An ObGyn's Guide to Advocating for Yourself in Labor and Postpartum

birth postpartum pregnancy Dec 16, 2019
by Christine Sterling, M.D., FACOG
Why do people feel the need to advocate for themselves in labor and postpartum?
Is it because your Ob provider is out to get you, sitting awake at night daydreaming about doing cesareans?
Not likely.
While there are certainly bad/corrupt OBs out in the world, the good news is that these people tend to make themselves obvious. They don’t listen to their patients in pregnancy, consistently dismiss their concerns, and act like they don’t have the time of day for you. 
This article is necessary, because you and your ObGyn are often speaking different languages and making decisions in very different ways. 
It’s a recipe for miscommunication and misunderstanding. 
So I’m going to give you some insider tips to communicating with your Ob provider.


Advocating for Yourself Postpartum

You were expecting me to begin with birth weren’t you?
I start with postpartum because, far too often, postpartum is an afterthought.  
Tip #1: Ask the following questions in your prenatal appts:
What are the available resources if I am having trouble with breastfeeding?
What are the available resources if I am concerned about postpartum depression or anxiety?
Is there pelvic physical therapy available as I recover from birth?
Do you have any materials on recovering from birth and/or symptoms to be on the lookout for? 
When will I be seen in the office after delivery? 
FYI: According to the recommendation from the American College of Obstetricians and Gynecologists, you should have contact, either in-person or over the phone, with your provider within the first 3 weeks after birth.
If your provider tells you that you won’t be seen until later, ask:
Is it possible to be seen sooner if I feel that I need it?
Tip#2 Know what to look for postpartum and how to maximize your 6 week appt 
Read Red Flags of Postpartum Recovery
Download The Must Discuss Guide to Your 6 Week Appt


Advocating for Yourself in Labor

Tip #1 Before we even get to labor, we need to talk about trust. You need to judge your Ob Provider as a human being.
You need to be cared for by someone you trust. Trust between a provider and patient is like trust between any two people. 
Do you believe that this person genuinely cares for you and has your best interest at heart?
If not, look for a different provider. If that isn’t possible, be open with your provider about how you are feeling. “I am feeling like you are not taking my concerns seriously. I want to trust you and to feel safe in your care, but I’m not getting that right now.”
Much of the time, it isn’t that your Ob truly doesn’t care, it’s that they are overwhelmed with their workload. Unfortunately, due to systemic problems in medicine, many physicians (and even midwives and nurses) are experiencing burn-out. Deep down they care, but they are drowning in work. Your honesty can break through their burn-out and overwhelm. I wish this wasn’t a reality, but it is.

Tip#2 Avoid saying “I’ve done my research...” when you are questioning a recommendation from your provider.
While this may be a true and accurate statement, it will not serve you. Why? Because often, it will trigger your Ob provider. This statement brings with it the baggage from all the other conversations your provider has had with individuals who declined their recommended treatments. 
Personally, when I hear “I’ve done my research” I am reminded of the patients who declined treatment of their cancers in favor of expensive and ineffective herbal remedies. One of whom came into the hospital bleeding heavily several months later. It haunts me to this day. When I hear these words, I feel my chest get tight. I remember all the blood and the fear that if I couldn’t stop the bleeding she was going to die. I’m working on processing this trauma but I promise you, I am not the only provider who has a visceral reaction to this statement. Behind closed doors, we share this truth with each other. 
I wish I could wave a wand and make all doctors immune to being triggered. But I can’t and I believe pretending we are superhuman doesn’t serve you.
There are better ways to communicate your concerns about a recommended course of action.
Tip # 3 Tell your provider how you feel
If your provider is recommending a course of action or intervention that you have reservations about- tell them how you feel. So instead of saying “I’ve done my research and I don’t want to do this for xyz reason,” you would say “I’m scared/worried/unsure about doing {insert intervention/course of action}.”
If your Ob provider is a decent human, which the vast majority of them are, you will be talking directly to the part of her that went into obstetrics to help people. Instead of feeling like she has to defend her recommendation, she will be called to help you. You will often get your provider to pull up a chair, sit down, and say “Let’s talk this through.” You will lead her into a space of compromise and understanding.
 This space of understanding helps create the tension-free, calming environment you deserve for your birth.

In Conclusion

Alright mommas, I know this was a doozy of an article! Feel free to reach out to me on Instagram if you have questions.

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