By Jessica English, CD(DONA), LCCE
Is the hospital you’ve chosen totally supportive of the six Lamaze Healthy Birth Practices? Once you educate yourself on the elements of a healthy birth, there may be times you need to advocate for yourself and your baby. Hopefully you’re able to choose a birthplace that largely supports your goals for birth, but if that’s not possible, here are some suggestions that might make negotiating easier.
1. Talk it out beforehand, and get it in writing. If something is particularly important to you, talk it over with your midwife or doctor at an office visit. For example, if you know it’s standard for women to get a routine IV in labor, explain your concerns to your provider ahead of time. If you can agree that you will not have a routine IV for a healthy, normal birth, ask your provider to write that in your chart and either put it in writing on a prescription pad, or sign your birth plan. That way, if your doctor or midwife isn’t in the building when you arrive in labor, you’ll have that piece of paper to back you up. Individual midwives or doctors usually have the power to override routine policies for their own patients.
2. You’ll catch more flies with honey than vinegar. It’s great when moms and dads are passionate about healthy birth. Unfortunately, sometimes that passion can leave them feeling confrontational. You don’t need to start off with guns blazing. I suggest to my students that they are firm but very polite when working with the staff. Is continuous monitoring the policy at this hospital? You might say to the nurse, “Our midwife OK’d intermittent monitoring. We’d be so grateful if you could help us with that.” And if her answer is no, try again. “This is so important to us. I know it’s not the standard, but we really appreciate your understanding. We did OK it ahead of time.” Nurses, midwives and doctors are just people. A gentle approach is usually received much better than angry demands, and you’re more likely to get what you want. Be likeable.
3. Brainstorm. If you can get your nurse or provider working with you, they may start to take ownership of your ideas. Try asking for their help to brainstorm a problem. For example, a dad or other support person might say to the nurse between contractions, “We really want the baby to stay skin-to-skin after birth. Can you help us think about how that might work? Can some of the routine things be done while the baby is on her chest? What if we waited to weigh and measure him?” Or maybe continuous electronic monitoring is required because of a medical complication, and you’ve been asked to stay lying down in bed. Ask your nurse or provider to help you think through other options, such as laboring with continuous monitoring on the birth ball, on hands and knees or sitting upright. If they respond with reasons why something won’t work, you can always throw out a phrase like, “Let’s try together.” When people are part of the process they generally respond better than if you simply list your demands.
4. Bring a doula. An experienced doula has usually seen other families successfully negotiate in the hospital environment. She probably knows what’s possible and may have some techniques for helping you “get to yes.” For example, hospitals in our area require 30-40 minutes of continuous monitoring when a woman first arrives, with intermittent monitoring as an option after that time. The mom is usually asked to lay on her side in the bed for this monitoring, which is hard for most women to do when they are in active labor. Sometimes the nurse will stay and hold the monitor device on her belly, so that she can still move with her contractions without losing the baby’s heart tones on the monitor. Once one of my doula clients had a nurse who was not willing or maybe not able to stay. The nurse kept insisting that the mom lay on her side, and the mom kept insisting that she couldn’t do that because it would make the contractions too intense. I asked if it might be possible for the dad to hold the device on her belly. The nurse happily agreed. She was able to leave and still get the monitoring she needed, the mom was able to continue standing and leaning with her contractions, and the dad was happy to help.
5. Don’t stop at the first “no.” If you’re asking for something outside routine hospital policy, the first answer you receive will probably be no. Expect that first no, and be pleasantly persistent, using all the techniques mentioned above. I know one woman whose nurse kept telling her there was no way she could have the special requests she’d made for her planned cesarean, such as having both her husband and her doula in the operating room and having her baby skin-to-skin on her chest while the doctor finished the surgery. The mother just kept nodding and smiling and saying, “I understand, but this is what I want. How can we make it happen?” Her negotiations were successful, and her doula and husband were both at her side when that beautiful baby was laid on her chest almost immediately after his cesarean birth. Had she accepted that first no, her birth experience would have been much different.
