How do you know you’re getting good care? In the U.S., there is a vast range of maternity care practices—from the highest-quality care to the downright medieval. To make it even more confusing, “luxury care” doesn’t necessarily look that way: some of the poshest hospitals I know, with the slickest ad campaigns, have some of the worst birth practices! Seriously! On the other hand, you’ll never hear about some of the low-key places that deliver stellar care, if you don’t know what to look for.
To close out 2014, Improving Birth is talking about what good care looks like—care you can trust. As part of this campaign, we’ve put together a list of some signs you can trust the care you are getting. (Check out moms’ firsthand accounts of great care on our Facebook page, too!)
> You are treated like an individual. Every woman, baby, and birth is different. You may go into labor at 38 weeks or 42 weeks, and it might last four hours or forty. This is all normal. As the baby is coming, you may want total silence in a bathtub or you may need tons of support while you walk laps around the room. No one can predict these things. Birth is about what each pair of mothers and babies needs to be most safe and supported.
> Your provider recognizes that you are the one delivering the baby. Sounds funny, doesn’t it? The truth is, women are the ones doing the heavy lifting in childbirth and care should be centered around them. Some things may be more convenient for your care providers, but are harmful for you and your baby—like inducing without true medical indication1 (“big baby” or going past 40 weeks are not medical indications), being on your back in stirrups, or getting an episiotomy to speed things up. Your provider should be focused around what you need to do your job—not what they need to do theirs.
> Your provider practices based on current scientific evidence, over “traditional” birth practices. Many very nice, well-meaning providers still practice the way they learned as a student. Research on best birth practices has exploded in the last ten or twenty years, and things look a lot different—or they should look a lot different—than what is still, unfortunately, routine practice in most places. We urge you to educate yourself on what this means through an independent, out-of-hospital childbirth class and some of the high-quality resources we’ve listed here on our Resources and Information page. Then, talk to your provider to see if that’s how they practice. If it’s not, move on to one who does practice based on what science shows is best for you and your baby.
Best care—the kind that is safest and healthiest for you and your baby—looks like: freedom of movement, encouragement to move around in labor, access to a tub for pain relief, continuous support from a doula for pain relief and encouragement, fetal monitoring by use of handheld dopplers that are brought to you periodically, and no timelines for labor and birth unless you or the baby is in distress. More excellent information at Evidence Based Birth and Childbirth Connection.
This is a far cry from routine care that has traditionally included things like restricting you to bed, a bed pan, no food or drink, continuous monitoring with belts around your stomach, an IV placed in your hand, regular vaginal exams, pushing on your back with your legs in the air, being placed on a clock for labor progress and dilation, medication to speed things up if it’s not following a schedule from 1955, and an epidural as your only option for relief from this kind of management. Ask specifically what “labor looks like” to your provider!
> Your provider is transparent about his or her philosophy and track record. If someone is not open about their statistics and how they practice, why is that? Great providers are proud of their track records. There should be no mystery about how many episiotomies they cut or their criteria for recommending a c-section. Remember: this is your body we’re talking about—you deserve to know!
> Your birth feels like a special event and not a drive-through service. Labor and birth are important physiological processes and crucial hormonal events that require patience and gentleness—not as luxuries, but as necessities to safety. When women feel stressed or pressured, their bodies release hormones that negatively impact pregnancy and can “arrest” labor—instead of releasing the critical hormones that create healthy environments for babies and help the uterus and other organs do their jobs.2 Providers who understand that are better able to support moms in healthier, less complicated births.
> You are listened to and treated like a respected adult. You know what it feels like to be communicated with in a respectful way, and you know what it feels like when you’re being dismissed, ignored, or condescended to. If you think it’s annoying during pregnancy, wait until you’re breathing through contractions! As Sarah Buckley says, “All mammals seek a safe place to give birth”—and, conversely, mammals have a hard time giving birth when they don’t feel safe.3 In this vulnerable position, feeling respected is integral to feeling safe.
> Your provider uses language like, “We encourage you to…” and “We support you in…” —not “You’re not allowed” or “We will let you.” Language is important. It is an indication of how you will be treated in labor: as a respected adult or as a wayward child. It is a truly scary thing to hear in the delivery room, “That’s not how I do it,” when you’re saying you need more time or that you don’t want to be cut.
Red Flags: download the free PDF here (Enter “0” next to “name a fair price”)
> Your birth plan is welcomed with open arms. Your birth is about what’s best for you and your baby—no one else. Providers who don’t like birth plans are essentially saying, “This birth is about me, not you.” Red flag! It is important for parents to recognize the value of birth plans, though: they are not guarantees of anything. They are best used as tools for preparation (learning about your options for birth) and for communication (reviewing it with your provider to see if they are a good fit).
> Your doula is welcomed with open arms. As the American College of Obstetricians and Gynecologists says: “One of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula.”4, 5 Contrary to the popular view that doulas are luxuries, they are actually safety measures. Providers who care about moms and babies are thrilled to have doulas on the birth team because they know the odds of that birth being a safe and smooth one just got that much higher.
