What Makes Family Picnic’s Approach to Childbirth Ed Unique?

Different from many childbirth classes, Family Picnic offers a comprehensive program of support for pregnant and new parents that begins with the prenatal period and continues through the toddler years.  After moms and partners sign up for our classes, we are available at any time for their questions or concerns.  Taking our 5-week or intensive weekend Childbirth Class, we begin to get to know parents in intimate, small classes that foster sharing, discussion and support.  When our 3-hour Breastfeeding and Baby Care Workshop is combined with the Childbirth Class, parents receive an at-home lactation consultation following birth.  The consultation not only offers help with breastfeeding but is also a time for questions about baby care, to tell one’s birth story, and to generally see what support the family might need. A Postpartum Workshop follows for all parents about a month after birth. 

Following the Breastfeeding consultation and the Postpartum Workshop, we offer many groups and classes that new parents find helpful: A 5-week Mom and Baby Group; A group called “Motherhood: This Isn’t What I Expected!” for moms wanting to explore more deeply their feelings around birth and becoming parents; A Dad’s Group; Infant Massage; A Baby Play Group; A Sign and Play Class; Yoga for Mom and Baby;  a Toddler Play Group, and a myriad of workshops addressing specific needs of new parents.  In addition, referrals to experienced practitioners are available to our parents ranging from our perinatal therapist to physical therapy. Family Picnic thus becomes a center for support and friendship.  In doing so we welcome all parents:  single parents; straight and LGBTQ couples, immigrants, and moms and partners from many cultures and family traditions. 

Like many traditional childbirth classes, Family Picnic provides a detailed picture of the stages of childbirth and variations that may occur during it. It includes natural pain relief: Positions and movements to help the baby descend; Positions for pushing and birth: and skin to skin immediately following birth. The goal is to familiarize parents with many options so that when they are in labor, they have a repertoire from which to choose. The latest research-based information is included along with up to date recommendations from ACOG.  Many real labor scenarios are presented for moms and partners to discuss, recognizing that there is often not only one way to respond to a situation in labor, and that what might feel right for one couple, might be very different for another. 

Medical pain relief, inductions, and cesareans are discussed in terms of both benefits and risks, as well as situations where there is little choice because of the baby’s or mother’s health.  The effect of these interventions on birth wishes is also looked at, and flexibility encouraged depending on the course of labor. 

Because of the many changes that are occurring in cesarean births, we look at possibilities with Gentle Birth Cesareans. While all may not be available, parents are encouraged to explore them with their surgeon when time permits. The emphasis is on the active participation of the parents in ways that contribute to their positive feelings around their baby’s birth.

In the following ways, we may differ significantly from other childbirth classes with a strong focus on partnership and respect, family and cultural experience, expectations and fears, confidence, flexibility, participation in decision making, and postpartum needs.  For any family who requests it, the class is offered on a sliding fee scale, making it possible for any mom and partner wanting in-depth preparation for childbirth, to receive it.  Parents are never asked their occupation or educational background because the birth of one’s first child is viewed as an equal playing field for all. 

Closely tied with this, is the belief that parents enter a partnership with us and with their health care provider where they play a central role and are respected and listened to.  We know from Anne Lyerly Drapkin, M.D. Ob-Gyn, in A Good Birth:  Finding the Positive and Profound in Your Childbirth Experience that mothers who are at the center of their birth and who have been intimately involved in all decisions, view their birth as a positive one no matter the type of provider (doctor or midwife), birth place (hospital, birth center, home), or kind of birth (vaginal or cesarean). We encourage parents to ask questions and to participate in discussions.  This begins in our first class and continues throughout the course.  It is encouraged at prenatal appointments so that parents have the information before labor begins and are comfortable to continue this dialogue, whenever needed, in childbirth. 

