Your doctor has years of training and experience and can usually identify issues.
However, your doctor is usually basing diagnosis and decisions off the “average” or in some cases, what’s easiest for him.
He does not know your body, your pain tolerance or the way you communicate or don’t communicate problems.
Which means that sometimes, he will make a call which isn’t exactly right for your birth.
Many women forget that they have rights in pregnancy & childbirth.
Just like any other situation, no person can touch you or do anything to you without your permission – if they do, they run the chance that you could charge them with assault or sue.
Women have been conditioned to believe that the doctor is in charge and they must do what they’re told.
Although doctors, midwives and nurses are trained to do a job which involves keeping you and your child as healthy as possible, not all decisions are made simply based on your personal situation or best interests.
Often decisions are based on hospital timelines, policies, or even opening up more patient beds, holidays and the end of shifts.
You have the right to say no to anything or anyone during your birth – a medical professional or trainees.
However you also want to develop a relationship with your medical carers so that they are willing to work with you instead of feeling they have to fight with you every step of the way, and simply refusing all the time won’t build that trusting relationship.
This article will guide you through the steps of standing up for your rights while still staying on amicable terms with your caregivers.
The Dead Baby Card
This is one of the more common and unscrupulous methods medical staff use to convince a woman that she should make a decision that they’re advocating.
Starting any conversation with “Your baby could/will die if…”
• You don’t have a glucose test.
• You don’t get an induction.
• You don’t have a c/section.
• You want to VBAC.
• You choose midwife or homebirth based care.
• You don’t have an ECV/episiotomy/drugs/other interventions
• Or any other reason.
Is emotional blackmail, plain and simple, unless the sentence is followed by FACTS or anything other than broad generalisations.
This is an attempt to make a woman make a decision not based on research, evidence or her own preferences but on fear.
The decision may or may not be the right one in the situation, but that is the woman’s choice, based on getting all the facts, not with threats to her child’s life.
Saying No While Still Working Well With Medical Staff
Saying no to a carer who is simply trying to do their job and follow the hospital rules will likely get their back up and make them more difficult to work with. Here are some methods you can use to work with them while still making the best decisions for your own care.
1. Plan ahead.
Check with your midwife or obstetrician ahead of time whether your birth plan is manageable. This way you have time to work on either convincing them to let you do what you want, or finding a mutual way of reaching the same goal.
If your care providers haven’t seen your birth plan, they can’t tell you if anything in it isn’t supported by the hospital. Here’s a good guide to a natural birth plan. Some common things women want that not all hospitals as yet support, include birthing upright, delayed cord clamping and eating during labor.
2. Ask for time to decide.
It’s rare that you’ll be asked to make a decision that can’t wait even a few minutes. As long as it’s not an immediate life and death situation, request that medical staff leave the room while you discuss the decision with your partner and/or support people.
3. Ask for a deeper explanation.
If your carer’s reasoning doesn’t make complete sense to you, or you want more information, ask! Make sure you’re informed both of the risks FOR and AGAINST the procedure, and how much having or not having it will cause issues.
Ask what happens if the procedure doesn’t work. If you’re worried about what’s involved, ask more questions. Was the answer something neutral like “It’s hospital policy?” Ask to see the hospital policy!
QUESTION IDEAS:
-If I don’t have the procedure, what are the risks?
-If I don’t choose to induce now, and wait a week, what will happen?
-Is this standard hospital practice or specific to my case?
-Do you have any research to back that up?
4. Look for a compromise.
Don’t flat out refuse – staff will think you’re not easy to work with and will be less likely to try to accommodate your decisions. Look for a compromise – ask if you can wait an extra hour for the procedure or if you can try a different method.
EXAMPLE: If your doctor wants to do continual monitoring with you laying on your back, ask if you can do intermittent monitoring or use a portable monitor instead, so you can stay upright.
5. Acknowledge and explain.
Don’t simply refuse point blank. Acknowledge that you understand why they’re recommending that course of treatment and that you understand the risks. Then explain why you feel you’d rather not make this decision or wait for a later time.
6. Get more support.
Having trouble making yourself heard? Feeling passive? Not good at standing up to authority? Get your partner, or a close friend to help you. Or hire a doula who can help support you in what you want and is hired by YOU to support you how YOU want.
7. Get a new carer.
If you’ve tried everything but you still feel that every time you refuse to follow the exact steps your carer lays out for you, it’s a huge struggle, look for another carer if it’s at all possible. While many doctors and midwives do their best to support their patients, others care more about their jobs and getting patients in and out of hospital to a timeline.
If it’s not working out, do what you need to, to get a carer who makes you feel safe and listened to.
