How To Say No To Your Care Provider

Before I started this blog, I asked several mother friends to give me some ideas for topics.  What issues had they encountered on their journeys through pregnancy and birth?  What information were they lacking?  What would have helped them?  The resounding answer was “how to say no to your care provider”. 

Upon doing some research, I have discovered that pregnant and birthing women are not alone in this feeling.  Many people are intimidated by their doctors. This article explores information collected by a team of doctors and researchers on this subject.  The people in the focus groups expressed feeling uncomfortable challenging their doctor. Researchers said, “Many felt that questioning the advice or recommendations of their doctor meant questioning their expertise and possibly their authority. They also feared that this might lead to retribution in the form of lower quality treatment from their doctor somewhere down the road.”

 I believe that pregnant and birthing women have it doubly hard.  Not only do they have their own health to consider, they also have to consider the health of their unborn baby that means the world to them.  They are often scared about the unknown and worry that if they refuse their doctor’s orders they will put their baby’s life in jeopardy.  As mothers, we would endure ANYTHING for the health and safety of our children.   But why should we endure those things if they are unnecessary?  How can we decide what is necessary and what is not?  And, once we decide, how can we tell our care provider no?

The first part of the solution is for pregnant women to understand that they have certain rights with regard to their care.  These rights have been compiled by Childbirth Connection and can be seen here. One of the most important rights to remember from this list is, “Every woman has the right to accept or refuse procedures, drugs, tests and treatments, and to have her choices honored. She has the right to change her mind.”

Once women fully understand their rights, this next tool can be useful in deciding on how to proceed with a specific test or procedure.  The acronym B.R.A.I.N. can be used to remember the various points to consider (in some emergent situations there may be no time for this option).

B.R.A.I.N. stands for:

B - What are the potential BENEFITS of the action?

R - What are the RISKS?

A - What are some ALTERNATIVES to this action?

I -What does my INTUITION suggest?

N - What happens if I decide to do NOTHING?

The childbearing woman should have her care provider answer these questions, but also, if time allows, do her own research and/or get a second opinion.  Child Birth Connection and Evidence Based Birth are great places to find information to aid in decision-making.  For decisions that need to be made in labor, it is wise to hire a doula.  They have a wealth of knowledge about labor and birth options and can remind you of your choices and give you the courage you need to speak up for yourself. 

If these tools lead you to a choice that differs from your care provider’s recommendation, you are left with the difficult task of saying no.  Here are some ideas for that:

1.   Buy some time.  Get a second opinion or ask to think about it and discuss at a later time or date.  I’ve read about women who have “forgotten” to show up to their scheduled induction for a postdate baby to give their bodies a little more time to go into labor naturally.

2.  Bring someone to the appointment (and have a support person in labor) who can help you feel more confident in standing up for yourself.

3.  Find a new care provider.  If you feel your care provider will not listen to you or respect your decisions, perhaps you need to find a care provider who will.  It’s almost never too late to switch.  I’ve read stories of women switching at 38, 39, and 40+ weeks. 

4.  Discuss your feelings with your care provider.  Don’t flat out refuse, if that makes you uncomfortable.  Simply tell them why XYZ procedure worries you.  I think doctors are so used to doing procedures, tests and interventions that they forget there is a person on the receiving end with feelings and concerns.  They may soften their approach if reminded of this.

5.   JUST SAY NO!!!  Ultimately, you are the one who has to live with the choices you make, not your doctor.  Practice in front of the mirror, in the car, with your spouse.  Put on your brave face, march into your appointment and stand up for yourself.  You’ll feel so good about yourself afterwards.

It is important to remember that your care provider is not the sole person responsible for your health.  Your input is just as valuable as any doctor’s. If you don’t feel your doctor values your opinion or feelings, or won’t take the time to listen, then something is wrong.  The doctor patient relationship should be that of a team, working towards a common goal.  In this case, a joyful and safe birth experience that ends with a healthy mother and baby. 

Mothers Deserve Better

“The whole point of woman-centered birth is the knowledge that a woman is the birth power source. She may need, and deserve, help, but in essence, she always had, currently has, and will have the power.”   ~ Heather McCue

Believe it or not, many pregnant and birthing women cross state lines to get the kind of care they deserve.  They give birth in hotels, hours away from their own homes so they can have a “home birth”.  Women seeking a VBAC (vaginal birth after cesarean), labor in the parking lots of hospitals so they can “walk in pushing” hoping to avoid an unnecessary cesarean.  Every day women are bullied into cesareans or inductions for a suspected big baby just because the OB’s malpractice insurance thinks it’s less risky.  Shouldn’t women have access to all the evidence based information they need from their care provider and then be trusted to make a sound decision for themselves and their babies?  I have heard stories of countless women who spend their entire pregnancy under the care of a doctor who is nice to them, makes them feel comfortable and who seems to be on board with the type of birth they desire.  These doctors suddenly turn the tables at the very end of pregnancy or during labor, sometimes using scare tactics to convince their vulnerable patients to go along with whatever they say.  Often, the “doctor’s orders” go against what has been scientifically proven to benefit birthing women and their babies.   So many women feel the need to drastically change their approach to the type of care they seek for subsequent births because they were so damaged, physically and emotionally by the way they were cared for with their first birth.  The term “birth rape” should not exist.  There are actually women out there who feel so violated by their birth experiences that they feel they were raped.   Doesn’t that sound so 3^rd worldish? Nope, it’s going on right here in our country.  We treat pregnant/birthing women and new mothers so poorly in this country.  It is a disgrace.

It is so sad to me that childbearing women have to fight for their rights to be cared for in a way that is, not just scientifically proven, but is gentle, kind and holistic.  As if we don’t have enough on our plates with making sure that we are taking care of ourselves and our families, preparing physically and emotionally for a new baby, and all the worry that goes along with it. Mothers deserve better.

So, what’s the solution?  Women need access to licensed and regulated midwives in hospitals AND in their homes in every state.  We need midwives and OBs to use technology judiciously with every patient.  Care providers need to provide ALL the risks and benefits to their patients of every drug and procedure administered during pregnancy, labor and delivery.  Care providers, then, must respect a woman’s decision on how to proceed, even if she refuses treatment altogether.  We need to stop the assembly line style of care for birthing women in hospitals.   Women need doctors who actually care about their health and wellbeing more than their own pockets.  We also need major reform of malpractice and health insurance policies.  All women should have adequate physical and emotional support in labor.  We need to assuage women’s fears of giving birth, starting with how it is portrayed in the media.  Women should have access to a decent amount of paid maternity leave to be allowed time to bond with their babies and establish breastfeeding.  We need to stop treating women like leapers for breastfeeding in public. We need to be fighting for all these things FOR birthing women.  When it comes time for a woman to experience pregnancy and birth, she should not have to do any fighting or defending of her rights.  Above all, we need to respect mothers and we need to respect how important the process of giving birth is, not just to mothers and babies, but to our society as a whole. 

My vision for this blog is to help educate and enlighten readers to the transgressions within our current maternity care system, but more importantly to empower and support women through the most important time in their lives.