We ask both moms and partners to come to the first class having explored their own birth stories with their parents.  Discussing these, we learn of the beliefs and traditions in many different families in their varied birth experiences.  It provides an opportunity to discuss the rapid changes in birth today, and in particular, changes in the way parents can participate in the birth of their child. For example, a dad was concerned about the importance of prayers for his son immediately after the birth.  Reassured that these were workable expectations, this dad talked with his wife and their health provider about making space for them;  It also opened up opportunities for other dads to explore what their role would be in the immediate postpartum environment.  Another time a mother, whose own mother had had all natural, at-home births, was feeling pressure to meet this ‘ideal’ birth. Through discussion, and especially support from other women, she began to see that her ‘ideal’ birth could be quite different from her mother’s births.  This led other moms to consider conflicting wishes between family traditions and their wishes for their birth.  Gradually in our setting, open to different views and beliefs about childbirth, couples start or continue to navigate how they wish to view both their labor and postpartum environment.

These discussions also open up the importance of flexibility, and mom’s and partner’s wishes to be in control.  In our culture, we are used to making plans that will be carried out according to our wishes.  We tend to build expectations that are usually met, especially in our employment, and can be checked off as successful.  But childbirth is different!  Women do not get to choose the date or time that labor begins, nor the length their labors will take.  In reality, often the most carefully made birth plans are turned on end and unable to be followed.  This raises the question of how a mom and partner can plan for something when neither of them knows the course it will take.  Ultimately, most couples realize that they cannot control labor, and develop wishes rather than plans for its course.  Essential to giving up this control, is building belief in a woman’s body.

We review what a woman’s body has already done.  With no instruction, or computer program, it has nourished a baby through the months of pregnancy:  Growing a placenta and umbilical cord for just this baby; Creating amniotic fluid; Keeping the baby warm, fed, and cradled in fluid; Protecting the baby from things outside the womb; Making it possible for a baby to hear and know the voices of its parents.  It is such a remarkable thing that a woman’s body knows exactly what to do in pregnancy; Why wouldn’t her body also know exactly what to do in labor?  And most often it does, especially when a woman and her partner can trust this process so that the mother gives her body over to this labor, following its changes with movement and sound as it prepares the mother and baby for birth.  Confidence in this process often plays a major part in how a labor will progress.  When that confidence is replaced by fear, and the wish to fight or flee the process, a labor becomes more challenging and difficult. 

For this reason, we also begin a discussion in the first class of the expectations and fears that both moms and partners bring to childbirth. To facilitate this, we divide into two groups:  one for partners and one for mothers, creating safe spaces for them to be shared. Throughout the classes, the leader addresses these fears as they apply to various topics: Research driven information; Participation in decisions; Trust in the expertise of health care providers; Relationships between past experience and fears; And rephrasing fears into positive affirmations. 

For example, a common fear among women is of episiotomies – the cut that used to be routinely made between the vaginal opening and the rectum. Episiotomies are rarely done today.  Physicians and midwives have discovered that tears heal more easily than cuts, and that vaginas in most labors, can expand to accommodate a baby’s head (the biggest part of a baby).  When an episiotomy is needed, the mother is almost always involved in the decision which may provide an alternative to a cesarean.  If there is not time for discussion, the mom and partner’s trust in their physician or midwife is critically important.  Building this trust throughout pregnancy is essential if birth takes an unexpected turn, and quick decisions must be made.  For this reason, we also encourage discussion of this kind of fear to occur with their health provider as well.  

A fear like this is sometimes related to a mom’s past experience, perhaps other times when things occurred to her body over which she had no control.  Recognizing this, a mom might choose to discuss this with a perinatal therapist before labor begins.  And finally, as moms and partners build trust in the mother’s body, they also develop more positive perspectives and create affirmations such as:  “My body was made to deliver my baby;”  “My body will release my baby and help me to bring her into the world;” “I trust my doctor/midwife to help me make the best decisions.”

