I am a childbirth educator working in 2 hospital systems and in private practice and I frequently find myself walking a thin line between knowing I can create fear and divisiveness between an expectant family and their physician and wanting my families to feel confident in their medical care. As a representative of the hospital it wouldn’t behoove me to stir the pot of mistrust. However, I find that that most of my students are well read, and come into class with a substantial amount of distrust of the “system” all on their own own. So what are my options…
I bring it back to the birthing person. I may ask in a general way: “How do you feel in your visits with your Dr.? Do you feel your Dr. listens to your concerns? Do your questions get thoughtfully answered? Have you asked specific questions about your doctor’s standard of practice ? ( ie.. skin to skin, episiotomy, delayed cord cutting). I trust my students intuition and know they will get clarity when their physician does not meet their expectations, particularly when skills like listening, thoughtful responses are on the table for discussion and evaluation. When my expectant families ask “ how can we be sure we won’t be pressured into a c-section, because the Dr. has someplace else to go” my only response can be… We’ve all heard about these unfortunate situations. Great communications with your practitioner is the best defense. I say: “Trust your intuition. If you don’t feel comfortable, heard or on the page with your doctor- you need to pay attention to those feelings”. In this way, the evaluation of a Doctor is not something I do, but something that happens in the privacy of a birthing person and their partner’s head… to take action or make changes as they see fit.
A few areas where I absolutely encourage pregnant couples to be proactive is…
1) if they experience prolonged vomiting or diarrhea during the course of their pregnancy… pregnant persons who experience these symptoms in the cold and flu season are often brushed off as having something “seasonal” or benign. However, without a through examination, there is no way to know this for sure. More than likely it is something simple… but it only took one client in my 25 year career to have been diagnosed with HELLP SYNDROME, to be rushed into emergency surgery, and for months after have to watch for her dangerously high blood pressure for me to be clear that sometimes things that look simple may not be. It’s rare, but it’s a killer. Our couples needs to know it’s ok to push harder to get seen and make sure everything is ok.
2) Common practice tells us that the only way to “resolve” toxemia or pre-eclampsia is to deliver the baby. However, recent evidence shows us that dangerously high pressure can persist weeks or even months after the birth of the baby and threaten birthing person’s health. As an educator, our expectation is that prior to discharge, new families will be given a list of warning signs that may indicate the birthing person needs medical attention… but it’s very important to stress in class that anyone who has developed pre-eclamsia in pregnancy, must continue to have their blood pressure monitored regularly to make sure any irregularities are caught promptly.
3) The Post-Cesarean section time frame is another extremely vulnerable time. Major abdominal surgery thought of as common place and insignificant can lead to dangerous and life threatening situations. We need to alert couples that even if they feel “better” a week post surgery… it does not mean the internal healing is completed. Going back to a full schedule of activities should be discouraged, and rest and repair for the 4-6 weeks post surgery should be emphasized. Post- surgical infection, postpartum hemorrhage, sepsis are all life threatening and need to be addressed urgently. Even minor delays in treatment can result in death.
4) Any time a birthing person feels “off ” dizzy, nauseous, just not right we MUST be proactive in getting attention immediately. As partners we MUST advocate for the birthing person to be HEARD, and concerns addressed. The bottom line is that Birthing People MUST be listened to!
We think of the United States as having the best medical system in the world and yet we are the only developed country with worsening rates. 60% of these are preventable. Black and BIPOC birthing people are in the greatest danger with 3-4% times risk because of systemic racism.
As educators we need to proactively inform our parents so they can be aware. Knowledge is power.
https://www.nationalgeographic.com/magazine/2019/01/giving-birth-in-united-states-suprisingly-deadly/
https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
https://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-maternal-deaths-in-the-developed-world