By Anna Deligio, MSW, Labor Doula, LCCE, Reiki Master
First, do no harm.
This instructional value statement is often attributed to different versions of the Hippocratic oath medical doctors take as they embark on their healing careers. It seems simple enough and certainly it would be easy enough to assume that its interpretation is universal.
We all know what happens to you and me when we assume, though, and to do so within conversations with your medical practitioner can often lead to more than just a need for clarification. Ensuring that a shared understanding exists of the language being used is critical to ensuring that you receive the care that is best for you.
Take the idea of “doing no harm.” Let’s say you’re in active labor and have been going strong for some time without any medicated pain management. You are working through your contractions well but are tired, overwhelmed, and lacking good support. You are starting to feel like you may not be able to continue without medication. The next time your nurse comes in, you say that you’d like to talk about getting an epidural. The nurse alerts anesthesia and soon you are talking with that person about the potential of getting an epidural.
Drawing on what you learned during your pregnancy from your own research and your childbirth preparation class, you know that epidurals can come with increased risks. You ask the anesthesiologist if the epidural will harm your baby. The anesthesiologist gives you a quick and confidant “absolutely not.”
Does that mean that you move forward with the procedure? Not necessarily. First it is important to make sure both of you are operating from the same understanding of “harm.” You might be thinking that “harm” includes the potential for a sleepy baby after the birth and one who may struggle to establish good breast-feeding. The anesthesiologist may be thinking that “harm” means the epidural would kill or permanently damage your baby. Without clarifying follow-up questions such as “What impact will it have on the baby?” and “How long can I expect that impact to last after the birth?” you are risking approving a procedure that is not in line with your values of birth.
An online search for “tips on communicating with doctors” reveals a theme of writing down questions before the appointment, remembering that you are the consumer, bringing someone with you to appointments, and writing down the answers you get. Added to this needs to be, “ask clarifying questions until you are confident that you and your provider are using the same definitions for words.”
In many childbirth preparation classes, the acronym BRAIN is used to teach participants what questions to ask when faced with a decision. The letters cover the Benefits, Risks, Alternatives, your Intuition, and the potential of doing Nothing and are a way to remember which questions to ask in order to ensure that the procedure undertaken is the one you want. This model is a wonderful first step, but can still lead to miscommunication if clarification of terms is not established through follow-up questions.
This can be a laborious process and not one you necessarily want to step into during your labor. More the reason to have these conversations during your prenatal visits, write a succinct and clear birth plan, and make sure that you have a support person with you during labor who understands your intent during the birth and can support you in communicating that intent to your medical staff.
Language is wonderful in its ability to convey specific ideas and still leave room for interpretation. While it may be fun to explore the intended meaning behind words when reading a piece of creative writing, it is critical to explore the intended meaning when discussing your care with your medical provider.
Insurance and funding permitting, the ability to pick a provider from the start that shares your values will go a long way in making sure language meaning is shared. That said, you will likely interact with many medical providers during your labor and, like us, each brings his/her own lens, values, histories, and definitions to the conversation.
Practicing asking clarifying questions during your appointments will give you the confidence needed to draw on that tool during your labor with each provider with whom you interact. Each question will get you closer to creating a shared understanding with your providers and build your confidence in your ability to participate actively in the labor you intend to have.
Anna Deligio is a Lamaze Certified Childbirth Educator and Labor Doula through her business Nourishing Roots, work that is greatly informed by her previous experiences as an MSW working with families in crisis and babies in foster care, a Special Education teacher of high school students with learning and emotional challenges, a marketing writer, and a waitress at a French restaurant. She loves working with pregnant people and their support people during the transformative time that is pregnancy and birth. When not enjoying the company of pregnant people, she enjoys relaxing with her partner Cathy at their home in Salem, OR.