What's Your Biggest Concern About Being Pregnant?
First time mums-to-be will say "everything" because up until now it's been a subject that's needed no thought. However, you may want to be concerned with how your maternity care is being managed.
“I’ve been told I won’t be able to have a home birth if I go over 41 weeks.”
“Just had my 36 week appointment with the community midwife and there was more talk of still birth, shoulder dystocia etc.”
“I am classified as high risk simply because I’m over 35.”
“I’ve been booked for an induction because they think I have a big baby.”
“My partner wasn’t allowed in the room during my c-section.”
“All the extra tests, all the scans and measurements every few weeks that reassure you for a few days until you start worrying about the next appointment.”
Especially if it’s your first pregnancy, you worry about so many things. It’s unfamiliar territory. You’ve now entered a world where you’re inundated with new information, given a busy schedule of not-to-be-missed appointments, a huge list of do’s and don’ts and an even bigger list of complications that you might be at risk of.
When you start your journey of endless appointments it can feel like you are being pushed and pulled into many different directions and it can become difficult to take ownership of your experience. For most, you naturally trust your care provider and with good reason because you should be able to trust your educated care provider, right? While I choose to believe most people working in maternity services do so because of the right reasons, it’s become common for doctors and midwives to give you information that you don’t understand and give recommendations as if you don’t have a choice without explaining the correct risk statistics and alternative options.
When I met with my doula (I highly recommend you hire one for support), she told me a few stories which drove home the importance of being educated and confident to take charge of your pregnancy care.
For example, it’s routine practice to recommend fetal growth scans at certain stages of pregnancy. They have a growth chart (below) that everyone is expected to fall in line with at all stages. The outer most lines represent the normal range and the middle represents the average.
The trouble with this is that growth doesn’t necessarily happen like that on the chart. Your developing baby might have a growth spurt one week and measure out of range, and then not grow so much and measure in the normal range a couple of weeks later. In addition, there is a certain margin of error with the scans (typically up to 20%) depending on the experience of who performs your scan, if the baby had a full bladder (can give you an over estimate on size), and if it was moving around.
If you get one single reading that isn’t near the middle line hospital policy usually prompts the midwives and consultants to act swiftly and begin testing you for things like gestational diabetes, book more frequent scans, and start talking about the risk of shoulder dystocia and make a plan for early induction. When doing so they often conveniently forget to mention the risks of induction, the absolute risk of shoulder dystocia and alternative ways to monitor and manage your “issue”. This is what I call fear based practice and can lead you to believe that you are powerless and have no alternatives but to do as they say.
At what point did the system stop trusting women’s bodies and start managing pregnancy rather than supporting it?
Hospital Policy Is Not Law.
In fact it’s quite the opposite. Everything that you are told is always optional. Every appointment booked for you is an invitation and you have the right to decline as much or as little as you desire without any reason needed. I can be hard to remember this because you’re spoken to as if it is law and it takes quite a bit of courage to command respect for your rights and decisions.
Some Interesting Facts Which Your Care Provider Likely Won’t Ever Mention.
Since I am based in the UK most of these are UK statistics.
Shoulder dystocia occurs in less than 1% of all births. It’s actually closer to 0.5-0.75% and is most likely to occur in those born via induction.
Epidural contains Fentanyl. I cannot speak to the dose but do you really want you and your baby exposed to this?
Epidurals can take several hours to take effect and in some women work partially or not at all.
When you have an epidural you lose muscle tone and your bodies innate ability to birth which means more intervention (causing trauma) is often necessary.
Half of all inductions end up as c-sections (which is major abdominal surgery!).
Any trigger of stress (noise, bright light, constant interruptions by midwives, vaginal examinations) produces adrenaline which inhibits the hormones needed for a physiological birth.
Giving birth laying on your back (as in the typical hospital setting) reduces the pelvic canal area by 30% (which the baby needs), increases the length of labor and also the need for pain control and intervention such as foreceps (which requires an episiotomy) and/or c-section.
Informed Consent
I’m willing to bet most of the things above are completely brand new to you. If that’s the case, how are you expected to make important decisions that concern you and your baby without proper informed consent? It is your care providers responsibility to ensure that you are informed, yet this rarely happens. By choosing to leave out your alternative options and explaining all the risks they are effectively coercing you into making a decision.
Also remember that hospitals have such invasive guidelines because if they don’t test for something or warn you of a risk and document it, they are liable in case something goes wrong and they most definitely want to avoid a lawsuit. In fact, 50% of all hospital litigation claims are made against the obstetrics department.
Reclaim The Experience You Deserve
If this is your first pregnancy and it’s all overwhelming for you (understandably so) or you’ve had traumatic birth experiences in the past I encourage you to seek out the help of a doula. Their emotional support is worth the price, not to mention their education on birth rights and ability to convey your wishes on your behalf when you are vulnerable. They are 100% unbiased and advocate the birth plan that you’ve set out to achieve.
If you don’t have the ability to hire a doula you can look up your birth rights via various sources such as birthrights.org.uk. In the US each state may have different rights and the most convenient source I’ve found is via @sacredbirthdoula on Instagram where you can purchase a birth rights package relevant to you.
Find supportive Facebook groups , listen to podcasts, read books and get as educated as possible. A few of my favourites will be listed on the main page.
If during your appointments you start hearing language such as “your at increased risk of… “ or “in your case, the risk doubles” politely ask them for the actual statistics and for supporting evidence. Remember that in most cases where available you can request a different care provider if the midwife or doctor on duty isn’t listening to you or respecting your expressed wishes.
Lastly, remember that you are programmed to do this. Trust your body and listen to your intuition.
Every new mom needs to understand these topics!