Going into labor and giving birth to a baby will always be special and important to you — whether you are going in to deliver your one and only, or having your tenth baby. For the staff at your hospital, your birth is one of many. Though it’s likely that your OBGYN or midwife and the other staff at the hospital chose their jobs because they wanted to help people have babies, your baby’s birth is just another day at work for them.
Hospitals come with routines, and protocols, and with people who find comfort in sticking to those things. As a laboring woman, this may make you feel as if you’re on a conveyor belt. What kind of situations may arise during a labor and birth that the mother and her family feel uncomfortable with? All kinds! You may feel as if procedures are imposed on you without proper explanation. You may feel uncomfortable with the number of staff coming into the room. You may feel that you do not play a proactive role in your own labor, and this may bother you. Many other situations can come up. In all, it is important to understand your rights.
The right to informed consent
Informed consent basically means that you — the “patient” — have a right to be fully informed of any procedure hospital staff are proposing to carry out. You can ask questions about the procedure itself, and about its benefits and risks. You can ask again and again if you didn’t understand the explanation given. And, you have to give your consent before a procedure is carried out. You have the right to refuse a procedure as well. There is a catch, though: your OBGYN is caring for both you and your baby. If refusing to consent to a certain procedure truly puts your baby at risk, the doctor has the right to proceed regardless of your refusal. Such situations are rare.
Labor and delivery can move rather speedily, with little time in which to make important decisions. Because of this, it is in your interest to get to know the hospital at which you will deliver ahead of time. Research their protocols by asking for documents, or chatting with your own doctor or other hospital staff in detail. Most maternity wards will do tours for pregnant women, and this will provide the opportunity to find out plenty.
Families who are naturally minded and wish to exercise a great deal of autonomy during their labor and birth will need to be especially careful. Refusing procedures like continuous fetal monitoring, IV lines, or an episiotomy may get you labeled as an inconvenient patient. Again, it’s good to check your hospital out in advance. Find out what their c-section rate is, how many episiotomies they do, and if they are open to doulas. These are three great indicators that will tell you if this hospital is right for you. You may consider a more naturally-minded hospital, or a birth center of homebirth midwife, if you want to have an unmedicated birth with as little intervention as possible.
Refusing to consent, and emergency situations
What if you refuse to consent to a certain procedure? Well, that depends what is happening.
Doctors have the right — thankfully, really — to do anything it takes to save your life or your baby’s, even if you don’t want to consent. If your baby is in distress and you don’t consent to a cesarean section, it will likely happen anyway. This rarely happens, obviously, since you care about your baby’s safety more than doctors do. Mothers who refuse interventions for their baby when doctors have good reason to believe that they are quite necessary will get a visit from social workers, either before or after the intervention is carried out.
In cases where you or your baby are not in danger, you have the right to refuse any procedure. You can leave the hospital against medical advice at any point, you can alter consent forms, or you can simply refuse to have things done to you. Be aware that this may create insurance problems, however, and seek out the details in advance if you think you are going to be one of those “tricky patients”.
Negotiating your birth in advance
You can make a written birth plan and discuss it with your OBGYN while you are still pregnant. Some hospitals have now started to refuse to accept birth plans. This is a great signal to look for another hospital. If your OBGYN and hospital are willing to work with you, a birth plan can be a very helpful tool for all involved parties.
On a birth plan, you can detail all your wishes, during a normal birth, in an emergency, and about your baby’s care after birth. Birth plans should be one-page documents that specify the mother’s preference for pain relief and monitoring during labor, wishes during emergency situations, who will be present at the birth, and what she wants to happen right after the baby’s birth (skin to skin contact, the father cuts the umbilical cord, immediate breastfeeding, etc). You can google sample birth plans to get you started. I’ve blogged on how to write birth plans before too. You can start with: Talking about birth plans during prenatal appointments.