The unfortunate reality is that the labor room is one of few places where the paying client often has to fight with their provider to deliver the service they are requesting. It's easy to assume that medical advice is based in sound science and therefore should be followed. However, what we know about science changes rapidly - procedures and practices that were once common practice as "best for mom or baby" become nearly obsolete as we learn more. See: routine episiotomies, routine use of forceps, and thalidomide to name but a few. Some doctors still recommend outdated practices, and sometimes a good Google search really does know better than their medical degree. Additionally, second opinions are standard of practice in nearly every realm of healthcare (except childbirth). And that's because opinion does come into play in medical care - nothing is black and white, and the outcomes of any procedure, intervention, or lack thereof, are never fully known until after the fact.
This is where self-advocacy comes into play. Sometimes your gut, your research, or the advice of another provider, tells you to go against the advice of your physician or midwife. The question becomes: HOW do you do that?
The short and easy answer is that you simply stick to your guns. The truth is, you're allowed to do that, and no doctor or midwife is allowed to provide any medical care without your consent. You can just say no to anything. It sounds so simple.
But sadly, it often isn't that easy.
The reality is that it's hard to stand up for yourself during labor and birth when faced with a disagreeing medical provider standing in front of you. You feel vulnerable, unsure of yourself, responsible for your baby's safety, and often a loved one or partner is present and the fear tactics used by you medical provider sway their support, undoubtedly out of their love for you and your unborn baby.
As you prepare for your birth, here are a few tips for advocating for yourself in the labor room:
Choose Your Birth Team and Location Carefully
As someone recently said in The Birth Zone Group on Facebook, "when you choose your provider you’re choosing whatever their typical outcome is." If your provider has a 40% cesarean rate, that means there's a HUGE chance you'll end up with a cesarean birth. If your provider has a 90% induction rate, you can almost bet you'll be convinced of the need for an induction. The same goes for your birth location: hospitals are going to have a highly medicalized and time-management approach to labor, vs home or birth center options. If you want all the medical bells and whistles, hire an OB who manages lots of high risk pregnancies, and deliver at a hospital with a level 4 NICU (where they care for the most vulnerable and premature infants). If you'd prefer a more natural or hands-off approach to your labor, consider hiring a midwife and having a homebirth. There's a lot of gray area in between, such as hiring a nurse midwife for a hospital birth, or delivering at a birth center.
Have a Birth Plan
Call it birth wishes, birth preferences, or a birth plan... I don't care, but we all know what I mean. Some people feel like having a birth plan sets you up for disappointment and a sense of failure when the unexpected inevitably comes up, but a birth plan is an enormously helpful tool when it comes to advocating for yourself. First, you'll use that written birth plan to help guide a conversation with your OB or midwife prior to labor, at a prenatal appointment. This will give you an opportunity to hear their opinions about your wishes, and figure out if there are any hot button issues you need to iron out before you're in the middle of labor. Additionally, your birth plan will serve as a compass for YOU during your labor. When you aren't sure what to do next, you'll have a birth plan to fall back on.
Ask Lots of Questions
Often asking questions is the first way to diffuse a potentially tense situation, and begin making a case for advocating for yourself. The following questions can help in most situations when you're being offered a change of birth plan that you don't want:
Take Time To Consider Every Decision
When a provider suggests anything that deviates from your birth plan don't give an answer immediately unless it is a true immediate emergency situation (which are rare). Let your provider know that you'll need time to think about this recommendation and/or to discuss it with your support person. Examples might be when your provider offers to start pitocin or break your water to speed up the pace of your labor. This extra time pushes the pause button for a moment while you really consider what you're agreeing to, so that you're in charge of the change of plans rather than feeling pressured in the moment.
Hire a Doula
Like how I embedded this one in the middle of my list? I didn't want to lead with it, because it seems so self-serving, but it's also way too important to leave it last on this list. The truth is that everyone feels more empowered when they have someone on their side in the room, and it's a huge bonus FOR YOU if that person isn't a close friend or family member whose emotions are getting the way. A doula will recommend birth locations and medicl providers who are in line with your wishes, help remind you of your birth plan throughout your labor, remind you to ask questions about risks and benefits for any proposed procedure, and will ask if you need time to consider any suggested deviations from your birth plan. Basically all the first four suggestions I listed will become much MUCH easier with a doula by your side.
Do Your Own Research
Knowing the research and statistics for yourself allows you to feel empowered and confident in your decisions, even if they go against your provider's advice. My favorite website to research best practices in birth is https://evidencebasedbirth.com/. It's easy to use their search feature to see the research on most topics about pregnancy, labor, and birth, including induction for big babies, induction for being past your due date, VBACs, and many more.