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As I learned in Child Birth class when it comes to making decisions use your B-R-A-I-N, Ask what are the Benefits?, What are the Risks?, What are the Alternatives?, What is your Instinct/Intuition telling you? and What happens if you do Nothing. I ended up doing number 7 myself, while my doctor who was a male was nice enough he didn’t really seem to meet my needs, I switched to a Midwife, best decision ever! She really listens to me, people think I am crazy but I feel like she really gets what I want because she has kids and has personal experience. I feel like Male doctors in general just kind of put up a wall and they do whatever is convenient for them because they realistically have no clue what it’s like to be pregnant. My first doctor told me that I would have to have a C-section because I was overweight before I got pregnant and I wanted a second opinion which is why I switched to a midwife. Anytime I need her I can reach her she has been so wonderful and doesn’t make me feel crazy when I say something doesn’t feel right.
As a 30-something female Obstetrician and women’s health advocate, I encourage my patients to ask questions and speak up. I absolutely recommend discussing your birth plan with your care provider early, so that your individual clinical picture can be reviewed and both of you can agree on what is reasonable. .
Please understand, however, that the clinical picture can change almost instantly, so flexibility is key. Keep in mind that though your physician or midwife may agree to your plan, other providers in the group may be responsible for your care when you arrive in labor, and they may not be open to accommodate all of your wishes.
I think that most OBs (especially females) & midwives really genuinely want to give you the experience that you want, and will work with you. However, the most important thing is that you and your baby go home safe and healthy! Some procedures are in place for very specific reasons–most are geared to reducing fetal/maternal morbidity and mortality.
My patients know that they can trust me to respect their wishes as much as possible, and they know that if I am pushing them on an issue, it’s because I’m extremely concerned about the potential for disaster. Few women and families realize all the dangers that can be involved in pregnancy, labor, and delivery. They shouldn’t have to think on all of that. It’s my job to guard against those things while they focus on their joy and preparations for a new addition. But when I am somber and issuing a warning, I do expect patients to be reasonable. After all, God forbid, if things come crashing down, you will want ME to suddenly make a new plan that makes everything done or not done in YOUR plan turn out alright…
I am a labor nurse and I actually REALLY liked this website. I wish more patients would stand up for themselves and the dead baby card gets pulled WAY too frequently. I do understand they need to tell you the risks and benefits of a procedure (which will often include fetal death) but it drives me nutty!
Great article. One thing I will say may be taken the wrong way & I’m sure was unintentional. A doula is to support the family in the decisions they make but are not a representative or spokesperson to medical staff on behalf of the family. The doula can help the family remember the right questions to ask but a doula does not make a decision or speak for the family.
Doulas are for the pregnant woman, not for the family.
Useful article, thanks for the balanced approach! Although as a male obstetrician it’s disappointing to see generalisations in the comments about male doctors; we might not physically have been through the process, but we’ve often seen our wives go through it, and can in fact be more sympathetic (I’ve known women feel like their female carers have an attitude of “I’ve done this before, it’s not that bad, pull yourself together!”). We don’t expect any other physician to have gone through the same condition as their patients! (I realise pregnancy isn’t a disease.)
The only point at which I would debate the content of this article is regarding risk, and insistence on personalisation. It’s great when mothers ask questions and want to know the pros and cons, but inevitably the recommendation with the best evidence behind them are based on huge studies, and therefore are by definition non-personalised.
If I say to someone “we recommend induction in this condition to reduce the risk of stillbirth, which is increased”, that’s based on meta-analysis of thousands. I’m not going to be able to tell you what your exact risk is, whether you would be one of the lucky or unlucky ones, whether the fact that you’re slightly over or under weight adjusts that risk up or down (unless a robust sub-group analysis was done) and so on. So the question “what will happen if I don’t?” is kind of fair, but also kind of difficult. The answer is probably “it’s quite likely nothing would happen – but you are accepting an increase in the risk of XYZ, which I really can’t quantify for you.”
The reason the dead baby card gets pulled (and I agree it shouldn’t be, other than in the most dire of circumstances when it is absolutely true) is that, to an OBGYN, it seems crazy to say “my birth experience is worth increasing the risk of a dead or damaged baby”. I don’t think any of us would make that choice, and it’s very hard for us to accept that some women will!
Tom,
It is interesting how your first paragraph jumped right in speaking about your feelings being hurt. Of course women would rather have female doctors and female support. Do you hear women or understand when women say what a woman feels when make doctor and male staff have access to their bodies or a man seeing and touching her checking your naked body while you are flat on your back.?
I firmly think that you as a man would defend men who preferred another man to do treatment on their genial parts.
Try not be so quick to scold women for wanting only females to examine and care for their naked bodies. It’s very normal and natural. Lastly, it is very true that you as a man does not know how pregnancy and childbirth feels. Seeing your wife go thru it, still does not afford you the real experience. Why do you men try to be included in us telling you this? Womencannot ejaculate sperm into our wives’ bodiesand we will never know how you men feel, and we certainly don’t write comments on a male site or get our feelings s hurt about male issues.