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 Some doctors still recommend outdated practices, and sometimes a good Google search really does know better than their medical degree.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.