You just found out you're expecting a new baby! So much is changing already! You want to know you are getting the best care possible to have a healthy and safe pregnancy and birth. Open communication is extremely important between care provider and the patient/client. A good care provider will not rush out of your exam room as quickly as they can get out the door, but will take the time to discuss your questions and concerns. They will also give you tips for how to stay healthy and low-risk. They will want to know about your nutritional intake and ask if you have been experiencing any difficult pregnancy symptoms or problems. They will offer ways to deal with those concerns, often sharing the safest options first. But how do you know your care provider is truly concerned about your well-being and that of your baby? How can you tell if he or she is interested in respecting your choices and allowing you the freedom to make decisions?
I'd like to share some "red flags" that *could indicate that your care provider is not interested in you making decisions about your care, but rather wants you to quietly comply with their standard practices, whether or not those practices are backed by extensive research.
1. Your care provider tells you that you or your baby will die unless you agree to their intervention or medication they are offering. Outside of true life-or-death situations, this could indicate you are being coerced into choosing the option the caregiver wants you to choose.
2. You are told that there are no alternatives to the intervention or medication they are offering you. That may very rarely be the case, however in most instances there are a few or multiple options available to you. For instance: you are told that the only option you have when you are "one week past your expected due date" is a medical induction. However, unless there is a true medical condition or problem with mom or baby, just coming to an arbitrary date does not necessarily mean an induction is your only option. Some providers will offer testing to check on baby, have more frequent visits to the care provider, and/or have the mother monitor baby's kicks throughout the day to ensure baby is safe while they wait for labor to start on its own, if possible.(1)
3. They will not provide you with actual current research. If they have thoroughly studied the topic, there should be different articles for or against different options. They should present you with the research and allow you to choose the option with which you are the most comfortable.
4. They tell you your baby is "too big", your pelvis is "too small" or your labor is "too long" to continue. Again, there may be rare circumstances in which these may truly be legitimate concerns, however research supports that the only real way to know if baby won't fit is to give the mother the chance to labor and birth her baby.(2) It also supports the fact that labors are all unique and should not necessarily be sped up simply because they are taking a long time. If mom and baby continue to handle the labor well, it should typically be allowed to progress at a natural pace.(3)
5. They are unwilling to allow you to make decisions such as delayed cord clamping(4), hiring a doula to support you and sometimes to help you avoid pain medication in labor (5) or "intermittent monitoring" of baby during labor (6). All of those are backed by research showing improved outcomes and/or a lower need for interventions for many mothers and babies. A provider who keeps up with current research will often give you more options to choose from.
If you find your care provider is not willing to allow you to have a say in decision-making, please remember you have the option of changing providers! A good care provider will allow for open communication and will allow you to say either yes or no to decisions. You will not feel rushed or just like another number. You will feel you are respected as a person. If you are only allowed to give a yes answer but are not allowed to say no, is it truly consent at all? I would say that it is not.
This information is mainly the opinion of the author, based on several years of experience. See sources to begin your own research. It is impossible to know what the "right" decision is for every situation. I highly encourage you to speak openly with your care provider about your birth wishes. If you feel you do not understand what they are telling you, ask questions and do your own research or consider hiring a doula to help your voice be heard. Seek out a second opinion if you feel it would benefit you. Listen to your mothering instinct which will often be a helpful guide for mothers!
*There are many ways to figure out if your situation is a true emergency or not. One method some families use to tell if they are in a life-or-death situation is to ask if they can have time to think about the intervention (in that case it is most commonly a cesarean birth that is being discussed). If the family is told there is no time to think about it, mom and/or baby will be in danger if they don't act right away, the family can be fairly certain that they are dealing with a true life-threatening emergency.
Karen Gartner is a birth doula in North Carolina with over 13 years of experience helping families achieve their goals for labor, birth and beyond. She also has 20+ years of experience helping mothers with breastfeeding. As a doula and mother of 4 growing children, she has a lot of wisdom to share with new mothers and clients.