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!

Want to get notified when new blog posts arrive?  Sign up for my email list here:

Birth Intentions not Birth Plans

Writing your Birth Plan?  Consider reframing it as your Birth Intentions.

We all know births don’t go according to plan, right?  I’d love to see a shift away from calling the birth plan a birth plan and more towards something that allows for sharing our ideas about how we want our birth to go without the “commitment” of a plan.

The Problem with Birth Plans

One of the problems with birth plans is that they can be perceived by hospital staff as a setup for failure or disappointment.  The joke is sometimes bandied about that the birth plan is a ‘ticket to the OR.’   I don’t think anyone who is planning a vaginal and/or unmedicated birth wants to invite that presumption to their birthing space.  A slight change in our language can help hospital staff see what we hope for our birth experience while also showing them that we understand the situation is fluid.

I’ve also heard people call the birth plan their “Birth Preferences”.  While this does acknowledge that birth is no place for a rigid plan, I think that the word ‘preferences’ is too non-committal for the hospital staff because preferences are perceived like this:  I would *prefer* to have black olives on my pizza, but it’s okay if I don’t get them.  Using preferences for your birth:  I would *prefer* that you don’t stick your hand in my vagina, but it’s okay if you do.  <—-  That doesn’t work for a lot of reasons.   But, the main reason I really don’t like the word “preferences” is because it gives the power to someone else.

Why We Should Call Them “Birth Intentions”

Showing up with your Birth Intentions conveys a few ideas.  First, that you the birthing person are, in fact, the person with the power.  You are asserting your autonomy.  Second, it creates a space where you can say what you want about your birth without feeling guilty or disappointed if things go differently.  Third, naming your birth intentions clarifies for your birth team what you expect to happen, unless you deem otherwise.  Intentions are hopeful versus dictatorial (plans) or submissive (preferences).

So let’s say a few birth intentions together, shall we?

My Birth Intentions
i intend To receive my child skin-to-skin immediately after birth and remain this way for as long as we desire.
i intend To keep the umbilical cord attached and intact until it appears white, allowing my baby’s blood to return to their body from the placenta.
i intend To remain undisturbed during active labor unless I specifically ask for support or interventions.
i intend To labor and birth in any position that my body tells me.

 

Now, create your own Birth Intentions.  You can do something as simple as changing the title of your document from “Birth Plan” to “Birth Intentions”.  But, because I’m a fan of the law of attraction, I highly recommend trying to phrase your intentions in such a way that you are inviting them to happen.  This has a way of shifting our mindset if we are in need of reclaiming our power.

I’d love to hear your birth intentions so please share in the comments if you’d like .  It feels empowering to put them out in the world and inspires others to create their own.

Power to the Birther,

Earth Mama Jenn