A common fear among partners is that they will pass out.  This fear is normalized knowing that fainting can happen to anyone, and that there are ways to avoid it, or to deal with it, if it were to happen.  Partners can place themselves beside or behind the mother as he/she supports the mother.  Looking at the mother’s face directs one’s vision away from the actual birth and focuses the partner on the tremendous power and strength of the woman as she delivers their baby.  In this position, partners have the same view as the mother when the baby is lifted up and placed on the mother’s chest – and not on the baby as it emerges. If a partner were to feel faint, she/he can reposition, sit down and get their head lower so that the blood returns to it.  There is no shame in this, only a response that accommodates often overwhelming feelings.  Affirmations develop such as, “I want to help my wife through the labor process and I know to do this I will need to focus totally on her;”  “I am going to let the midwife know that I don’t want to be involved in catching the baby or cutting the cord;”  “I am choosing to be present at the birth to support and encourage my partner as she births our baby.”

Another fear that comes up in every childbirth group is the fear of a sick baby or death at birth of either the mother or baby.  It is understandable that a fear of illness or dying would arise around the beginning of life – after all, both are the critical events which determine our time here.  This fear is normalized as part of being human so that it can be talked about.  Parents are reassured by having selected a provider and hospital they trust, and having enrolled in a childbirth class to be informed participants who will be involved in all decisions effecting the mother’s or baby’s health.   And when asked what they would do if their baby were sick, they invariably tell us that they would make sure their baby had the best care and do whatever was necessary to ensure that.  Considered this way, parents are often reassured by their inner strength that they may have overlooked before.  Affirmations emerge such as, “I have taken good care of my body and my baby throughout pregnancy;” “I know exactly what the hospital will provide if my baby were to need special care;” “I will love and care for my baby and partner no matter what problems might emerge.”  Fears shared and talked about openly give parents many opportunities to deal with them in a variety of ways before labor.

In addition to the group discussions that Family Picnic has, we also encourage dialog between partners.  We use games and discussions for partners both in class and for homework.  Questions for home might include:  How do the mom and partner each feel about the partner seeing the mother exposed and vulnerable in the throws of labor?  What does the mother need to feel protected and safe at this time?  Moms and partners are also asked to work on labor scenarios together, to strategize about them and to see if their responses are similar. A game is played where parents are challenged to each jot down their wishes about a particular issue and then compare them.  For example, questions like the following are used: “When would you leave for the hospital?”  Or “How would you like to deal with pain relief?” This again helps moms and partners work together to resolve or accommodate any differences.  In the final class, moms and partners play a game where they choose all the things they would like for their birth.  Then they are gradually asked, to change the cards to the opposite, and to see how they would feel; then to see how they would feel if they were listened to and respected? In all of these activities, the goal is to help couples recognize their preferences, to build their flexibility, and to work together to resolve issues they disagree on.

We see making decisions during childbirth as the beginning of parenting where throughout the eighteen years of raising children, parents will be making countless decisions.  They will do their best: Some decisions they will be glad about; Others they will regret and want to change.  There is no such thing as a perfect birth, just as there are no perfect parents or children. Rather, it is the desire to do one’s best that often gets parents through challenging times. It is this desire and good will that parents are encouraged to count on. 

Toward the end of our sequence of classes, parents are encouraged to discuss the many changes in their lives that becoming a family of three involves.  While some of these changes are positive, some of them are not.  Some of them involve loss while others are the beginnings of something new and wonderful.  Acknowledging this broad range of feelings, parents can begin to grapple with the dramatic changes in their lives that having a baby will initiate.  They no longer have to pretend, as the world often demands, that everything is wonderful.  Instead, in acknowledging such profound changes and variations in response to them, parents become more prepared and less apt to be taken by surprise. 

This leads to thinking about what a new mother needs after birth in order to recover and care for her baby, including the critical role the partner plays in the postpartum period.  Included, is an in-depth discussion of postpartum depression, and the steps that can be taken to provide the mother with the help that she needs so that she can return to full health as quickly as possible.  If difficulties occur, Family Picnic remains actively involved here, helping mothers and families obtain what they need, and supporting them in doing so. 