When All Else Fails
You have rights! No is a complete sentence, and it should be respected by every medial professional. If saying "no" isn't doing the trick, try saying "I don't consent to this." Finally, every hospital room should have the phone number posted for the patient advocate. This is an employee of the hospital whose job is to help sort out problems patients are having. I usually recommend going up the chain of command first, but if you're getting resistance don't hesitate to reach out to the patient advocate.
Reporting Problems After The Fact
Sometimes people choose not to continue "fighting" while in labor, for a variety of reasons including feeling broken down and bullied into the advice they didn't want to take, feeling vulnerable to retaliation, or being unaware of their rights. When this happens, you have options after the fact of reporting the bullying or mistreatment you experienced. You can report medial professionals to the medical group they work for, as well as the hospital where you were treated. It may feel as if this "goes nowhere," but the only want to make change is for more and more people to start speaking up about their experiences, and demanding better.
Doula life is unpredictable, but almost always busy! Every day looks different, but for those who are interested, here's a fairly typical series of days while on call for a birth.
Last Tuesday around 5pm: On the way to a prenatal appointment my doula partner (Karissa) and I had with a client who had been in prodromal (i.e. very long and slow) labor since Friday. Her surges were finally picking up a bit. I let her know we'd be near her house for two prenatals that evening and to call when/if she needed me as I'd be the one attending her birth.
5:30-7:00ish: We had a great time chatting with our clients at our first prenatal meeting of the night. We finalized their birth plan, and Karissa taught them several acupressure points to use in labor.
7:00pm: As we were walking out of that meeting my phone rang and it was our client in labor. Things were progressing, but she wasn't ready for me yet. I had her stay on the phone chatting with me long enough to hear her through a few surges, and I had a feeling it wouldn't be long until she asked me to come over. (Doesn't my doula mobile look cute?)
7:30pm: We arrive at our second prenatal meeting of the night. This couple had chocolate and strawberries for us!!! I got exactly one bite into my first strawberry when my phone rang again. This time it was the husband of the laboring client. That typically means it’s go time (when mom is too busy laboring to call me herself). Sure enough, he reported that she was ready for me.
As I was about to zip out the door the client at our prenatal meeting kindly put some homemade soup into a mason jar for me since I hadn’t eaten dinner yet. Karissa and the couple at our meeting joked that I should take a selfie while driving and drinking my soup. We all deemed that ultimately unsafe, so instead I took a soup selfie before getting into the car - blurry because I wasn't taking time for photo ops on the way to a birth.
I did end up drinking the soup as I drove to my laboring client's home, and I ended up VERY grateful for that soup as I would have very little to eat over the next 24 hours! (And it was DELICIOUS!)
8:00pm: I arrived at our laboring client’s home to find her snuggled up in a cozy robe on her bedroom floor, with lavender oil diffusing, and peaceful lullabies playing as she was eating dinner while leaning up against her bed. She felt safe and comfy - perfect! And she was EATING - important because the hospital would discourage her from eating once we arrived.
Her surges had lessened in intensity so her husband was worried they had called me too soon. I assured him that following his wife’s lead and calling when they did was the right thing to do. After prodromal labor it can be hard to believe it’s the “real deal,” but I could tell.
We spent the evening alternating between walking, lunging, in child’s pose, and resting.
12:30am: The couple talked and together made the call that it was time to go to the hospital. We drove separately and I grabbed some Taco Bell on the way. (Note: it’s harder than you’d think to find food in the middle of the night).
When I arrived at the hospital I changed out of my not-labor-friendly boots into a ratty old pair of gym shoes I keep in my trunk for just this occasion. They aren't pretty, but I was grateful I had them.
We spent the remainder of the night continuing to labor much as we had at home. I set-up fairy lights and fake candles and turned off the lights in an attempt to keep the environment as safe and cozy as it at felt at home.
People often ask if I sleep at labors. I do when and if I'm able, but often I don't. If my client is resting peacefully and there's a place to close my eyes for a few minutes I will. I also follow my own advice for my clients: when the estimated due date is approaching take daily afternoon naps so you're rested if labor starts that evening.
8:00am: Another client went to a different hospital for a scheduled induction. Karissa was handling this case. Throughout the day she and I texted many times sharing progress updates and suggestions regarding our two labors.
8:00pm: 24 hours after my arrival at their house the night before, mom delivered a beautiful and healthy baby girl!
