Advice to pregnant women often centers on things we shouldn’t do in labor: don’t have a convenience induction, don’t lie on your back, don’t do any number of things. I think it’s really important to give moms options of things they *can* do. Anyone can not do something, it’s what you *do* instead that matters. So with that in mind, I want to look at a few things that women should do.
Do: switch to a care provider who meets your needs, whatever those needs are.
Look at your care provider and your prenatal appointments. Do you see a different practitioner every time? Is your provider a 2-minute, in and out, doesn’t really care about you or your family, kind of provider? Is that the kind of person in whose hands you really want to place your life, and your baby’s life? Is that the kind of person who will do their best for you, or their best to avoid a lawsuit? I’m sorry to say that there are plenty of care providers who do practice this way. The good news is that there are also those who don’t. While I believe strongly in the midwifery model of care, I also know that respectful caregiving has little to do with a caregiver’s credentials, and everything to do with putting the laboring mother’s needs first. We are fortunate to have some very good, respectful OB/GYNs in our state who understand that birth is healthy and normal, not a medical event.
Especially if you are a first-time mother, you will do well to choose the kind of care provider who will do everything in their power to help you have a physiologically normal vaginal birth. While c-sections are lifesaving when needed, the risks are high for you, baby, and future pregnancies so it only makes sense to avoid one. Is your care provider going to decide that a c-section is less time-consuming, more fun, and more profitable? Often the first sign that your provider is planning to perform an unnecessary c-section on you is evident in your prenatal appointments. Dr Johnathan Weinstein, OB/GYN, says it far better than I could – This should be required reading for all pregnant women.
We all have things that are especially important to us, while we are less particular on other things. So where does your caregiver line up with your beliefs? If you are adamant on not having an episiotomy, make sure you choose a provider who rarely performs them. (There are some who do them on just about every woman – which is both unsupported by the evidence *and* just plain wrong, especially if the woman prefers her perineum intact.) Other issues that might be on your shortlist are physiological third stage, pushing in an upright position, food/drink in labor, etc. Whatever you particularly value for your labor, make sure your provider is on board. If they begin to add statements like, “Well, that’s a great goal but remember that very few women can do that in their birth” or “Insurance (or hospital) policies don’t allow us to do that” or “In my experience many first-time moms need [x, y, or z that you’ve just said you didn’t want]…” it’s probable that you’re not going to get what you want. Caveat emptor.
Often it can be hard to break up with your care provider, even when you know you deserve better care than you’re getting. We worry that they’ll be mad at us. We feel like bad patients who have let them down or somehow defaulted on a contract. Sometimes we rationalize that probably nothing will go wrong. Look at it this way: if your gut tells you something is wrong, it probably is. And you have too much on the line – your body, your baby, your future health – to gamble on a care provider who doesn’t respect you.