Lastly, the childbirth course focuses on the immediate care of the mother and baby after birth and the decisions that parents must make in those first few hours.  This leads naturally to our workshop which follows:  Breastfeeding and Baby Care.

In all these ways parents are prepared for labor and birth, and the immediate period following it.  The mother is more confident in her body and its ability to labor, and more confident in her inner strength to meet the demands of labor; The partner has grown in his ability to support and care for the mother, and in his ability to ask questions and participate with the mother in decisions.  They both know that all one should expect is to do one’s best, and that this will be good enough both in childbirth and parenting.   

 

This Childbirth Class was developed by Sue Gottschall, M.Ed., Ed Psy and Rebecca Nguyen, M.Ed.   It is drawn from our experience as educators, doulas, therapist, and from the Childbirth Educator Trainings of BirthWorks and Informed Beginnings (revised and updated Bradley method).  It represents a compilation of what we believe are the best approaches in several different childbirth class methods (Bradley, BirthWorks, Informed Beginnings, Lamaze, and Birthing from Within), as well as experiences working in education and therapeutic settings.

References

American College of Obstetricians and Gynecologists (ACOG), “Approaches to Limit Intervention During Labor and Birth (December, 2018) P 1-9, https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Approaches-to-Limit-Intervention-During-Labor-and-Birth?IsMobileSet=false

American College of Obstetricians and Gynecologists (ACOG) “Nations Ob-Gyns Take Aim at Preventing Cesareans” (February, 2014), https://m.acog.org/...ACOG/.../Nations-Ob-Gyns-Take-Aim-at-Preventing-Cesareans

American Journal of Obstetrics and Gynecology, “Safe prevention of the primary cesarean delivery,” (March 2014, Vol 210 Issue 3), p 179-193

 Bardacke, Nancy, CNM, mindful birthing, Harper Collins Publishers, 2014

 Daube, Cathy, Birthing in the Spirit, Birth Works Press, 2007

 Davis, Elizabeth, HEART & HANDS  A Midwife’s Guide to Pregnancy and Birth, Celestial Arts, 2004

 Anne Lyerly Drapkin, M.D. Ob-Gyn, A Good Birth:  Finding the Positive and Profound in Your Childbirth, Penguin, 1913

Gaskin, Ina May, The Guide to Childbirth, Bantam Dell N.Y. 2003

Gaskin, Ina May, Spiritual Midwifery, Book Publishing Co., 2002

 The Gentle Birth Cesarean:  www.npr.org/sections/. . ./the-gentle-cesarean-more-like-a-birth-than-an-operation

Goer, Henci, The Thinking Woman’s Guide to a Better Birth, Penguin, 1999

 Simpkin, Penny P.T. and Phyllis Klaus, When Survivors Give Birth:  Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women,  Classic Day Publishing, 2004

 Simpkin, Penny P.T. and Katie Rohs, The Birth Partner:  A Complete Guide to Childbirth for Dad, Partners, Doulas and All Other Labor companions, 2018

Simpkin, Penny P.T., and Janet Whalley, R.N.. B.S.N., and Ann Keppler, R.N. , M.N., Pregnancy,Childbirth and the Newborn,  New York 2001

Choosing a Provider: A Comparison of Care

Pregnant? What Should You Consider When Choosing a Health Care Provider for Childbirth?  Your Current Gynecologist? A Midwife?  What are the Differences Between Ob-Gyns and Midwives?  Here’s What You Need to Know

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The history that lies behind our birth choices in the United States:                                      

