Imagine—you’re vulnerably propped up on the delivery table, sweating bullets, feet up in the stirrups, epidural in place, and your cervix dilated to 10 centimeters. Then, all of a sudden you hear the “snip-snip” of scissors, and look with alarm at the doctor who decided, without your consent, to do an episiotomy.
This is the experience that Kelly, and so many other women experience during the labor and delivery process. More often than not, women’s rights and wishes during labor and delivery are not taken under consideration. Furthermore, the expectation from a patient is that the healthcare providers are going to make the best decisions. After all, during this emotional and exhausting experience, the patient is at the mercy of the doctor’s clinical judgement and available technology.
Ideally, the doctor’s clinical judgement would be in line with what is the most recent evidence-based care, but often it’s driven by profit, time constraints, hospital policies, and even just tradition. According to Brenda Lane, a seasoned doula, often medical professionals are overseeing multiple patients and little “bedside care” is offered to women in labor. By virtue of the sporadic communication in between the provider and patient during labor, decisions to medically intervene can be made without much, or any, input from the patient. Brenda Lane states that “one example of this is obstetricians who continue to perform episiotomies even when the last 20-25 years of research has shown little to no benefit.” Such was the case with the aforementioned Kelly, and 60% of mothers reported in a 2013 survey that they were not consulted prior to their episiotomy cut.
According to the Association of American Physicians and Surgeons, Inc.’s Patients’ Bill of Rights, any competent patient has the right: “To refuse medical treatment even if it is recommended by their physician(s); and to be informed about their medical condition, the risks and benefits of treatment and appropriate alternatives.” According to a dentist Patients are consulted and required to provide informed consent before other procedures, so why is it that a woman’s rights are so often violated in labor and delivery scenarios?
We had the privilege of talking to two awesome doulas, Brenda Lane and Kate Herzel, who both encourage their expecting patients to compile a birth plan. Creating a birth plan, with the help of an advocating professional, helps ensure that evidence-based practices will be employed during labor and delivery. Additionally, the birth plan factors in the mother’s preferences when cooler heads prevail, rather than in the heat of the moment when communication is scrambled.
Creating a birth plan seems to be a logical step for expecting mothers, but regrettably women are often met with resistance by their medical providers. According to Kate Herzel, they’re told that “a birth plan basically guarantees you have a C-section,” or to women who want to have a natural birth, “We’ll see how you feel about that epidural in labor; you’ve never even had bad cramps!” An obstetrician even just brushed aside a woman’s birth plan with the comment that, “You can’t plan birth.”
Not only are these comments hurtful and condescending, but it comes across that some healthcare providers feel that their authority is challenged. Ideally, all healthcare providers would be included in the creation of a birth plan, and view it as a communication tool, but, anecdotally, it appears this is easier said than done.
Ultimately, medically intervening without adequate communication can, at the least, lead to distrust of healthcare workers and, at the worst, can be traumatizing for the patient. In some cases, such as those involving episiotomies, the doctor’s actions could be classified as assault and patients can press charges. Regardless, both short-term and long-term damage can be wreaked during the susceptible experience of giving birth. Communication, researching before deciding on a medical team, and finding adequate social support are all essential.
Brenda Lane has been in the field of childbirth education for 25 years and a doula for 20 years.
Kate Herzel is the owner of Heartland Doulas in Peoria, IL.
Many thanks to Brenda Lane and Kate Herzel for providing valuable insight into the labor and delivery world! We couldn’t have written this article without their help.