Thursday, October 2, 2008

"Only When I Need To"

When an expectant mother asks her care provider for information about how often (s)he does inductions, cesareans, episiotomies, etc., one common response is:
"Only when I need to..." or
"Only when it's necessary..."

Are those good responses? The problem is that these answers are subjective; they're dependent on a particular doctor or midwife and his/her training, experience, and personal perspective - even someone's personality can come into play.

If all doctors and midwives provided individual care based on evidence, this type of answer would be more acceptable. However, other factors besides the individual and the evidence come into play in decision-making. I read in Pushed that "A 2006 analysis of ACOG obstetric recommendations found that only 23% were based on ‘good and consistent scientific evidence’ and that nearly half were based primarily on consensus and expert opinion, the weakest level of evidence" (Block 266).

To take it out of the medical field - because I believe subjectivity is part of being human, not just a factor in medical decisions:

I used to be a high school teacher, before my children were born. Whenever a parent would ask me "When do you call parents?", I would explain the particular situations that would elicit a phone call home. I could have said, "only when I need to", but I wouldn't have, because it does not truly answer the question. I do not think most parents would have accepted such an answer - nor should they.

Some teachers really hate calling parents, or don't want to spend the time to do it, so they may call only when a student is in danger of failing the class & it's mandated by school policy. Others may call when a student is in danger of failing, or is having behavior issues, to try to get parents to help turn the situation around. Others may call when a student is in danger of failing, for behavior issues, as well as for a sudden change in work quality, behavior, attendance etc. Finally, some teachers truly value home/school communication and make it a priority - those teachers may call for the previous reasons plus to congratulate students for a particular achievement. I'd bet all of those teachers would say they're calling when they "need to" - it's just that their opinion of "need to" is obviously very different.

Since "only when I need to" isn't a real answer, I believe a follow-up question is in order, even if it is hard to ask. Moms and dads deserve to understand the routines the care provider uses, so they can make an informed decision about whether or not that doctor or midwife is a good fit for them.

Some follow-up questions might include:
What percentage of births do you do ____________ for?
What specific situations do you use ____________________?
What other procedures/medications do you sometimes use instead & when/why?
I'm really hoping to avoid _________________, what can I do ahead of time or during the birth?

Besides, the response to the follow-up question can be very telling as well. Does the doctor or midwife become defensive or aggressive ("When did you go to medical school?")? Does he/she use scare tactics ("Well, you wouldn't want to tear from here... to here, would you?")? Is the answer still vague ("I don't really know how many ______________ I do... when the baby/mother needs it... sometimes" etc.)? It's a good thing to know sooner than later if your care provider responds to thoughtful questions in such an unprofessional way.

Or, does the care provider sit down and answer the question: "well, I don't usually do episiotomies, let's see - I've done three or four in the past year, when we needed to use the vacuum extractor to help mom push the baby out" or "for most first-time mothers, I do episiotomies. A clean cut heals better than a tear". Another example, "I'm comfortable with moms birthing in any position - I've caught babies with mom on hands/knees, using a birth stool, leaning on the back of the bed, in the water tub; many moms do seem to end up using the bed...; I offer suggestions sometimes, and would be happy to help you find an efficient position for pushing, if that's what you're looking for. Tell me more about what you're hoping for..." or "I want moms to be on the bed so I can monitor the baby. Some moms are propped up, some are lying down, or on their side."

Not all of those answers are based on evidence (baby can be monitored very nicely in a variety of positions, it just depends on care providers experience; episiotomies do not heal better), but at least the mother knows where the doctor or midwife stands on the issue and can make a real decision, ahead of time.

The best overall resource I've read about choosing a caregiver is in Henci Goer's The Thinking Woman's Guide to a Better Birth - she has a whole chapter to discuss options and questions to ask etc.

Two of my most popular posts also address choosing a care provider: Choosing a Care Provider & Birth Place and Pregnancy and Birth: What Are My Choices?.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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