Until the late 1800’s most childbirth happened with a midwife at home.  This was especially true in the South where Black women served as granny midwives for other black women and poor Whites.  While they had no formal training, the midwifery tradition was passed down from woman to woman through experiential learning which often resulted in deeply respected and knowledgeable midwives, who safely delivered many babies.  At the end of the 19th century as childbirth moved from home into the hospitals, male doctors began taking the profession over, and midwives were blamed for poor birth outcomes.  But in fact, it was the introduction of two factors that strongly effected positive health outcomes for mothers:  Hand washing between patients; The introduction of antibiotics to fight infection.  These two factors once implemented caused significantly better outcomes in maternal care. (source)

As the midwifery profession began to vanish and birth became more medicalized, doctors became the authoritative voice in childbirth.  Women, who were often anesthetized so that they were unaware of the birth that was happening, turned their births over to the hands of the doctor.  In doing so women’s knowledge about childbirth, whether it was intuitive or passed down in one’s culture and family, went unrecognized as doctors told women how to birth.  Fathers were sent to the hospital waiting rooms and were only summoned after the birth to view their baby.  In 1943, my own mother-in-law went into labor expecting to have one baby.  When she woke up from the anesthesia, she discovered that twin babies, a boy and a girl, had been delivered.  Other family members and friends knew before she did.  What a surprise! 

In the 1970’s, women began to seek out midwives and more family centered birth.  Fathers were permitted in the labor rooms, and babies began to spend more and more time with the mother after birth.  Today, “rooming in” is a standard practice, where babies seldom leave their mother’s room unless they need specialized care.  Most hospitals in Chicago are now striving for, or have received, “Baby Friendly Status” where breastfeeding is promoted by all staff members who have been specifically trained, and the baby from birth onward, is kept with the mother.  Formula is no longer offered or sent home with the parents, and mother and baby enjoy a grace period of 1-2 hours after childbirth to have skin to skin contact, and initiate breastfeeding - a very different picture than just a few years ago.  In 2014, The American College of Nurse Midwives reported that midwives perform just 12.1 per cent of vaginal births in the United States and only 8.3% of all births. (source)  Contrast these statistics in the United States to those in Europe where 75 % of births are handled by midwives. (source). This high number of midwife births in Europe reflects the history of midwives who have provided health care for women in pregnancy and childbirth for thousands of years in these places.

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Do you need to choose a different physician or midwife to see in pregnancy and childbirth? 

You may already have a gynecologist (who also delivers babies) whom you like, so the easiest thing is to stay with them.  But before you decide that, consider whether the same person who you use for women’s health care, is also the person you want for childbirth.  Having a yearly exam or getting birth control is very different than the hours you will spend in childbirth, one of the most important events in your life, where you are also your most vulnerable self.  Consider the differences in care and support described here, and then interview your own and/or other Ob-Gyns and midwives to decide whom you want for childbirth. 

When deciding on the provider who will handle your care during pregnancy, labor and birth, there are some important differences between providers that you will want to consider.

Let’s start with the differences in training between an Ob-Gyn Physician and a Certified Nurse Midwife (the only type of midwife who can practice legally in Illinois) 

A Certified Nurse Midwife must be a licensed Registered Nurse (RN), who has completed a 2-3 year Masters’ Degree Program in Midwifery.  This includes classroom time and clinical internships in office, labor and delivery, and postpartum areas. Midwives then pass a rigorous certification exam.  They are trained to care for low-risk pregnancies; They can prescribe medications, order labs and ultrasounds; They use birth technology such as fetal monitoring, and can repair any tears that have occurred during delivery.  Ob-Gyns are physicians who after four years of medical school, complete an additional residency in obstetrics and gynecology.  They are trained to care for high-risk pregnancies and births, and perform related surgical procedures such as cesareans, and vacuum or forceps deliveries, when needed. 

Sometimes people confuse Doulas and Midwives, when in fact, they are very different.  Doulas are trained to support women in childbirth but to do nothing medical, whereas Midwives are highly trained in the medical care of normal deliveries.  Doulas provide emotional, physical, and informational support, but more about them in a future blog.

