Sunday, June 1, 2014

A Scary New Trend

    My apologies if this seems like one of my ranty posts, but I’m starting to get kind of annoyed with a new trend that seems to be popping up. This is purely anecdotal, but from what I can tell natural and or evidence based birth has become some kind of marketing strategy. Now, part of this is desirable and to be expected. More women are being informed about their rights and options and are pushing providers to, well, provide. So in a way it is kind of encouraging to see hospitals remodeling L&D to be more family friendly and comfortable and to see places offering tools like birth tubs, stability balls, and wireless fetal monitors.  One would expect that more doctors and midwives would be looking at the actual research on things like doulas and VBACs and the hydrotherapy and adjusting their practices accordingly. These are all wonderful things.
   The problem is- from what I can tell, there also seems to be trend of providers paying lipservice to these practices and the failing to deliver. I’m talking about OBs saying they are supportive or pro natural birth and VBACs, but then at 38 weeks talking big babies, ruptures, inductions, failure to progress, and c-sections.  Or OBs and even pediatricians who claim to be pro breastfeeding or even having lactation credentials suggesting formula and supplementation without even addressing latch issues or supply. It’s like they realize that women want these things, but they aren’t invested enough to actually help them achieve it. There could also be a more insidious reason, which I hope isn’t the case- providers patronizingly assume that these women are jumping on some trendy natural birth bandwagon and don’t really know what they are asking for (and I guess ignoring the fact that these practices are based on the best medical evidence).
   Whatever the reason, it’s a worrisome trap because we have women who are well informed who are actively seeking out support for their choices- they know they need to find a OB who is on board and seek one out- only to find out at the eleventh hour that they were mislead.  So how do you tell the phonies apart from the real deal?
-          Interview. You are hiring this person to assist you in the birth of your child. Get recommendations, interview several people, and pick the one who feels like a good fit.
Red flags: If you don’t have enough time in your initial visit to go over your questions or the provider seems annoyed with you, it’s a good indication that they are not going to be very helpful or supportive. They are used to doing things their way and everyone else is just along for the ride.
-          Ask them to walk you through a typical birth of theirs. What procedures are standard? It is true that you can opt out of whatever you choose, but if your provider is used to doing things the exact opposite of what you want, there will be stress and friction and that is bad birthing mojo.
Red flags: If they say “everyone” or “all of my patients,” be suspicious. Unless they have only had one patient, I highly doubt that every birth, mother, and baby were exactly the same. You want someone who can recognize each birth as a unique and individual situation and can do what is best for YOU and YOUR BABY.
-          Ask for stats to back up their claims. They say they are pro-VBAC? Ask what their VBAC success rate is. Ask for their c-section rate, their rate of induction.
Red flags: If they don’t know or won’t tell you, it’s a bad sign. Doctors with good rates are proud of them and they are happy to tell you.
-          Get the specifics. Under what circumstances would they recommend induction? C-section? Supplementation?
Red flags: Be wary of dismissive language. Any “you don’t need to worry about that” or “just leave that to me”s. You are asking for their professional expertise. Hell, you are paying them for it. It shouldn’t be guessing game.
-          Don’t be afraid to switch. This is your birth and your baby. It’s kind of a big deal- like, way more of a big deal than some doctor’s ego. If you don’t feel 100% comfortable with that person, find someone else. There are way too many amazing doctors and midwives out there for you to be giving the shitty ones your business.

Other red flags: Watch out for the words “try” or “let” or “see how it goes”, i.e. “we can try a VBAC” or “I will only let you go to 40 weeks before inducing”.  You need someone who is completely supported and invested in your birth. You need a provider who is going to say “you will have a wonderful natural birth”, “you are going to VBAC this baby”, “ I recommend X, but the decision is up to you”.
You have a right to change your mind. If you decide you want that epidural, or that induction, or that c-section, or that you don’t want to breastfeed- that is totally okay. It’s one thing for people to try and help you stick by your original decisions (the “Are you sure?” and “But you said…”s), but no one should make fun or belittle you or make you feel guilty about changing your mind.
Don’t put up with providers who make fun of or talk down doulas, birth plans, etc. It’s not uncommon to hear statements like “one way ticket to the OR” or “oh, one of THOSE patients”. These birth practices are based on the soundest medical research and backed by ACOG. Would you go to a heart surgeon who scoffed at evidence-based medicine?

I know it seems sad and suspicious to be so distrusting of providers, but I have seen too many people get railroaded into a disappointing and even traumatic birth experience by someone they thought had their back. Do your homework and trust your gut. 

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