Respect & Negotiation
Updated: Sep 7, 2018
My approach to working with medical staff.
First, I’d like to say that I am thankful for the obstetricians and nurses who have studied, practiced and trained to provide specialized services for the complicated exceptions to normal birth. Your expertise is crucial and life-saving in those special circumstances.
For expecting families, I'd like to explain my approach to working with medical personnel (doctors, nurses, interns, etc) in hospital birth settings. It essentially comes down to two words: respect and negotiation.
I respect the unique role and set of skills that your OB and nurse(s) bring to the labor and birth process, specifically their expertise in situations of true emergency and when there is a need or desire for intervention. That being said, my default is to approach birth as a normal physiologic process.
I will behave respectfully and speak respectfully to your care provider.
I will also respectfully encourage you to speak up. If you disagree with a suggestion s/he has made or you feel that your rights have been ignored, it is my role to encourage joint decision-making and to empower you as a patient. This is why I will encourage you to talk openly with your nurse(s) or doctor and to ask for what you need and want. Some medical professionals, especially those who practice what Dr. Lissa Rankin refers to as "Old Medicine," find this collaborative approach frustrating. This top-down approach induces fear, and fear is the enemy of birth.
Hospital births are as much a process of negotiation as they are a physiological process. Women are often presented with many decisions and suggested interventions. (This is understandable when we remember that hospitals and doctors are essentially operating on a business model-- they have financial and time restraints to consider. Efficiency and safety are priorities, often to the detriment of the slow and often unpredictable nature of childbirth. Childbirth just doesn’t fit into a structured system very well-- it is too organic, too sui generis for that.) Because of these sometimes conflicting interests the role of a doula has become even more important. My goal as your doula is to help you navigate and negotiate along the labor and birth process, to work toward the goals that you have identified prenatally. What does this look like?
Negotiation is often just asking for more time: time for your body to work, time to consider your options, time to make a decision, or time to try something natural first.
Negotiation requires thatyour opinions, questions and concerns be considered and taken into account. It is my role to listen to you and to advocate for your needs and wishes, even when the process of doing so may cause inconvenience to your care provider. Childbirth Connection lists 20 Rights of Childbearing Women. Two of these rights are sometimes challenged in the hospital setting, which I have cited below:
“Every woman and infant has the right to receive care that is consistent with current scientific evidence about benefits and risks. Practices that have been found to be safe and beneficial should be used when indicated. Harmful, ineffective or unnecessary practices should be avoided. Unproven interventions should be used only in the context of research to evaluate their effects.”
“Every woman has the right to full and clear information about benefits, risks and costs of the procedures, drugs, tests and treatments offered to her, and of all other reasonable options, including no intervention. She should receive this information about all interventions that are likely to be offered during labor and birth well before the onset of labor.”
“Um, I can’t remember what I forgot”
Despite the hours women and their partners dedicate to reading and preparing for childbirth, some find that in the moment of labor, when their autonomic nervous system is guiding their behavior and other emotions such as excitement, nervousness or fear cloud their thinking, that they need reminders of their options. They may not remember that chapter that they read about induction or augmentation and all the different risks or benefits. As your doula, I can refresh your memory and reassure you in the decision making process.
In the context of a home birth, many of the complications above are eliminated. I’m not speaking of medical complications, but time restraints, deadlines, great concern over limitations and liabilities and other pressures are not prominent features of the home birth community. Among midwives there is a fundamental confidence and faith in women’s bodies. This translates into a lot of freedom and flexibility in the laboring process, which allows each woman’s unique labor style to unfold and her inner strength to shine bright. (I know, I’m getting a little poetic on you here... I can’t help it.)
That being said, it is very important for your midwife have training in situations of medical emergency and ideally, she should work in cooperation with a supportive and open-minded obstetrician who will handle true emergency situations in the case that you are transferred to the hospital.
I’d also like to clarify that home birth is neither an attractive or safe option for everyone. Some women would not feel safe or comfortable giving birth at home and their decision to birth in a hospital setting is legitimate and appropriate. Also women who have high risk pregnancies are not good candidates for home birth. I personally believe that a home birth should only take place with the support and guidance of a highly trained and professional midwife, who is held accountable to a code of ethics and scope of practice established by a professional organization.