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Now let’s look at the differences in actual practices between Midwives and Ob-Gyns          

The midwifery model of care emphasizes that pregnancy and birth are normal physiological processes. Most Nurse Midwife groups work in collaboration with an Ob-Gyn practice, and can refer as needed to an Obstetrician if complications arise in pregnancy or childbirth.  Midwives believe that a woman’s body knows what to do in labor and birth, and reserve interventions for times when a mother or baby need medical assistance.  They want women to make informed decisions about their own and their baby’s health by being a part of the discussion on the benefits and risks of any suggested procedure.  Midwives want you to be involved in your care by asking questions that are important to you.  Women often report that their midwives seem to take more time listening to their concerns.  Many women, laboring with midwives, choose to labor without IV fluids or to have only a heplock, instead hydrating well with fluids by mouth.  As long as labor is normal, Midwives frequently use Intermittent Fetal Monitoring with a hand-held Doppler (ultrasound) which allows women more freedom to move about without the constraints of monitoring belts. This ability to move about and assume different positions helps the baby to position itself well for birth and to move down.  Many mothers also find labor pain much easier to deal with when they can walk and change positions. 

Obstetricians generally prefer IV fluids hooked up and Continuous Electronic Fetal monitoring, where two belts are placed around the mother’s abdomen to measure continually the baby’s heart rate and the mother’s contractions. These belts are connected to a machine which monitors the results on a graph.  This can restrict the mother’s movements to the area between the bed and the machine.  Studies, since Continuous Electronic Fetal Monitoring was introduced in the 70’s, have shown that Intermittent Fetal Monitoring is just as effective as Continuous Electronic Fetal Monitoring in predicting outcomes.  There is also evidence that the rise in Electronic Fetal Monitoring may be connected with the increase in cesarean rates. (source(The Thinking Woman’s Guide to a Better Birth, Henci Goer. P 97-98.)

Once a laboring mother is admitted to the hospital by the Midwife, she sees her frequently throughout her labor.  The Midwife is present to do exams, suggest position changes and to encourage and confer with the mother and her partner.  Midwives also tend to be more receptive to a doula’s presence whom they see as someone they can work with throughout the labor.  Obstetricians, typically, see the mother less frequently throughout the labor, unless significant changes require intervention.  Mothers may be visited more frequently by the residents on the floor.  While some physicians are amenable to a doula, many see no need for a patient to have one. 

Studies suggest that midwives have a lower use of inductions, augmentations, epidurals and episiotomies.  Perineal lacerations are lower, and breastfeeding rates are higher.  The lower use of these interventions were associated with fewer cesareans.  Babies of Midwife patients more often stay with the mother for the entire hospital stay, and have fewer complications. Obstetricians are more apt to recommend or use epidurals, and to perform episiotomies and instrumental deliveries. The maternal and fetal health outcomes of the Midwives and Ob-Gyns were both found to be equal.  It leaves no doubt that midwifery care is safe and effective with a reduced use of interventions. (source),  (Rosenblatt et all, Interspeciality differences in obstetric care of low-risk women, American Journal of Public Health 1997),  (Johantgen et Al, Comparison of Labor and Delivery Care provided by Certified Nurse-Midwives and Physicians:  A Systemic Review, 1990-2008, American Journal of Public Health),  (Journal of Midwifery and Woman’s Health, 2018, 63.1, pg 90-107)

Because Midwife attended births are mostly in hospitals, the statistics suggest  how important it is to find out the rate of cesareans at the hospital you will be delivering at, as well as the cesarean rate for your Midwife or Ob-Gyn group in particular. The rate of a particular group can differ dramatically from the hospital rate.  The World Health Organization recommends a cesarean rate between 5-15% suggesting that rates outside of this may do more harm than good.  In Illinois, cesarean rates increased from 19.3 % in 1997 to 30.4% in 2007 with contributing factors thought to be:  a low priority in believing in and supporting women’s ability to birth; and a casual attitude toward cesareans that suggests a limited awareness of the harm they might cause. (source)

In summary, Midwives tend to see childbirth as a natural event which needs to be supported with as little interference as possible in a nurturing environment:  Ob-Gyns are more apt to see birth as a medical event where a physician is often needed to treat the difficulties that arise.  There are, however, physicians who will work with a mother to allow birth to proceed naturally, just as there are Midwives who treat birth from a more medical viewpoint.

