In an ideal world, every pregnant person would have the ability to carefully and intentionally choose a maternity care provider who was a good match for them.
In Calgary, the reality of choosing a maternity care provider is more akin to “You get what you get and you don’t get upset”. This means that sometimes you and your maternity care provider are not a good fit for each other and the relationship may suffer from a breakdown in communication, mutual respect, and/or trust.
Sometimes, you may be able to change care providers. But if not, or you choose to stay with your current care provider, what can you do to cultivate a more positive, functional relationship? How can you advocate for yourself and your baby in a kind and assertive way?
Why does advocating for yourself matter?
“The research shows that more activated patients have better health outcomes and better care experiences than patients who are less activated. Studies also show that activation can be modified and increased over time…” READ MORE >>
Take stock of your values and beliefs around perceived medical authority and assess whether they are currently serving you. Here are some questions that may help:
How do you define a good care provider?
How do you define a good patient?
When you think back on your previous interactions with medical care providers, do you notice any patterns? Do you tend to consistently accept medical recommendations? Do you tend to consistently decline them? Do you do a mix of both?
Have you ever found yourself consenting to a medical treatment that you didn’t fully understand? How did you feel afterwards?
Do you currently ask questions of your medical care providers? If not, why?
In the past, have you ever declined a medical recommendation? Why? How did you know it was the right thing to do? How did it feel when you declined that recommendation?
If you have a partner, have the two of you ever discussed your views on perceived medical authority? Do you have similar or different views? How might this affect your approach to decisions about your medical care in pregnancy and labor?
Practice makes…better. If after assessing your current values and beliefs around perceived medical authority you decide you want to increase your self-advocacy skills, it will likely feel really uncomfortable at first. There is a lot of social conditioning (often decades’ worth) that goes into the way we relate to perceived medical authority. Prenatal appointments during your pregnancy can be a wonderful opportunity to practice making small changes that will add up to powerful self-advocacy.
Cultivate curiosity. Ask questions. Ask ALL your questions. You can start with something innocuous and routine. Do you know why your care provider routinely checks your blood pressure at every appointment or measures your fundal height? If not, now’s a good time to ask. Find words that feel comfortable to you. Before your appointment, you can practice by role playing with your partner, a good friend, or your doula. You may also find it helpful to write your questions down in advance so you don’t forget anything.
Take some time. When something is recommended, let your care provider know that you are going to take some time to think about it and will get back to them. Sometimes, you can’t process everything you want to ask about a recommendation on the spot. Allowing yourself some time takes the pressure off. You can offer a specific amount of time (one day, one week, until your next appointment), or just leave it open ended. It’s up to you.
Lower your defenses. If you find yourself getting defensive during your prenatal appointments, practice acknowledging whatever’s coming up. Name the feeling and breathe into it for a moment. Then invite yourself to be curious – ask your care provider for more information, or to clarify their reasoning. If you feel safe to, take a risk and be vulnerable – let them know that you’re feeling defensive and why. The more you are able to be open and honest with your care providers, the more opportunity there is to build mutual trust.
After each appointment, notice what’s coming up for you – you may respond in a variety of ways to your new role as self-advocate. You may feel proud, vulnerable, angry, respected/disrespected, defeated, strong, empowered, etc. Whatever you’re feeling, it’s valid.
Educate yourself. Having a basic understanding of pregnancy, birth, postpartum, and some of the more common complications that may arise goes a long way in increasing your confidence in advocating for yourself. Some options to increase your knowledge:
Read books on pregnancy, birth, and postpartum (if you are a Five Elements Birth Services client, ask your doula about our lending library)
Take a comprehensive, independent childbirth and parenting preparation class.
Ask your care provider for more information. Not sure what to ask? Use your BRAIN.
Benefits (what are the benefits of the proposed treatment/procedure?)
Risks (what are the risks of the proposed treatment/procedure?)
Alternatives (what alternatives are there for the proposed treatment/procedure?)
Intuition (check in with yourself – what are your thoughts and feelings about the proposed treatment/procedure?)
Nothing/Not now (what if you do nothing or don’t do the proposed treatment/procedure right now?).
Hire a doula. Doulas are your walking, talking childbirth class that comes with you to your birth and then supports you postpartum.
Know your rights. As a Canadian citizen you have the legal and ethical right to informed consent and informed refusal of medical care.
What is informed consent?
From Alberta Health Services Policy on Consent to Treatment/Procedure(s):
“Patients have the right to be informed about the benefits and risks of any Treatment/Procedure offered to them, and to make a voluntary decision (with certain exceptions under the Mental Health Act) about whether to undergo the Treatment/Procedure.
The principle of respect for persons reflects the importance of Patients being able to determine what happens to their own bodies, in keeping with their values and beliefs. Where Patients cannot make their own decisions, respect for persons is upheld by recognizing the decision-making role of an appropriate Alternate Decision-Maker.
