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.