6. Remember, it’s your body, your birth and your baby. If it comes down to the line, remember that no one can force you to do anything or accept any intervention that you do not want. Shared decision making requires your consent. I remember my client who was pushing on hands and knees with a nurse, only to have a midwife come in at the last minute and tell her to turn over on her back. She asked why, and the midwife replied, “I don’t deliver babies this way.” Between strong pushes, the mom simply said, “No.” The midwife told her again to turn over, and again the woman said, “No.” The midwife successfully caught the baby while she stayed on her hands and knees. It was a beautiful birth! It can be intimidating to have professionals in scrubs and white coats telling you to do something, but if there is no clear safety reason for the request, it is always your right to say simply and clearly, “No.” After all, it is your body, your birth and your baby.
Jessica English, CD(DONA), LCCE, is the owner of Birth Kalamazoo, which offers birth and postpartum doula services, natural childbirth and breastfeeding classes, and in-home lactation consults. A DONA-certified birth doula and Lamaze-certified childbirth educator, she teaches an 8-week series of classes called “The Best of Natural Birth.” She is the editor of DONA International’s eDoula newsletter. A longtime writer and business woman, she also works as a consultant for organizations and birth professionals.
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Thanks for writing about this topic. I find many mothers are either too passive, “Yes, doctor. Ok, whatever you say.” Or they are much to aggressive and demanding, and they behave like the hospital staff are servants. My advice to them is treat the hospital staff like you’d treat the bank teller when you’ve bounced a check… “I know this isn’t standard procedure. I can respect your point of view. However, I feel that “X” is best for my birth.” That, and I tell them to bring cookies… a bit of a snack goes a long way at the nurses station!
Deena, I find your comment really perplexing. So women are either too passive or too aggressive? Great, we still live in a world where even the people who are supposed to support our getting good care won’t allow us to assert our needs without being labeled “aggressive.”
Why would I treat hospital staff like I’ve done something wrong? My being in labor is not analogous to my bouncing a check and I shouldn’t have to make any apologies about getting what I need/want. It’s always great to be a nice person, but we should be treated well, with respect and dignity, and with attentiveness to our stated desires even if we’re complete jerks.
I’ve worked in hospitals, I know how slavishly hospital staff will stick to standard procedures even when they’re harmful, but I also know that most hospital staff understand their job to be actually serving the people in their care as best as they can. That’s their job and I’m paying them to do it. If I need to bribe them to do that job, something is really, truly wrong with this system.
I think a lot of good points are made in this article but I can’t help but feel so sad reading it. It is so sad to me that this even has to be a topic of discussion. Who’s birth, body, and baby is this anyway. No one should be trying to get the mom to do anything that isn’t what she has decided she wants. I realize that is not the reality of the system and that’s what makes me so sad.
Mom’s shouldn’t have to make concessions about some things to be able to negotiate others. This shouldn’t be a negotiation at all. I am a woman paying for a service, you serve me the way I want to be served. Period end of story. It is so unfortunate that we have allowed this system to become so high and mighty that we feel like we need to tip toe around them to get what we want.
If I don’t want monitoring that should be my choice end of story no further discussion needed unless a medical emergency arises. If I want my baby on my chest that shouldn’t be a discussion, it’s my baby and my chest, who are you to say anything to the contrary.
I know a mom who was giving birth beautifully on hands and knees and then the hospital staff came in and started yelling at her that if she didn’t turn on her back she would kill her baby. Her scared husband believed them and also started yelling at her afraid she was going to hurt the baby. At no point was this baby even in danger, it was just hospital protocol that moms lay of their backs. She held her ground and birthed on hands and knees. So the birth physically went beautifully but mentally and emotionally she was being abused from everyone around her. The difference in the potential of that birth experience if only she had loving support is astonishing.
It is sad to me that when women are in a state where what they need is love and encouragement, the ability to let go, relax, and maybe even lose control (not of decision making but of mental and emotional barriers) that they are being forced into situations where they have to be on guard and have to be fighting for what is best for their babies. Even though birth may still physically go wonderfully when mom does stand up for herself, it isn’t the same mentally, emotionally, or spiritually when she has to be fighting instead of going within and being with herself and her baby.
I agree that it’s sad that we need this kind of negotiation, Dr. Nancy… But I know we have all seen women coaxed, cajoled and coerced into things they did not want for their births or their babies. I wrote this piece in the spirit of reality, not ideal. I have often told my students and clients that “you can’t have a home birth in the hospital.” You just can’t. I’ve seen a lot of beautiful natural births in the hospital, but NEVER a “home birth in the hospital.” As you said, it’s just not the same mentally, emotionally or spiritually.
