence-based care. Do you find yourself having to advocate for things you know are best practice? For example, intuition and an overwhelming amount of evidence support the golden hour after birth (baby skin-to-skin with mom and no one but the parents touching baby). Is this standard practice for your provider and hospital? What about delayed cord clamping? Intermittent monitoring? Be wary of a provider who labels you as high-maintenance or even high-risk for questioning or declining certain practices and interventions.
- Bait-and-switch. This is the hardest one to prepare for, and the one that happens so heartbreakingly often. Maybe you were told that your hospital has L&D rooms with beautiful tubs. But you weren’t told that you can’t get in one if your membranes have ruptured. Or that they don’t have waterproof monitoring and you will have to get out of the tub every time a nurse needs to check heart tones. Or that you can’t actually birth your baby in the tub – it’s just for labor, not birth. Or that only some of the rooms have tubs and there’s a chance you won’t even have one in yours. Were you told intermittent monitoring is acceptable and available? Does that mean the use of a wireless Doppler during contractions? Or does “intermittent” mean 20 minutes out of every hour spent on your back in bed with two bands around your belly while you are denied freedom of movement. Were you promised a “birth center” and instead given a dressed-up hospital room with all of the same hospital protocols and interventions you were trying to avoid? Did you choose a respected doctor who is an amazing surgeon but doesn’t support physiological birth? Did you, looking for a natural approach, choose midwives but find that they aren’t practicing the true midwifery model? That they order unnecessary tests and ultrasounds? That they have a financial stake in your birth and it influences your care? If you’ve experienced any of these red flags, consider looking for alternatives. Pregnancy, labor, and birth proceed best in a calm, peaceful, environment free of stress. If you are entering your birth experience already on the defense, or you’re caught off-guard by surprises you weren’t prepared for, you’re creating stress hormones that will impede labor, opening the door to the cascade of interventions, poorer outcomes, and dissatisfaction with your birth experience as a whole.
- It doesn’t feel right. This is the last item on the list but arguably more important than all of the others combined. Trust. Your. Gut. Do you feel anxious at appointments? Does your provider use scare tactics? Do you dislike calling him or her because you feel like are being a bother? Did your provider call you by the wrong name or forget an important detail about you or your pregnancy? It may not be quantifiable, but you know something doesn’t feel right. Or… is the opposite true. Do you look forward to prenatal appointments and get a warm, fuzzy feeling when you tell your friends about your provider? Do you chat like old friends and hug at the end of appointments? Do you pop into the office just to say hi, greeted by smiling faces happy to see you? Is the office staff pleasant on the phone and in person? If all of these things are true, you likely have no need to worry about 1-7 above. But if you sense something is off, or you sense you need more from your care, honor that instinct and explore other options. It’s almost never too late to switch providers or birth locations and choose a provider who is on YOUR team. Don’t take your chances and promise to do something differently “next time.” This birth counts too.
Diana Petersen received her journalism degree at the University of Arizona. She is a DONA-certified doula and Lamaze-certified childbirth educator at Babymoon Inn, an accredited birth center and full-scope midwifery practice in Phoenix, Arizona. For more information about Babymoon Inn, please visit http://www.babymooninn.com. To follow Babymoon Inn on Facebook, click here.
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