How women can advocate for evidence-based care in the delivery room.
Most women about to give birth enter the hospital with significant trust in their care providers and in the quality of their maternity care.
But in the United States, home to advanced medical technology, women giving birth may face too much of a good thing. According to Lamaze International, safe childbirth guidelines include low to no medical intervention — it’s simply not necessary in healthy, routine childbirth, the organization says. Yet in U.S. hospitals, women routinely undergo medical interventions during childbirth for which there is little to no medical evidence.
According to “Listening to Mothers,” a 2013 study of new mothers, 80 percent of women believed their maternity care providers were very or completely trustworthy, and 83 percent said the care they received was good or excellent. The nonprofit Childbirth Connection, the Boston University School of Public Health, and Harris Interactive collaborated to publish the study.
Yet the nationally representative survey, which collected responses from 2,400 women, also found many didn’t receive care that followed best practices. Just two out of five women walked around during labor in the hospital — recommended by Lamaze to allow gravity to assist the birth while helping mothers reduce pain and stress and feel more in control of their delivery. In addition, two-thirds reported giving birth on their backs, with just 23 percent saying they gave birth in a propped-up position — but Lamaze recommends other positions, such as sitting or squatting, for comfort and to assist delivery.
More serious surgical procedures are still common in the United States, yet also lack support from medical evidence. About one in six women in the study reported having an episiotomy (KRAMES) (an incision in the perineum), but only 41 percent said they’d had a choice about the procedure. And almost a third of mothers had a cesarean section, which the World Health Organization recommends as medically necessary for 10 percent or less of all births, but one in four reported feeling pressured by their medical providers to do so.
Medical interventions like these often do more harm than good for mothers. That may be why a national health regulating body in Britain suggested in December 2014 that women who are otherwise healthy and expect uncomplicated births are statistically safer giving birth at home under the supervision of a midwife rather than in a hospital. The body recommended all women in the United Kingdom be given the option.
The Lamaze organization’s principles of safe childbirth include minimal medical intervention; allowing labor to begin on its own; and the ability for a mother to get up and walk around, eat and drink, and give birth in the position of her choosing (rather than prone). All help make birth easier and less painful for women, the organization says.
If your healthcare provider doesn’t follow these practices, what can you do to advocate for yourself? It may be the last thing you want to think about during the stress of delivery, but your wishes about your own health are paramount and should be respected. Here are several ways to prepare:
- Take the time to explore evidence-based childbirth practices and maternity care. (Lamaze International is one excellent, time-tested source of information, but whatever resources you use should be based on recent, careful medical studies.) Then, decide what you’re comfortable with for your child’s birth and your own health.
- Ask obstetricians you’re considering how often they use interventions like inducing labor, continuous fetal monitoring, or episiotomy. You have the right to refuse these procedures, which have not been shown to help the newborn and may even harm the baby or you by making labor more painful and difficult. In many cases, women are safer and healthier not undergoing them.
- Ask providers how long mothers stay in the hospital after giving birth, and how long the delivery process generally takes. Longer times in the hospital may actually signal better care, since birth should be allowed to come about on its own, not induced to comply with a doctor’s or hospital’s schedule.
- Discuss your birth plan with your obstetrician. If he or she is not supportive of your choices, consider finding an obstetrician who is. Finding a supportive healthcare provider and delivery setting are likely to be the most crucial steps you can take to ensure a stress-free delivery.
- Bring an informed friend, family member, or midwife or doula with you to the hospital. During childbirth, it can be difficult to advocate for yourself, particularly when it comes to last-minute, in-the-moment decisions. Having an advocate who knows your preferences and can support your choices in discussions with healthcare providers will help ensure your wishes are respected.
April 07, 2020
Christopher Nystuen, MD, MBA