Every pregnancy and labor is different, whether it's your first baby or your fourth. The hustle of the labor and delivery process can overwhelm even an experienced mom, and it might feel easier to take a backseat to your care team.
Fortunately, you have plenty of time to prepare for an empowered birth in the delivery room—nearly 40 weeks in some cases. In those many months of prenatal checkups, be sure to ask your doctor important questions that can help you have your say on delivery day.
Specifically, experts recommend asking your OB or midwife these questions.
How Can I Ensure I'm Receiving Patient-Centered Care During Delivery?
From bump to baby, your entire care team—nurses, doctors, and other specialists—should aim to provide you with patient-centric care.1 This type of healthcare requires shared decision-making between you and your clinicians to ensure your needs are considered at all times.
Patient-centric care is essential, but it can be challenging to advocate for in the delivery room when patients feel more vulnerable or physically unable to speak up. To preempt these concerns, think through what patient-centric care would look like for you during labor and delivery. For example, you may want to ensure you have the ability to decide whether you'd like an epidural. Then, brainstorm with your doctor about steps you can take beforehand so you receive the kind of care you want.
Some strategies might include creating and packing your birth plan in your "go bag" so nurses have it on hand (thereby removing the need for you to explain your preferences) and engaging your partner in prenatal appointments so they can be your voice during labor if you cannot.
How Can We Keep Communication Open Throughout Labor?
During labor, your obstetrics provider likely won't stay in the room with you the entire time. Most patients see the hospital's labor and delivery nurses much more frequently than the doctor who will eventually deliver their baby—and there will be many times when it's just you and your partner alone in the room while you labor.
Ask ahead to see if this setup will apply to you, and if it does, check in with your provider regarding how you might be able to maintain communication with your OB and nurses. For some patients, including GE Healthcare's own Michelle Dowell, CHFP, options may include bedside technologies.
"I appreciated that I had access to a call button I could push if I wanted to communicate with a nurse through the intercom or if I wanted them to come to me," said Dowell, a Senior Usability Engineer at GE Healthcare. "Knowing that someone would always be on standby was essential."
Are There Aspects of My Birth Plan That Might Change?
Review your birth plan with your doctor long before you go into labor to see if any of your preferences might need to be more flexible. While birth plans are helpful tools, they may need to shift quickly if medical needs change. For example, you may want a medication-free labor and delivery, but if you or your baby begin showing signs of distress or infection, it may become medically advisable to use medication such as Pitocin to induce or augment your labor.
Dowell experienced this scenario first-hand. "I had written in my birth plan that I wanted to try natural pain management, but I also didn't exclude an epidural as an option," she explained.
"While on Pitocin, the pain did become intense beyond what I could manage," she said. "Ultimately, I decided on the epidural, and I'm glad that the flexibility in my birth plan encouraged me to feel comfortable changing in the moment."
Keep in mind that you can't predict or plan for everything. Sometimes, medical necessity will require ad-hoc changes; being mentally prepared for possible impromptu changes is essential.
What Happens If My Preferences Aren't Being Respected?
Everything could go well during labor and delivery—but there's also a chance you'll hit a few unexpected speedbumps.
Imagine, for example, that you want a vaginal delivery, but your doctor recommends a C-section. Or, you might be uncomfortable with a certain piece of equipment or procedure proposed during the delivery process, such as the use of forceps. Or, perhaps you want to keep your baby in your room during newborn screenings, but a nurse takes them away. That's what happened with Dowell, whose care team needed to take her daughter to another room for additional care, despite what her birth plan said.
"I wish I had prepared for this scenario so that I could have spoken up," she said. "If I could've done things differently, I would have at least asked if they could explain why it was necessary—perhaps she needed to be taken away, but at least I would have known why."
Talking with your provider to learn about common medical practices during labor and delivery can help you maintain an empowered birth experience. Partner with your OB to troubleshoot solutions to potential problems or breakdowns in communication that might happen with your care team, along with questions you can ask in the moment. Nobody likes feeling unheard, but if it happens during labor and delivery, it's good to have a contingency plan for how to address it.
Remember: Your Voice Matters
Clinicians may be trusted experts in healthcare, but you are the expert on yourself. Together, you and your care team can make informed decisions that put you and your baby at the center of a medically sound and empowered birth experience. Take the time to ask these critical questions so that you can be prepared for almost anything on your big day.
References:
- NEJM Group. What is patient-centered care? NEJM Catalyst Innovations in Care Delivery. January 2017. https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0559
