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What to Do if Your Care Provider Pushes Back

Pretty much the last thing we need during labor, right?

Say you are in labor and your care provider (obstetrician or midwife) says they are going to use an intervention.  You do not wish for this intervention to be performed, but they push back and tell you that it’s hospital policy, or *only* tell you the risks of not doing the intervention; or worse, they don’t say anything and start making threats.  What can you do?

First let me say, as a laboring person you should not have to worry about getting non-evidence based care.  Planning ahead and choosing a birth setting, care provider and model of care that aligns with your birth wishes can go a long way in preventing this situation from transpiring, but unfortunately it can *still* happen even with all the advance planning in the world.

That being said,  here are some steps you can take:

  1. Ask for the provider to walk you through the informed consent process.  Your provider has a legal and ethical obligation to provide you with this process for any/all interventions.  They must discuss with you the benefits, risks and alternatives to the intervention.  This must include the benefits/risks of the alternatives, as well.  They must also disclose what would happen if you did nothing.  They must answer any question you may have.
  2. Ask for some time to discuss the matter with your support person/people.  This may include your partner, your doula, or any other person whom you have invited into your birth space.  The person you talk with doesn’t have to be knowledgeable at all, really.  The goal is just to see if you can buy yourself some time.  If you are dealing with an emergency situation, you won’t have time to talk.  If they give you time to talk, you know it’s not a real emergency.
  3. Give your consent or refusal.  If you give your consent and change your mind later, you can tell them you’ve changed your mind.  it’s okay, it’s not a contract.  You can revoke your consent.

If your provider makes threats or is combative and difficult to speak with despite your best efforts, you can ask for a new provider.  You have the right to switch care providers (yes, even while you are in labor.)  You can ask for another OB or midwife in the hospital to attend your birth.  If you are in a birth setting where they do not have another provider available, you can ask for the patient advocate or chaplain.  These individuals can serve as a mediator of sorts, to help facilitate communication between you and the care provider.  This may seem extreme, but the alternative is checking out of the hospital against medical advice (AMA) and heading to a different hospital.  It’s probably the last thing you want to do when you’re in labor, but it has been done.

This, of course, begs the question . . . What kind of threats could they make?

I’ve heard of providers threatening to call CPS on families who refuse to cooperate with their plan.  This is mostly an empty threat because a.)  CPS understands that you have the right to informed consent and refusal and b.) even though CPS is obligated to respond to the call, it doesn’t mean that anything will come of it.

TIPS:

  • Don’t buy the line about “it’s hospital policy”.  Yea, it’s the care providers obligation to abide by hospital policy, but it’s not yours.  Hospital policies are not laws, therefore you are under no obligation to follow them.
  • Recognize their humanity.  Something that will make any situation a lot easier is to acknowledge that the people you are dealing with are just trying to do their job.  They are mothers, fathers, sisters, brothers, aunts, uncles, cousins, grandparents . . . just like you and your family.  They have job stress, life stress and family stress just like you.  Acknowledge this to them.  Say, “I understand you are just doing your job [say their name] and I appreciate that you are being thorough, but I do not consent to this.”
  • Start off on the right foot!  Right when you get to triage and then again in L & D, introduce yourself, or have your partner/doula introduce themselves to the staff.  Read their name tag, say their name when you introduce yourself, shake their hand.  Thank them for supporting you/your partner.  Ask them about their life outside of work, their job, their kids, anything . . . make small talk and tell them things about you outside of your exciting journey to becoming parents.  Bring a little treat for the nurses station.  You don’t have to go over the top, it can be candies or cookies or whatever.  Gifts of food are a way to show them that you are thoughtful and kind.  It’s a way to humanize them and yourself.  Write your names on the gifts so they remember you/who they are from.  You are building a little relationship with the people who are supporting you and you want them to consider your feelings/wishes/preferences if push comes to shove.  This is more likely to happen if you’ve already made an impression that you are kind and thoughtful.

Do you have any other tips for handling a situation where your care provider disagrees with your choices during labor?  Please leave a comment.  Thanks!

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Birth Preparation Methods and Why I don’t have a “method”.

Now that I am a Certified Childbirth Educator, I can look back on my childbirth preparation experiences with a more critical eye.  Let me first say, I don’t believe that there is one method that serves everyone, but rather, certain methods resonate with certain people.  You like vanilla, I like chocolate . . . you get the idea.  But how do you know what is a good fit for you?  Let me explain.

