Take Charge of Your Care
You have a choice before you. You can participate in the awesome responsibility of decision making for your care during pregnancy, labor, birth and for your baby, or allow routines and standards to determine your care. It’s easy to assume that “what is” must be “what’s best.” There must be a good reason why so many doctors require routine ultrasounds during pregnancy...why so many labors are induced...why women with a previous cesarean surgery must have another cesarean. It’s for the safety of the baby, right? Not necessarily.
It’s easy to forget that just a few decades ago, hospitals routinely used practices that we know now are useless or even harmful. They banned partners from delivery rooms; they separated babies from mothers immediately after birth; and doctors held newborns upside down by their feet and smacked their little bottoms. These practices ended because women asked questions. Unfortunately, there are other ineffective and harmful practices that continue today.
You have a wonderful opportunity before you to work with your care provider to create a plan that is right for you. You know yourself better than anyone. You know your individual circumstances, values and desires. You can weigh the benefits and risks of any course of action while taking into account your personal situation, your beliefs and gut instincts, and the advice and opinions of trusted sources.
Deciding what’s right for you and your baby often means asking questions respectfully, such as:
- What is the reason for this procedure?
- How do you do it?
- What are the possible benefits?
- What are the possible risks?
- How effective is this procedure?
- Can I rely on the results of this test or will I need more tests to confirm the findings?
- What are my other options?
- Does my current caregiver offer those alternatives or will I need to find another care provider?
- Will my caregiver support my choice? If not, would I consider switching care providers?
Fortunately, there is usually plenty of time to make informed choices. Unless something truly is urgent, you can ask for a few minutes, hours or even days to make a decision. Your caregiver should give you the privacy to think it over without feeling pressured.
Communicate openly with your care provider, respect one another and share information. If you need more information, or more time to make a decision, say so. You will get the best care when you and your care provider are equal partners. All of this is easier when you and your care provider share a common philosophy of pregnancy and birth.
Adapted from The Official Lamaze Guide: Giving Birth with Confidence.
ASK AN EXPERT
Question:
My friend suggested I ask my doctor how often she performs cesarean surgeries, episotomies and induces labor. Is this important? How do I know what the “correct” numbers should be?
Response from Debra Bingham, MS, RN, DrPH, LCCE:
Your friend has given you good advice. Knowing if how often your doctor performs interventions such as cesarean surgeries, inductions and episiotomies can tell you a lot about their style of practice. More importantly, it can tell you if you are at increased risk of having one of these interventions—and suffering possible harmful side effects. It may or may not seem intuitive that if your doctor cuts episiotomies 50 percent of the time, you are very likely to have an episiotomy. Research tells us that a lot of the variation in intervention rates has nothing at all to do with the women themselves (such as their health status, pregnancy complications or preferences), but rather with the practice style of the care provider.
This helps explain why women cared for by midwives have lower rates of many interventions compared with similar women cared for by doctors (Midwives tend to have a “low-intervention” approach and use natural or supportive techniques whenever possible). However, you can't assume how high or low the rates are just by what type of provider you are using. There is a lot of variation in cesarean, induction and episiotomy rates even from one provider to another. Additionally, policies and practices in hospitals and birth centers can affect intervention rates, so there is wide variation from facility to facility as well.
But, it gets even a little more complicated than that! Some providers, including some midwives, specialize in the care of high-risk women. The cesarean rate in high-risk women may be higher for good reason -cesarean surgery may be necessary and unavoidable in such women. Similarly, factors such as whether the woman has previously given birth and her age may naturally affect rates of obstetric interventions as well as health outcomes. Your provider’s rates may be higher or lower because of these factors. However, even in mixed-risk populations, there are some good rules to go by.
A recent review of the research found that:
- The overall episiotomy rate can be safely 5 percent or less.
- The overall cesarean surgery rate can be safely 15 percent or less.
- The overall rate of labor induction can be safely 10 percent or less.
This means that any hospital or practitioner with rates higher than these is probably intervening too often. While the likelihood of requiring one or more of these interventions will vary with individual circumstances, if your care provider’s rates are equal to or lower than those listed above, you can trust that provider’s judgment should she recommend intervening in your case.
If your doctor won't tell you his or her intervention rates, or the rates seem too high, don’t be afraid to search for a care provider whose practice style - and rates - suit you better. It may turn out to be the most important choice you make in your pregnancy.
Debra Bingham is a leader in the field of maternal and child health nursing. She is a passionate advocate for quality improvement in maternity care. She currently works as a project director for a state-wide maternity care quality improvement program in California and has completed a doctoral degree in public health, focusing on leadership in health care quality improvement.
HEALTHY TIP
Finding Strength by Letting Go
In pregnancy, as in life, there are many unknowns. You may worry that the alcohol you drank before you knew you were pregnant has affected your baby. Or, perhaps you’ve had a miscarriage before and fear that may happen again. This anxiety, while normal, can cause you to lose trust in your body at a time when you could be honoring the remarkable work it is doing.
One way to cope with a case of the “pregnancy worries” is to have some daily quiet time with your baby. Set aside 15 minutes each day to love your baby and yourself. Send loving thoughts to baby, quietly visualize baby growing inside you or repeat positive affirmations to yourself, such as, “I am growing a healthy, beautiful baby.”
TESTIMONIAL
“In my first pregnancy, I was one of those women who just decided to go with the program. I didn’t feel in control of my choices, and I trusted that my doctor had my best interests in mind when he offered to induce me a week before my due date just to make sure the baby didn’t get “too big.” I realize now that I had many choices I didn’t even know about then. This time around, I changed to a different doctor and I am going to be asking a lot more questions! I’d rather seem pushy than put up with another bad birth experience.”
– Renee
RESOURCES
“I believe in the power of accurate information to help women make the wisest choices for themselves.”
– Judy Norsigian, co-founder and co-author of Our Bodies, Ourselves
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