The Most Responsible Health Practitioner providing a Treatment/Procedure to a Patient has a duty to inform the Patient of the nature of the Treatment/Procedure, its risks and benefits, alternatives, and consequences. Advice about risks and benefits should be as specific to the Patient as available knowledge and information will allow.
Information should be conveyed accurately and in a manner that the Patient can understand. Consent must be obtained without coercion or undue influence from any Health Practitioner or third party.
Informed Consent may be expressed verbally, or in writing, or be implied.
Informed Consent should be a process between the Patient and the Most Responsible Health Practitioner. Information may be discussed over a period of time, culminating in the Patient’s decision to accept or refuse the Treatment/Procedure. A written Consent Form when required is evidence of the Patient’s agreement for the Patient to undergo a Treatment/Procedure and should only be signed once the Patient has had time to reflect, ask questions, understand and reach an informed, voluntary decision (with certain exceptions under the Mental Health Act).”
What is informed refusal?
“An Adult Patient determined to have Capacity to make Treatment decisions regarding a particular procedure, may refuse the Treatment/Procedure(s) on any grounds, even when it is clear that Treatment is necessary to preserve his/her life or health. In this instance, the Treatment/Procedure(s) shall NOT be carried out, even if failure to provide such a Treatment/Procedure(s) may result in the Patient’s death. “
Increasing your knowledge and confidence, practicing asking questions, taking time to make your decisions, and being aware of your own beliefs and values around perceived medical authority, can help lead to clearer communication, and more positive and assertive interactions with your care provider.
But what if, even with improved communication, you and your care provider still don’t see eye to eye on a proposed treatment/procedure? What if you find, for whatever reason, that you want/need to decline a treatment/procedure?
Informed Refusal. It can feel very vulnerable to decline a recommended medical treatment/procedure. You may find yourself wanting your care provider to agree with you and your position but keep in mind that informed consent and informed refusal aren’t about changing your care provider’s mind.
Your care provider doesn’t need to agree with your choices to support your rights to informed consent and informed refusal. They DO need to respect your rights.
What are some reasons that care providers might struggle to do that?
Your informed refusal may be against standard of care. Standard of care simply means what other care providers would normally do in that situation. Whenever a care provider is not following standard of care, they are potentially increasing their liability.
They may not trust that you fully understand the potential risks of your informed refusal or they may not trust that you won’t blame them if the outcome of your choice is not good. Trust and respect in the care provider/client relationship is a two way street and when you claim your rights to informed consent and informed refusal, you also need to claim the responsibility.
They may have previously had a poor outcome in a similar situation and they are very afraid that it might happen again. The vast majority of care providers are good people who want the absolute best outcomes for you and your baby. Sometimes fear can overcome the best of intentions.
It can be helpful in these moments to remember that, at the end of the day, care providers are human beings with all the vulnerability that comes along with trying to do their best in their role as your care provider. Sometimes taking a moment to acknowledge your care provider’s fears can create an opportunity to address and resolve those fears so that together you reach consensus on a course of action.
If you aren’t able to reach consensus though, you can Use your HEART.
Hear – “I hear what you are saying”
Empathise – “I know you want what’s best”
Acknowledge – “You want me to…because…”
Respond – “I want to/I intend to…”
Thank – “Thank you for your time/Thank you for your recommendation.”
Communication is hard, even when you’re communicating with someone you’ve had years of practice with. It’s not surprising then that you can sometimes hit a few road bumps when communicating with your medical care provider and the stakes are high for everyone involved.
Be compassionate. It helps to be compassionate towards your care providers, but it is also important to be compassionate with yourself. Learning how to advocate for yourself within the medical system is a skill set that takes time and practice to develop.
Sometimes it helps to just straight up acknowledge that there will be times it doesn’t work as planned – you may be overwhelmed with emotion, you may feel scared, you may revert back to more comfortable patterns that served you in the past, your care provider may react in a way that is hurtful
You arrive at pregnancy with a lifetime of experience, values, beliefs, and social conditioning that influence the choices you make. You won’t be able to change all of that overnight. But like any new skill, you get better and better at advocating for yourself within the medical system the more you practice it.
Acknowledge any frustration or disappointment, recommit to practicing your new skill, and keep going. Be kind and compassionate with yourself as you add this new tool to your toolbox.
Rachel is a DONA International Certified Birth Doula, Birthing From Within mentor, and mother of three. She is passionate about helping women and their partners discover their own inner strength and wisdom so that they can begin their parenting journey with confidence. With a focus on supporting her clients as they determine what their own priorities and preferences are for their birth while giving them the tools they need to realize those priorities, she feels fortunate to witness her clients come into their own and become their own best advocates.