6 steps to ensure the labor and birth you want

The most important things you can do to protect your rights in the delivery room
By Leigh Shulman  Published on 05/30/2018 at 10:00 AM EDT

Giving birth, especially for the first time, may feel overwhelming. There are a lot of aspects to consider, and plans to make. Also, with the current state of birth and maternal health in the US, it can feel intimidating knowing what may be the right choices when it comes down to your desires versus what your provider wants. The more you know your rights and options, the more likely you are to experience a labor and delivery that finishes with a healthy child and happy mama.

Here are some concrete steps you can take to find a medical care provider who will respect your wishes and your agency throughout the process of giving birth.

  1. Create a birth plan. Atlanta area doula Chasity Millen recommends talking through your birth options long before you enter the delivery room, and creating a short, clearly written outline of your wishes. Your birth plan can include your wishes about pain management, episiotomies, induction, forceps delivery and many other details. Think about the kind of birth you’d like to have before you walk into a doctor’s office. Are you hoping for an unmedicated, vaginal birth without any intervention? Would you prefer an epidural? Create a one-page plan to share with potential providers. Working on this plan will familiarize you with the procedures you may encounter while in the hospital, what they mean and what you want in a variety of situations. You’ll share this plan not only with your doctor, but with anyone who will be with you during labor and delivery. This includes hospital staff, family, friends and, most notably, whomever you choose as your main advocate during the birth.
  2. Choose your provider carefully. Millen suggests going to “healthy mom groups and crunchy mom groups where people talk about their providers. The doctors known to honor natural childbirth are discussed a lot.” You can also ask local doulas for recommendations, as many of them have been in the delivery room with the doctors and can provide first hand information about their practices.
  3. Ask questions. Ask the hard questions when meeting with potential providers. What percentage of their patients require C-sections? How many mothers have they lost? How often do they do episiotomies? Doctors are required to provide these numbers, and if they seem uncomfortable or refuse to answer, it can be a red flag. Next, find out how open they are to what you want. Are they willing to allow a vaginal birth after Cesarean (VBAC)? Walk them through your birth plan, and see if you get any pushback or notice they’re condescending or otherwise not showing respect. If you don’t think a doctor is a good fit, trust your instincts and interview other people. When you find a doctor you like, ask to have the same conversations with their backups in case your primary doctor isn’t available on the actual day you give birth. “You want to get a sense of who they are and whether or not they’ll respect your wishes in the delivery room,” says Millen.
  4. Know the policies of the hospitals your doctor uses. Each hospital has different policies that can drastically impact what happens during an emergency. You want to know them before you arrive at the hospital so you’re not navigating potentially crucial information in the moment of crisis. Knowing local hospital policies is a good idea even if you’re planning to deliver at home or in a birthing center, in case you need to be transferred. Hospitals may not always be willing to give you their policies, but it’s important to ask, says Cristen Pascucci, founder of Birth Monopoly, executive producer of the upcoming birth-focused documentary Mother May I, and a vocal advocate for women’s rights in labor. “Do you induce at forty one weeks? If you have diabetes, do you have to induce at 39 weeks? If you come in with you water broken, do you only have twelve hours to deliver before going into a C-section? These are real things that impact labors and deliveries, and [hospitals] don’t disclose them until you’re in the moment.” To be clear, no matter what hospital policy states, no hospital or doctor has the legal right to treat you or impose any intervention without your consent.
  5. Communicate directly with hospital staff. In an emergency, the best way to learn details of what’s going on is to lock eyes with someone and ask directly: “What’s happening?” One of the most important things you can do to protect your rights during delivery is to bring an advocate. This could be a doula, a friend, family member or your partner. This person should already be familiar with your birth plan. Your advocate communicates with the doctors, makes sure you understand what’s happening, and helps the hospital staff respect your wishes. They’ll also make sure there is clear consent before allowing any interventions. Of course, unless your advocate is a medical professional well versed in labor and delivery, you’ll still need to rely on your doctor and care providers. Ideally, you, your advocate and your medical team work together to provide you with the best care possible.
  6. Know your rights. Hospital staff will sometimes cite rules, regulations, and laws intended to force you to follow their will. You might be told you must give birth within a certain amount of time or will have to be induced. They may even go so far as to threaten to report you for child abuse if you don’t comply. As a parent in labor, it’s almost impossible to say no. Many women will just go along with their doctors for fear of harming their babies. “No hospital has the right to impose a policy on you. People assume that because it’s a policy they’re legally bound by it,” says Pascucci. “Doctors and nurses will even present things as legal authority to impose policy when they can’t.”

While interventions are sometimes necessary, there’s no one right way to give birth.  Those of us having babies need to be able to make choices for ourselves, like where we will give birth and under what circumstances, including emergencies.

That’s why we need doctors who allow mothers’ instincts to guide us while doctors inform us with medical knowledge. We need to be able to trust the people who are there with us in those moments when we’re most vulnerable, so we can fully focus on pushing a new life into the world.

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