How to Be a Consumer During Your Pregnancy

Have you ever thought about how much time goes into planning a wedding? How about a big party? Many hours of research and planning may be involved in looking into a house you were thinking of buying or a neighborhood that you are considering moving to. But how much time to most women spend thinking about how they want their birth to go? Much of the time little, if any, thought goes into what type of birth a woman would like to have or what plans need to be set in place to achieve it. But, like anything else in life, your satisfaction with the outcome of your birth will be directly influenced by the amount of preparation and consideration given beforehand. Now, it is true, that birth cannot be “planned” in a certain sense. After all, we only have so much control over how things happen. Nevertheless, there are always things that you can do in advance to give yourself the best path forward for “success” …however you define that. And regardless of what the ultimate outcome is, you will be able to rest in the knowledge that you did all in your power to achieve your ideal birth and protect yourself and your baby. You will be able to look back on your birth experience with a sense of agency and no regrets.

In this article we will explore the four essential steps to becoming a consumer in the birth world.

1. Remember Who You Are

This may seem obvious and like it doesn’t need to be said, but think about it for just one moment. In the scenario of birth, you are an employer! Say that out loud to yourself: 'I am the employer.' And who is it exactly that you are employing? Well, first and foremost, your doctor or midwife. Secondly, the hospital or birth center where you are delivering. And perhaps also a doula. In each of those instances, you are in the driver’s seat.

Now, I realize that in our system, we use other words. For example, the word 'patient' sets an entirely different tone for the transaction that you are engaging in. But think of the wider world. In what scenario do you go anywhere, pay someone for services you require of them, and then they tell you what you must do? Nowhere else do we find this strange dynamic where the person paying for a service finds themselves in a position of being told what they are 'allowed' or 'required' to do.

It may be true that you are hiring these clinicians because they are more knowledgeable in the area of birth than you are. But the fact remains that, at the end of the day, they are consultants. YOU are the project manager. They may give you advice, but it is up to you whether you take it or whether you decide to go a different way. It is absolutely within your rights to question their advice, to ask them to defend it, or to ignore it and do something different.

Your doctor or midwife should absolutely inform you of problems or risks they see in your path, but only you and your partner are qualified to determine which risks you choose to assume. No one should be forcing you to assume risks that they think are best for you. Now that you are firmly grounded in who you are, we move on to:

2. Set Your Priorities

This is an important next step in moving forward because step three is to hire the right people.

But how are you going to know who the right people are if you are not sure of what the goals are? That would be like setting out on a journey without knowing your destination. I think we have already established that the foundational goal is the survival of all parties involved. But as for the specific goals, well, those are going to be as many and varied as the women who are setting them.

For some women, the goal is to have a stress-free birth where they don’t have to make many decisions and do not have to experience the pain of childbirth. Their priorities might be that their doctor is very personable and has a great bedside manner. For other women, the goal is to have a very 'hands-off' birth with as few interventions as possible. Those women may want to hire a midwife.

Or it may be that a woman’s priorities are not super set in stone, but the primary goal is to avoid a surgical birth. These women may want to look for a doctor or midwife, but they will want both the clinical providers and the hospital they choose to have a lower-than-average c-section rate.

In some cases, a woman might have an aversion to hospitals, and if she is healthy and low risk, she may feel like her highest priority is to give birth in her own space, and so she chooses a home birth with a qualified midwife. But in all cases, it is necessary to know what is most important to you BEFORE you move on to the next step.

3. Hire the Right People

Now, here is where things get a little trickier. As we all know, the way our system is set up, we often do not feel that we have as much say in these matters as we would like. For example, we let our insurance coverage dictate who our provider choices are, and then we just try to make the best choice we feel is available to us. This can make us feel limited or even trapped. But I want to give you a few things to think about. Let’s go back to looking at how other transactions go. When you go to build a house, you do not necessarily want to pick the cheapest builder just because he is the cheapest. The reason we may be willing to pay more is that we feel the quality of the work is worth the cost. Hiring a doctor is no different. The problem with our system of maternity 'care' is that becoming a doctor doesn’t automatically mean they are a good doctor. So, choosing a doctor based on the options your insurance company offers may not always be the best option.

Ask yourself: If I end up with a surgical birth because I was bullied into making decisions I wasn’t comfortable with, am I going to be happy with this hire? Remember step 1: you are the employer.

Also, asking for recommendations isn’t necessarily the best route either—unless you know that the person you are asking has the same basic priorities as you do. Are you going to be glad that your doctor was friendly and personable if you feel they did not listen to you, include you in decision-making for your care, or respect your desires? So, I am going to advise you to do your research with regard to the hospital and clinical care provider that you choose. This is one of the most important factors in the ultimate outcome of your birth. Take a look at how different the rates of surgical birth can be from one hospital to another and from one doctor to another, and you will quickly see that there is no one standard of care.

4. Know the Difference

Agreeing to go along with a doctor’s advice is consent... but it is not necessarily informed consent. Informed consent is when a patient is fully educated about the risks, benefits, and alternatives of a given procedure or intervention. Often in the realm of birth, things are not presented this way at all. It is much more common for patients to be told how things are going to be done. Many times, this is based on the conveniences of the clinical provider or on hospital policies that have little, if anything, to do with what works well for the patient and much more to do with what makes the most sense for the hospital or doctor.

When I was pregnant with my first baby, I have a vivid memory of naively asking my OB when we would talk about my options for birth. Her response is one I will never forget. She said, 'What options?' Knowing that you have the right to informed consent and understanding that things are unlikely to be presented to you this way gives you the permission you may need to question the advice you are being given, to ask for alternatives, and to understand that just because advice is given to you, doesn’t mean you have to take it. It also doesn’t mean that going another way would be unreasonable—although you may experience pushback from clinical providers who are not accustomed to being questioned, let alone refused. Hospital policies are not laws. Standing orders are not commands that you must obey. Further, it isn’t even common for decisions made during birth to be emergent… so usually it is very reasonable to ask for time. Time to process what is happening and to evaluate what you truly want to do. And if you do have to accept outcomes that are not what you wanted, at the very least, you deserve time to come to terms with things, rather than feeling like everything is out of control and being forced on you.

If this has given you some things to think about with regard to being a consumer in your birth experience, then it has been a success.

Remember, doctors and midwives don’t “deliver” babies. Doctors and midwives catch the babies that are delivered by their patients.

Your birth experience does not have to be something that a broken system imposes on you. Take it back. Own it. It belongs to you, and it is too precious to have it stolen from you.

The changes that really need to happen within our maternity care system will only begin to unfold when a majority of women realize this and walk gracefully and confidently into that reality. It may be a bit more work, but the quality and value of the outcome of that effort will be something that you will never regret.

Amy Bauer

Owner, Hoosier Doula Network

Creator of Pocket Doula,

Certified Doula, and Childbirth Educator

Find her online @hoosierdoulanetwork

and at www.hoosierdoula.net