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Questions to Ask Oneself When Selecting a Provider for Pregnancy and Childbirth

Working with Midwives would likely mean less interventions, fewer complications, and a better chance for a vaginal birth. If, however, you would feel safer with a physician experienced in all types of births where there might be medical complications, you might prefer an obstetrician.

Following are some questions you might want to consider in choosing between a Midwife and Ob-Gyn for childbirth:  1) Do you want to be able to discuss 1-2 questions at each appointment? - more than two should be saved for the next appointment.  2) Is your priority to have a vaginal birth?  3) Do you want your health provider to be part of your labor, visiting your room often?  4) Would you like intermittent fetal monitoring and to labor without an IV in an environment that encourages movement? 5) Would you like the least intervention possible, recognizing that flexibility will be needed depending on the labor and birth you get?  6)  Do you want an epidural as soon as possible, or are you more interested in avoiding one altogether, or waiting as long as possible?  7) Are you high risk such as carrying multiples or Diabetic?  8) Do you want to take a Childbirth Class to learn the movements/positions that facilitate birth, the natural methods of pain control, and evidence based information for making decisions in childbirth? 9) What does your gut, your intuition, tell you?  The latter I think is so important because intuition plays a major role in childbirth often helping the mother know how to move and make sounds to help a baby descend, and plays a major role in the decisions made throughout labor. (some of above questions come from:  (source).

What kinds of answers suggest that you might want to choose a different provider?        

There are some responses from health care providers that suggest they do not want to address your individual concerns.  Listed below are comments reported to me by mothers during their appointments with providers.  These do not reflect all obstetricians, but when used, imply a perspective that the physician is deciding about this birth without consultation with the mother.  Here they are:

“We don’t need to talk about that now.  We’ll wait till you are much further along”.  (By then, it may be too late to change providers if you are uncomfortable with the answers)

“I don’t have time to talk about that now.” (Perhaps a more honest answer, but when will she have time?  And will it be in time to change providers if you are uncomfortable with her answers?)

“I strongly recommend an epidural to make labor go well - you can get one as soon as you are admitted to the hospital”.  (Has the mother been asked what she wants?  Have any benefits and risks of an epidural been discussed?)

“Why do you want to put yourself through all that pain? (This comment feels like a criticism rather than asking what was influencing the mother’s choices)

“There’s no need for a doula; Your nurse will be taking care of you and telling you what to do” (Clearly this physician does not want a doula present, and expects the patient not to be involved in choices.)

“If you feel this way about labor and birth, I’d suggest you move to a midwife practice.” (This comment at least respects the mom’s requests, although it has a negative ring to it)

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In closing, I hope that each pregnant woman will carefully consider her choices for care, if she is fortunate enough to have them.  The doctor we choose for gynecological care is not necessarily the doctor or midwife who we would feel most comfortable with during childbirth.  In the process of choosing, keep in mind the following:  Does your health care provider see birth as you do?  Does he/she put you at the center of your birth, respecting and listening to you, making you part of all pregnancy and childbirth decisions? (A Good Birth:  Finding the Positive and Profound in Your Childbirth Experience by Anna Drapkin Lyerly, MD)   I want to conclude with a quote from this same book:

Only when the conscious experience of mothers’, potential mothers, and mothering persons are taken fully into account can we possibly develop understanding that might someday merit the description of ‘human’.  Virginia Held in the Introduction.