3 Strategies for Navigating Medical Decisions in Labor

Many people expecting a baby, particularly those planning to birth in a hospital setting, have heard stories about "the cascade of interventions." This is, essentially, the idea that some hospitals have become so accustomed to performing interventions during childbirth that they may encourage interventions that aren't necessary, and one intervention often leads to another and can carry associated risks.

That being said, modern medicine also helps to save countless lives and some of these interventions are absolutely necessary and helpful in birth. It's only becomes a problem when interventions are being recommended that aren't really necessary (birthing person and baby are doing well). The goal of this article is to help you understand how to ask good questions, know your options, work well with your care provider, and feel good about the decisions you make during labor.

I have 3 techniques I teach my doula clients for how to do this - first, ask a lot of questions ahead of time so you understand your care provider's philosophy regarding interventions. Second, when faced with a decision in labor, go through the BRAIN acronym to better understand the decision at hand. Third, ask for some time to make a decision.

1: Questions to ask your Care Provider ahead of time

Different care providers have different philosophies and strategies regarding interventions, so it's important that you go into your birth with a good understanding of where your provider stands. Before asking these questions, I recommended reading through the Evidence Based Birth Blog, it contains up-to-date and evidence-based information that will be helpful to understand to have a well-informed conversation with your doctor.

If labor starts with my water breaking, what is your policy about how quickly I need to deliver the baby?

What do you recommend if I got past my due date? At what point would you recommend an induction?

What percentage of your first-time moms are given pitocin?

What are some reasons that you would recommend starting pitocin?

What are some reasons that you would recommend breaking my water?

What percentage of your patients get IV fluids?

What percentage of your patients have C-Sections?

What percentage of your patients have a vacuum or forceps assisted birth?

After having this discussion with your care provider, you will hopefully have a good sense of where they stand in terms of interventions. Did they give you the sense that they think most moms need help in order to get the baby out? Did they seem uncomfortable with the idea of a long or stalled labor? Did they have a rule about how long after your water breaks you need to deliver your baby? If you are uncomfortable with your care provider's answers to these questions, it is always a good idea to start by voicing those concerns, and if you're still met with resistance, it may be time to consider switching care providers.

If you are confident that your care provider is comfortable with a more hands-off approach unless interventions are medically necessary, that's wonderful! But there's still one more thing I like to coach my clients on going into their births.

2. Go through the BRAIN acronym for making decisions

The norm in the hospitals is that your OB or Midwife is not in the room the entirety of your labor. You may not even see your actual OB or Midwife if they have a rotating call schedule. In most care models, they are caring for multiple patients and trying to balance many responsibilities. This means that, even though you've had many conversations about what you're planning and hoping for in your birth, you may still be faced with a medical professional that isn't on board with your plan. OR, you may be faced with a medical decision that you didn't expect to have to make, maybe they're worried about baby's heart rate or your blood pressure is starting to climb.

Whatever the reason, if you're faced with a medical decision in labor, it's important that you ask good questions and (if it's not an emergency) ask for time to make a decision. Even if you're relatively sure of your answer, talking it through can help you to feel that much more confident in your decision. So here's what I would recommend doing if a doctor or midwife comes in and says "I think we need to do XYZ." This is also where having a doula can really come in handy. If you look overwhelmed and not sure how to proceed, I'll usually cue you by asking "Did you have any questions about that? Did you want a few minutes alone to make a decision?" which gives you the space to advocate for yourself and do what we've practiced, use your BRAIN!

B - What are the Benefits?

R - What are the Risks?

A - What are the Alternatives? Is there anything else we could try first?

I - What does my Intuition say? Do I have a gut feeling about how to proceed?

N - What happens if I do Nothing? Can we wait an hour and see if things stabilize before intervening?

3. Ask if you can have a few minutes alone to decide

If you have a doula and/or a birth partner, talk it out with them. Make sure you understand what your options are and why an intervention is being recommended. My main priority as your doula is always that you feel good about whatever decision you make, so I will never try to talk you into one option or the other. But I can help answer questions for you or help you frame your questions to the doctor.

If it is a medical emergency and there isn't time to talk through pros and cons, just do this one thing - ask that they explain what's happening and why. According to this study,one of the leading causes of trauma in childbirth is "lack and/or loss of control and issues of communication and practical/emotional support." Ask the Nurse or your Birth Partner or your doula to help you understand what's going on and what they're doing. This can make a big difference in how you feel about the experience afterwards.

So there you have it! Those are my strategies for navigating medical decisions while you're in labor. As I said, my goal is never to sway your decision on way or another, I really just want to make sure that you feel involved, informed, and confident in the decisions that you make. I hope this was helpful!!


Claire Baker Madison Doula

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