Who’s got your back?

I just read a wonderful post from Birth Without Fear (possibly the best name for a birth blog I can imagine!) about switching providers if your midwife or OB is not respectful or supportive of your choices.

This is something that I advocate for a lot. If you encounter resistance from your HCP during your pregnancy, even on minor points, I think that it is always worthwhile for you to consider finding someone else. Having someone that you know you can depend on to attend your birth is one of the fundamental aspects of birthing in an empowered way so that you can walk away from the experience feeling confident, proud and supported, rather than potentially ignored, humiliated and abused. There are many options open to women who are going to be giving birth – what is right for you may not be right for someone else, but only you can decide what is right for you and only when you are properly informed and supported can you make that decision (see my earlier post on informed decision making). No matter what you choose in terms of location, medications or lack thereof, interventions, comfort measures, etc., there are some things that are fundamental for every birthing woman: you must be somewhere that you feel safe, you must not be made to fear or mistrust your body and you must be surrounded by people who are caring, compassionate, respectful and supportive of you and your choices.

If your doctor or midwife can’t support the choices that you have made during the prenatal stage, she won’t be able to properly support you and respect your decisions during labour and birth either. What’s worse, is that you will be in less of a position to negotiate and could be more easily pressured or swayed to go against your own wishes. The stress of feeling that you aren’t being listened to or that you’re having to fight for your rights to be respected can have adverse affects on the very process of birth.

The tricky part is finding a new HCP. In Ontario, it can be challenging enough to get one midwife, never mind finding a second one if you aren’t happy with the one you’ve got. If you’re with an OB, things can be even trickier, since no matter who your OB is, there is no guarantee that they’ll actually be the doctor on-call when you go into labour. Ultimately though, it is worth trying.

Early communication about your wishes is the first step – if you’ve got a midwife, talk to her about the kind of labour you want to have right away. That way, if you decide that she isn’t the right HCP for you, you’ll still have time to switch (I had one client who, unhappy with her OB, switched to a midwife at 20 weeks, so it is do-able). If you’re with a doctor, do the same and also check up on the hospital’s policies – some docs may be open to your wishes, but the hospital they work for may not be. Find out if you can meet the other doctors who might be on-call for your labour. If you can’t meet them, be open with your OB about your concerns – ask her for her sense of the other physicians she works with and how open they’ll be to your preferences.

Provide your HCP with a copy of your birth plan early on – make sure it makes it into your file, so that anyone caring for you will have access to it. In addition, you can ask around about the hospital itself – if you’ve got a doula, she may have experience with births at the hospital where your doctor has privileges or be connected with a wider network of doulas who can share their combined experience to give you a sense of which hospitals tend to be more open to various birth options than others. In general, midwives tend to be more open to watchful waiting practices and natural approaches to birth, so if you have an OB and you are low-risk and you’re not feeling confident about your doctor’s support, get yourself on a waiting list for a midwife asap. It’s also of utmost importance that your partner is behind you in the choices you’ve made and knows how to make his or her voice heard if it becomes necessary to advocate for you while you are in labour. Prenatal education can go a long way towards helping you both to trust in your body, in birth and in the choices you’ve made. That trust makes self-advocacy a lot easier if it comes down to it in the birthing room. A doula can remind you of your wishes and can help you with strategies for self-advocacy, but she cannot be your voice.

Check out the Birth Without Fear post here, there are some great comments from women in that community who were able to switch providers for their births.

Keep in mind, you will remember your labour and birth for the rest of your life. You deserve to have caregivers there with you who, no matter what path your labour takes, will make you feel supported and listened to. As Penny Simkin and Annie Kennedy once wrote, “Women’s strongest feelings [in terms of their birthings], positive and negative, focus on the way they were treated by their caregivers.”

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