For my first baby, I took classes through the hospital, and I didn’t remember much of anything helpful by the time I was in labor.  Those hospital classes did not teach me any coping skills.  I was going to “try” to go natural (lol).  I ended up getting pitocin and thought I had to stay confined to bed.  None of the nurses there told me it would be easier for me to get up and move around.  (Maybe they didn’t know because they only ever saw medicated births?)  So, I didn’t.  Culture had me believing that I was supposed to stay in the hospital bed, even though no one ever actually said that to me.  Given that I was in tremendous pain, had no coping skills and my husband was equally at a loss to help me, I requested the epidural.   While the epidural was very effective in relieving my pain, I felt disconnected from my body and the birth experience.  I was an observer;  just another person in the room waiting for a baby to emerge.  I knew if I was going to do this again, I’d need to seek out a different kind of class to have a better birth experience.

Fast forward to my second birth:  we took a birth preparation class that was 12 weeks long.  It was a popular method that celebrates husbands.  We got a lot out of the class and I think it did a great job preparing us.  But there were weeks we *really* didn’t want to go.  I think if we were not already parents, we probably wouldn’t have taken that class.  The things that drove me to do it were a.) a “night out” without our oldest, b.) I really needed support from my instructor in navigating things with my care provider (another story for another time) and c.)  I was determined to have  a natural birth.  Long story short, I coped with all of my labor at home and in the car.  I don’t think my husband actually did any of the physical support he learned in that class.  Most of what I did to get through labor in those three very intense hours was primal and instinctive.  The main thing I got out of that class was that my body was made to do this.  The class convinced me that I could give birth without interventions.  (and I did!)  I appreciated that my husband learned how to identify the different stages of labor by observing my behavior.  He knew I was further along than I thought I was and thus, contacted our support people to come before I probably would have.  I believe the classes were a good investment of our time and money.

Third birth:  To prepare for our first homebirth, I read a book on self-hypnosis for labor which was accompanied by a CD.  (The book is also available in class format with instructor, which we did not take.)  I was confident in my laboring skills after my second birth but I felt like maybe I just got lucky to have a 3 hour labor last time, so thought it wise to add some more tools to my toolbox.  It was a little weird for me, to be honest.  I didn’t get into it, even though I love “new-age hippie” stuff.  Maybe self-hypnosis just didn’t resonate with me at the time, or maybe it was the scripts, or the voice on the CD.  I could not “connect” with them.  I also don’t believe calling contractions “surges” made them any less painful for me.  So, did it help me during labor?  What that book helped me do was understand that I had to be in a different part of my brain.  I suppose I inherently knew this already because I made the effort to plan a homebirth;  I couldn’t see myself laboring like I wanted in a hospital having had the previous experiences I had.  I think the birth hypnosis book most helped me engage in the idea of seeing contractions in different ways; waves, colors, etc. to help cope with them and brought me to understand the value of birth affirmations.

Fourth Birth:  By the time I was pregnant with my youngest child, I had already been a Childbirth Educator for several years.  I knew that all of my laboring instincts would kick in and that I could trust the process.  I had another homebirth and added a doula this time for good measure.  My doula was able step in and provide physical comfort/support while my husband took care of setting up the birth space and preparing supplies.  It was SO NICE to have someone 100% dedicated to my physical and emotional needs while Chris managed other equally important aspects of the birth setting.  The thing that stands out most to me, though, about coping with my fourth labor is that I had been able to turn inward and completely surrender to the will of my baby and my body.  I didn’t have to use my thinking brain to remember things to do . . . it was instinctive.  After reflecting on that birth, I came to the conclusion that the practice most closely associated with how I “turned inward” is known as meditation.

A pregnant mother practices meditation to prepare for birth.

 

I had never taken any classes in meditation until long after my fourth birth.  But when I started meditating, I knew instantly that this place in my brain seemed familiar.  It was just where I had been during the deepest, most divine part of my birth experiences.  After researching, I understand now why practicing meditation is so profoundly useful for pain relief during labor.

I believe that the efforts I made in preparing for birth during my pregnancies helped to get me where I needed to be for labor.  These classes and books gave me tools I may not have had otherwise.  Because I had experience with several approaches to childbirth preparation, I was able to make the informed decision to become certified by an organization (CAPPA) that doesn’t teach/promote/utilize a specific method, but rather draws from evidence based practices as well as the varied experiences and expertise of many mothers and birth professionals.  Coupled with my training, I am able to draw upon my own experiences and knowledge to teach expectant couples a wide variety of tools to help them through their birth journeys.  I firmly believe that a well prepared birth team has the best chances of having a beautiful and positive birth experience.   Now that I am also an Evidence Based Birth® instructor, I am able to offer even more support in the way of preparing families for navigating birth in a medical setting.

If you are deciding on a class that best suits you and your partner, there are many factors to consider including your schedules, your birth intentions and your birth philosophy.  The vast majority of out-of-hospital group classes are going to be great for most couples, but there are sometimes limitations with scheduling and availability, so be sure to explore your options around your community and even a little further out from home.  You might find a perfect fit just a little bit out of the way and it could make all the difference for you, your baby and your birth.