When even just one woman, though, is able to successfully negotiate for something she wants for her birth or her baby, she paves the way for the NEXT woman to have less resistance (or even zero resistance, as it should be) on that front. We have seen changes made here slowly but surely.
I am working with a local home birth midwife in our area to set up a small birth center, in hopes that this will give women another choice for their births. But for those who do choose the hospital, or for some reason have no other choice… Hopefully some negotiating tips will be of help on their journey.
Thank you all for your thoughts! I am hopeful that our long-term goals for mother-baby-friendly environments everywhere will be achieved one day. Keep working at it!
@Ariann,
The alternative to “aggression” is not bein meek and appologetic. That was Deena’s point. When you go into a restaurant, the waitress is paid to provide a sercice to you. But it’s totally unnecessary to go in and DEMEND she bring you a drink, and aggressively assert that your meal with be served a certain way because YOU are paying (!!!) Yu’re not likely to get good service that way. Fair or not, service workers are people too, and they’re simply not likely to expend extra time and energy making special accomodations for someone who treats them like a lesser-than simply because they’re being paid for what they do.
I didn’t understand the bank analogy at all LOL. But the suggestion was NOT that one be “appologetic” (een though the awkward analogy might have implied it.) Bt simply to be courteous and acknowledge the other person’s point of view before getting confrontational and demanding.
In the end, if you are firm but courteous and are still being pushed around, then do what you must. Just like anyone else who’s providing a service for you. If you try to reconcile your dissatisfaction kindly and respectfully, and they are not cooperative, then you might be forced to tell them who’s boss LOL. But that’s not usually a good foot to start on.
I love the story of the woman in #6 who just simply asked “Why?” and when the answer was not satisfactory, she simply repeated “No.” every time the request was repeated. What a perfect way to handle that. Don’t argue or negotiate. Whatever they throw at you, just kindly say “No.” and carry on. That midwife needs a smack though…”I don’t deliver babies this way”? Well, fortunately she’s not on an operating table, so you won’t be delivering this baby anyway. She will! Now sand back and watch
@Mamapanda – Deena definitely set up the dichotomy – aggressive vs. passive. The thing is if I’m refusing something (just saying no – which I also think is the best way), I don’t have any obligation to explain myself or be apologetic for it. I don’t have to say, “I know this isn’t standard procedure, but….” I just have to say no or “I need X.” I’m not against being kind, but it seems like a lot to expect from a woman in labor that she expend a lot of energy on kindness in order to get the basics of what she needs. And ESPECIALLY in a hospital setting, it is the job of the staff to care for their patients and not to make this stuff personal.
Thank you for this article, I have an appointment with my Consultant next week (pregnant with baby number 2, baby 1 was EMLSCS), I am pushing for a VBAC with minimal interference nad looking for evidence to support my argument. I am point blank going to refuse to have an IV and CFM just because it is hospital policy for VBAC, my body, my baby, my birthing experience so it is my way.
I am determind not to be denied the birthing pool because of my previous section as it helped so much with my son (until I “had” to get out),
If they refuse to let me labour my way then it will be another C-section because I not going for a moedicalised “natural” birth! This article has shown me how to negosiate to get my own way (I hope!)
i had to threaten the nurse. When i was in labor with my second baby, i wanted a full follow through of my wishes…no meds, no drugs…NO NEEDLES. When it came time for the IV hookup, I requested that to not be done. As a former nurses assistant, I remember the ‘patient bill of rights” we had to learn, and at the top of it was that the patient had the right to refuse treatment. After i explained this to her, she tried to use a scare tactic on me, “reminding me” of the implications of my decision should i not take the IV set up. I’d had enough and looked her square in the eye and told her if she didn’t get that damned needle away from me, it was gonna end up in her eye. The whole room got quiet, and she stormed off, saying “fine, I’ll get you a waiver”. I perfectly understand hospital policy, but hospital policy isn’t good for each patient. I need that by getting and IV, I’d be stuck in bed, and my labor would have been more intense, and less controlled, like my first one. Patients have the right to refuse. Hospital staff needs to respect a patient’s wishes, and if it does go against any hospital policy, to just go to the next step and get a waiver signed, not argue with a laboring woman who’s already got enough on her plate.
Really loved just the title of #2. Isn’t that the truth with everything in life. I will definitely have to remember these tips to share with my doula clients.