9:30pm: After getting baby latched for her first feeding, helping dad hold his daughter skin-to-skin, and answering questions from the nervously excited new parents, I said my goodbyes and slipped out just before they were moved to their postpartum room.
When I returned to my car I removed my mask (yep, I'd worn it the entire time), and then I laughed at my front seat filled with my discarded water bottles, Taco Bell bag, and empty soup jar.
Karissa still had a long night ahead of her, but I was headed home to bed.
Thursday: Karissa’s client also delivered a beautiful and healthy girl!
And that night, as I was about to fall asleep trying to catch up on my sleep, I ended up awake until past midnight talking my client through some challenges with breastfeeding and jaundice 24 hours past their birth.
So all in all that’s actually way more than a single day. But that’s #doulalife. It never really ends.
And I love it.
There's a secret about cesarean births (at least in the USA).
How many people do you know who had an "emergency cesarean"?
Probably a lot, because over 30% of births in the US are surgical vs vaginal. And many of those aren't planned - otherwise known as "emergency cesareans." Right? Wrong.
NOW THIS NEXT PART IS IMPORTANT: If you had a cesarean birth you are ALLOWED TO CALL IT WHATEVER YOU WANT!!! If it was an emergency to you, then it was an emergency. This is not meant as judgement on anyone's previous birth experience.
THIS POST ONLY APPLIES TO FUTURE BIRTHS. When planning for your birth experience it's important to know that there is a vast difference between an URGENT/UNPLANNED cesarean, and a true EMERGENCY cesarean.
A cesarean is typically recommended by your health care provider for a variety of reasons, usually surrounding your safety or your baby's safety. It could be risk of infection, heartrate issues, a less-than-ideal position of the baby making pushing difficult or impossible, and sometimes maternal fatigue after a long labor. Sometimes this is a true emergency situation: all hands on deck, rushing the pregnant person into the operating room with very little time to breathe or think about what's happening.
But many, many times the reasons are URGENT, but not an immediate emergency.
When you believe it's an EMERGENCY situation your fight or flight instincts kick in, typically placing the physical health of your soon-to-be- born infant above your own physical or mental well-being. Welcome to parenthood! You'll do this many, many times in the future years.
The only problem with this scenario is when there isn't a true emergency. Believing you're in an emergency situation when you aren't floods your body with unnecessary stress hormones, which can have a negative effect on you and possibly your baby. It causes the more rational and analytical part of your brain to take a back seat while the fight-or-flight center takes over - this may cause you to not process information appropriately when hearing the risks and benefits of the surgery. Finally, the urgency that accompanies this "emergency" belief causes us to skip steps that might reduce our overall stress and raise our satisfaction with the overall birth experience.
Consider for a moment what a difference it might make if, when your provider suggests a cesarean birth, you clarify that this isn't an immediate life-or-death emergency situation.
This is a MUCH more gentle approach, and you deserve to have the gentlest birth experience possible. Emergency cesareans ARE sometimes necessary and I don't certainly don't mean to invalidate anyone's previous birth experience. April is Cesarean Awareness Month, and with such a high rate of cesarean births in our country, it's important to be fully prepared for this possible outcome.
Unless you want to!
"I'm just going to check you quick."
"Just a quick stretch and sweep."
These procedures come by many names. But they're all basically the same thing: at a prenatal appointment in your last weeks of pregnancy your medical provider sticks his or her fingers in your vagina and feels around, presumably to tell how ripe/open/thin your cervix is. Sometimes they do more (with or without your consent) to manually stretch out your cervix (sometimes called a "stretch and sweep" or "membrane sweep" or some variation thereof).
Here's the thing: this procedure prior to labor provides zero useable knowledge. Literally zero. (Because it can change AT ANY MOMENT).
And... it comes with risks. Most notably, a risk of infection to you or your baby, a risk of unplanned breaking of waters (premature rupture of membranes or PROM), uterine irritability (lots of useless contractions or braxton hicks), and just plain old disappointment (because, honestly, no matter what info your doctor gives you it's never good enough when you're just ready for your baby to be in your arms).
So.... pregnant people... just stop letting people stick their fingers in your vagina without a solid reason.
Solid reason = your pleasure. Or knowing that some useable knowledge will come of it.
Unfortunately, as much as we'd all love to have a crystal ball, no one knows when labor will start, or how long it will last. Even your doctor (or midwife). Even if they have their fingers in your vagina.
Anyway, as always, I recommend you do with this information whatever YOU want. If you enjoy cervical exams, if you believe the snapshot of current information will relieve your anxiety, then by all means... go for it! Truly. No judgement.
But for those who find it invasive or uncomfortable... just fucking say no.