Decision Fatigue With Women's Healthcare
One of the most difficult decisions families make in pregnancy and the birthing process is who they will choose to surround and care for them leading up to the big day. A lot of women choose a doctor or midwife based on location, insurance coverage, and/or who their friends go to. You probably have heard the joke about how people research their plummer, the best restaurant in their area, and what pillow to sleep on but that most don't take much time researching and picking their health care provider. The thing is, the current health care system here in America doesn't make it easy to find the information families are seeking. It can be a very intimidating process learning all that is out there, especially if you live around a larger metropolitan area like Pittsburgh. Even if you have several OBGYN or midwife practices near you it's hard to really learn anything about them. If you live in a smaller area your options may feel fairly limited, and that can be just as disheartening. Regardless of your area, women deserve to find a practice or individual healthcare provider that fits their philosophy, needs, and desires for birth.
A Birth Story at Jefferson Hospital in Pittsburgh
It can be an especially important process choosing your doctor if you are a second-time mother who is striving for a VBAC (Vaginal Birth After a Cesarean). I recently had the opportunity to work with a couple who delivered at Jefferson Hospital in the South Hills of Pittsburgh with Dr. Eric Lantzman. This family did an excellent job putting a strong priority on educating themselves about their options to have the best chance at having a vaginal birth. They were an absolute dream to work with, and they absolutely rocked their birth. I loved capturing their birth story and being a part of their birth team.
It is very true that when a person comes into the labor and delivery room, both medical staff and family members, they can have a large impact on the birthing family either in a positive or negative way. I was so pleased that when Dr. Lantzman came into the birthing room his presence immediately had a very positive impact on everyone in the room. He greeted the laboring mother at her level, paused his conversation between contractions, praised her for doing so well, and reminded her how to breathe during the intense peaks of her waves of labor. I knew right then just in those first few minutes of interacting with the mother that my clients had carefully selected a doctor and practice that supported their birth wishes, philosophy, and model of care. He did many more things to show his character and displayed many more impressive qualities during this family's birth including allowing her to be in whatever position felt best to her, quietly listened to her Hypnobabies track with everyone in the room, and guided her in pushing the entire time in a very calm, comfortable manner.
How Do I Find the Right Care For Me?
How do I have that kind of experience? What ways can we find the right care for us? Truth is, it does take a little effort, but there are some tips and suggestions to guide you in selecting your health care provider during pregnancy and birth. Talking with your friends and family where they go is not a bad place to start, but it also shouldn't be the only place.
First, a couple must reflect and learn what is important to them. That can be difficult if you are a first time expecting family that has never really thought about or have been around birth before. As you progress in your pregnancy you will develop more of a vision or philosophy on how you'd like your birth to be handled. It may even change as you learn new information in your pregnancy, and that is okay, but most expecting mothers start their prenatal care within the first trimester. You may start with these few questions to figure out what may be important and what model of care you are interested in selecting.
- Do I have any pre-existing conditions that may impact my pregnancy or birth process? If I do have any physical or mental condition, can it be handled under only a physician's care or may be managed with a midwife as well?
- Am I someone who wants a lot of one-on-one time and care with my healthcare provider and will have a lot of questions about the pregnancy and birthing process? Or am I someone who may find decision-making overwhelming and stressful and would rather put my full trust in someone I view as an expert in the medical profession?
- Do I find a lot of comfort being watched closely and want to make sure everything is developing okay? Or do I want a hands-off approach with very little testing?
Remember, whether you are leaning towards a medication-free birth, towards an epidural, or not exactly sure yet because you don't know what to expect, don't forget that there is often crossover between OB's and Midwives. Not all OBGYN's are technology dependent and not all Midwives are as holistic as their stereotypes are depicted. They both also have a wide variety of personality types that may appeal to you more than others. Learning whether you want to delegate a lot of decision-making to your healthcare provider or are leaning more toward a collaborative model of care can get you started when moving onto the next step of researching, interviewing, and visiting the practice.
Questions to Ask the Potential Healthcare Provider
- Tell me about a “typical” birth that you attend.
- What is your standard practice for women who go “past due?” Are you comfortable going into 41 weeks and beyond?
- What is your rate of induction? What is the most common reason for induction?
- What percentage of your patients have a natural, spontaneous childbirth?
- What percentage of your patients’ births do you attend?
- What percentage of patients have a cesarean in your practice?
- What are your beliefs or philosophy on pregnancy, labor, and postpartum?
- What do you think are your strengths as a doctor/midwife and what do you think really sets you and/or your practice apart from the rest in the area?
There are many different places to ask questions of health providers. A lot of times you can make an appointment to go into a OB or Midwife practice's office for a free consultation. Home birth midwives often come to your home for a consultation. If they don't generally do that they may be open to one, or at least have someone who is part of the practice talk with you over the phone. You should explain to them that you are expecting, but not sure what practice is best for you and that you are making sure to find a doctor/midwife/practice that will fit your needs.
When asking your questions pay attention to their bedside manner, the way they speak to you, how thorough they answer your questions , and how they are making you feel when talking. Do you feel they are talking with you? Or at you? Are they engaging and acknowledging your partner? What are their potential strengths and potential weaknesses? And most importantly: trust your intuition.
If at any time in your care there are red flags or you are becoming uncomfortable with the direction your prenatal care is taking, it is never too late to take back control by either having a frank conversation with your doctor/midwife or switching practices. There are doctors and midwives who will accept patients that are very late into pregnancy. There are women who have realized with only weeks left that their birth vision was no longer in line with what they wanted or realized that it was never in line with what their practice supported. It is an extremely tough decision to leave, but if you are careful in the beginning the risk runs low that you would need to take drastic measures at the very end.
If you are able to find the right care then a lot of things easily fall into place. Whether you are a first-timer or a seasoned mom, prioritizing what is important to you and your baby will eliminate unnecessary decision fatigue and set you on the path to a happy, healthy pregnancy.