I was talking to a woman the other day about her birth. She said to me,
“I did not ask too many questions, I pretty much did what the doctor said." When I asked why she did not ask questions she replied, “Well I know my doctor would never hurt me, she just wants the best for me and my baby."
In theory this woman is right. She should be able to trust her doctor to put her health and that of her baby’s first and foremost. What she does not take into account is how busy her provider is, and how different the doctor’s views of pregnancy and birth might be from her own.
Women take it for granted that every care provider is the same and assume that all providers have the same knowledge, talent and training. In reality every provider brings with them different training, talents and views of pregnancy and birth into their practice. Because of their busy schedule most providers look to extended training seminars or other office staff to keep them current on new research and techniques in the birthing environment. You may even find providers who refuse to change a certain practice or technique to new or research proven methods because of comfort. This creates very different forms of care, possibly even in the same practice. The type of care providers available in the obstetric field is as diverse as the women seeking care from them.
The problem is, every day in hospitals across America women are subjecting themselves to procedures, protocols, policies and needless interventions with little or no information on choice. Having a baby has become ‘a business.' This business is formed around policies that create an assembly like environment. The bottom line has become the focus of attention and birth as a business has grown to gigantic proportions. Providers see so many pregnant women in their practice that they need a chart to remind them of who they are and what care they have been receiving. These women are not seen as people, but charts and cases, liabilities that must be taken charge of. Many providers spend less then 5 minutes a month with these women and yet feel confident to make major life changing decisions for them without thought of choice or will. All pregnancies, births, mothers and babies are treated exactly the same. The fix has become the focus not prevention. Problems are not foreseen and prevented, but treated at their worst moment, generally in a very harsh and controlled environment. Knowing this final fix is available eases both provider and parents minds but comes at a much higher cost then preventing such issues would cause for both mother and child.
Interventions such as routine vaginal exams, induction and assisted deliveries have become so commonplace that the average woman rarely questions them, let alone refuses. Inductions are done is such a number that they are no longer questioned. When after spending only 55 minutes on average with the mother, the provider insists this is the best way for the mother to have her baby; she does not question the medical necessity. She does not ask why, and no further explanation is given. The provider speaks as if there are no adverse effects to the early birth of a baby and assures the mother of how often induction is done and how many healthy babies are born. Talk of premature birthing; distress or surgical delivery risks are glossed over. The mother does not question the reasoning and never considers that there might even be an ulterior motive of convenience behind the induction.
It is not that this woman is being reckless, she is simply trusting that her provider has her best interest and the health of her baby in front of all else. Once this early induction begins she does not question the provider releasing her membranes, or using pitocin to speed up her sluggish progress, but puts her life and that of her babies directly into the trusted provider’s hands.
To their credit the provider’s objective is not to cause harm or injury. Rather they are just too busy to give personal and individual attention to their patients. Attention that would take time away from their personal lives, their other patients and cause them to slow their practice to a reasonable rate. The interventions may not be necessary for the mother, but are necessary for the provider. Birth has become a business; interventions, injuries and surgeries are all accepted norms of that business. Prevention and emotional balance are no longer incorporated into pregnancy and birth care. Whatever arises is dealt with as a matter of consequence of that pregnancy.
For providers who practice in this manner, women who are informed enough to ask questions about their care are taken as a threat and deemed as an irritant. The woman is made to feel she has done something wrong by questioning the care of her body and her baby, and yet she does not change to another care provider. The fault is deemed as her own since she is not the one with training and she discredits her instincts and knowledge of her body.
We know that prenatal care is of utmost importance. To have healthy babies, women need good prenatal care. Since a complication cannot be self-diagnosed a woman must be under the care of a person trained in pregnancy, birth and postpartum care. This may be a midwife, a nurse practitioner or an obstetrician. It must also be clearly stated that the midwife and nurse practitioner have been trained in normal pregnancy and birth and the obstetrician has training in complications of pregnancy and surgical birth, but very little training in the normal pregnancy and birth process.
It is important that the woman have a good relationship with her provider and feels that she can ask questions, speak freely and get the information necessary for her to be in good health during her pregnancy. Informative literature should be available to all women that contains information about nutrition, medical care choices, birthing options, fetal positioning, postpartum recovery and breastfeeding. The care provider should become the source of all options and be willing to help women obtain the best care available. Office visits should be pleasant, relaxed and unhurried. The provider should take the time to sit with the client, ask questions, listen to answers and answer questions in return. Preventive pregnancy care should be forefront with focus on nutrition, stress free living, and pampering moments for this mother to be. The woman should exit her provider's office feeling empowered, confident and emotionally full. Focusing on these simple steps would bring about lower complications rates during pregnancy and birth and increase the number of vaginal births of healthy term babies to healthy mothers.
However this would remove the provider from their ‘in charge’ position. They would become the caretaker instead of the choice maker. This would also mean the volume of business they could manage would be almost half of what most current practices handle. They would spend 15-30 minutes a month with each woman, and would be less likely to induce for non-medical reasons. This might interfere with their personal life and they could see less income in return. Yet these simple steps would create a flourishing practice of healthy happy families. Women would flock to these providers until those that practiced the ‘business way’ would have to change or quit. Our induction and cesarean rates would fall along with premature birth rates and babies born with complications from birth. Lastly we would see a decrease in our postpartum depression rates and a raise in our breastfeeding rates. Demanding the best does not mean we choose the one with the most toys, but the one who views us as an equal. The providers who are willing to give personal care with attention to details, emotions, prevention and support are the best choice by far.
Yes, it seems easy to see what the beneficial changes should be to our prenatal care system. The answer is consumer awareness and the taking back of our consumer stance. We remind the system and care providers that we are financially in charge. It is the care provider who is offering their services for a fee, not the patient who is offering their care needs. Good prenatal care is every woman’s right, but the right to know over powers the right to control. It must be said that the care of our bodies is ours alone, we consult with those who have studied in the area we need assistance however; the decision to consent is still a choice that can only be taken away when power is given. It is the woman’s responsibility to use her power of choice to protect herself and her baby from harm.
Pregnancy and birth are not medical events unless complications arise. The uterus was meant to grow the fetus and the vagina and perineum meant to birth a baby. A woman’s body was created to carry and bring her child into this world. With good nutrition, healthy living, exercise and education, pregnancy and birth proceed wonderfully in most cases. The provider's job is not to intervene for the sake of change, but to support, nurture and protect when nature becomes overwhelmed.
It is the system that is flawed, not the woman, the pregnancy or birth. Bringing into focus what is vital to a healthy pregnancy and what creates healthy mothers and babies is to shine a light onto gentle, woman centered prenatal care. It has never been, and never will be the providers place to make medical decisions for those they care for. Their job is to support, inform and assist with the care of those they have chosen to serve.
In this futuristic provider's office there is a wonderful picture of a mother giving birth with these words written below it. “I believe birth is a miracle and the mother the miracle worker.”
**Chantel Haynes is a Pregnancy and Birth advocate. She has worked as a birth professional since 2001 and volunteered as the Arizona state coordinator to Operation Special Delivery during her career. Chantel is the mother to 4 children and continues to assist birthing families in her new location with support and education during their births. She plans to be a voice of change in American birth practices for many years to come.
Originally published in Having a Baby Today
A Midwifery Today publication