> Your provider is consistent. When it comes to their philosophy, your plans, and how your birth is going to go (barring any changes in health status, of course), what they said at 20 weeks is the same as what they say at 30 and 40 weeks.
One place to look out for this: Your birth plan. Sometimes women tell us that their provider started out gung-ho about their birth plans, but as time went on, started placing conditions on it even though nothing had changed with the pregnancy. It’s kind of like the guy who flakes on setting a date for the wedding, or when the car mechanic’s bill is twice what the estimate was: it’s a Red Flag. If you are a fully, respected partner in your care, you deserve real talk.
> Your provider takes the long view: pregnancy and birth are not just about pregnancy and birth. Your provider understands that childbirth is more than a baby exiting a uterus—it has repercussions on the postpartum period, your breastfeeding relationship, and how you may be treated in future pregnancies. Good providers will consider the long-term impact on your family life and reproductive life of the care they deliver.
> Your provider believes in you, with a focus on wellness–what you can do, not what you can’t do. If you have not had serious talks with your provider about diet, exercise, and stress levels, you are missing a component of great care: preventing common complications like gestational diabetes. This is not about the DON’Ts, like “Don’t eat sushi,” but the DOs: exactly what kind of nutrition you need to be getting, how to be in top physical shape for a more comfortable pregnancy and easier birth, and why and how to manage stress levels. Yes, you can get a lot of this stuff from books, but, this is exactly why you have a healthcare provider. Great maternity care doesn’t take complications for granted; it helps you avoid them in the first place. (Hint: midwives are experts in avoiding complications, and in most parts of the country, you don’t give up obstetrical care by getting a midwife–you get the best of both worlds!)
If a provider is great at what they do, they understand that women are strong and capable. You are no exception.
Remember: maternity care is a service and you are a customer. If you’re not getting the best service for the most important event of your life: take your business elsewhere. If you’re having twinges of doubt, but hesitate to switch, ask yourself why. Are you worried about hurting your provider’s feelings? Are you afraid you will be seen as high-maintenance? Is it less intimidating to just go with the flow? Now ask yourself if your vagina, your newborn baby, your long-term mental health, and your dignity are less important than those things.
We know it’s not always possible to switch care for financial, insurance, and logistical reasons. We are working hard to improve care in ALL settings, so that this kind of great care is the default and not the exception. There is still a lot you can do when faced with a not-so-great care provider, and knowing your rights is one important thing.
Improving Birth believes in you. We know that your care is one of the most important factors in how your baby comes into the world and that having a safe, emotionally supported birth helps launch you into the tough work of motherhood in the best possible way. We believe that you and your baby deserve the best—and we hope you believe that, too.
When is it too late to switch care? NEVER. I wrote this article, and I switched care at 41 weeks, 6 days pregnant. Yep! I know of two women who switched care DURING LABOR when they realized their providers’ practice style wasn’t going to work for them. But I recommend you switch as early as possible, if you can, as you will have more options and have more time to make a good decision. — Cristen
What do you think? How did you know you could trust the care you were receiving? Share in the comments below or on our Facebook page!
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1 “There are certain medical indications that require early delivery, including preeclampsia/eclampsia, fetal growth restriction, placental abruption, multiple fetuses, and poorly controlled diabetes.” More from the American College of Obstetricians and Gynecologists at: http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Early-Deliveries-Without-Medical-Indications
2 “You and your fetus/newborn have innate abilities to start labor, labor and give birth, breastfeed, and become deeply attached to one another. The ebbing and flowing of hormones drives these well organized, finely tuned processes.” More from Childbirth Connection at: http://www.childbirthconnection.org/article.asp?ck=10184#hormones
3 “Labour and birth involve peak levels of the hormones oxytocin, sometimes called the hormone of love, and prolactin – the mothering hormone. . . As well as these, beta-endorphin, the body’s natural pain-killer, and the fight-or-flight hormones adrenaline and noradrenaline (epinephrine and norepinephrine) play an important part in the birth process.” More from Sarah Buckley at: http://sarahbuckley.com/pain-in-labour-your-hormones-are-your-helpers
4 From “Safe Prevention of the Primary Cesarean Delivery,” March 2014, here: http://www.acog.org/Resources_And_Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery
5 “[W]omen who received continuous support were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and C-sections. In addition, their labors were shorter by about 40 minutes and their babies were less likely to have low Apgar scores at birth.” More from Evidence Based Birth at: http://evidencebasedbirth.com/the-evidence-for-doulas/
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Author Cristen Pascucci is the former Vice President of ImprovingBirth and is the founder of Birth Monopoly, co-creator of the Exposing the Silence Project, and executive producer of Mother May I?, a documentary film on birth trauma and obstetric violence. She is dedicated to promoting the rights of women in childbirth. She’s recently released Take Back Your Birth, essays written to inform and inspire moms to expect better from birth and their care.
Have you seen what Improving Birth is up to? We’re supporting women all over the country, as well as working with mothers, providers, and policy makers to lead change in numerous communities. Please support our work with a gift here and plan to participate in our annual Rally to Improve Birth–the only national event of its kind, where consumers come together to raise awareness about the maternity care crisis and demand change. We’ll see you there!