06.22.11: The power of making informed choices.
How important is prenatal education for getting good quality patient care? An article published in The Los Angeles Times about a study conducted by The Child & Family Research Institute and University of British Columbia says fewer than 30 percent of first time mothers are attending prenatal childbirth education classes. Instead most women either did their research online, through books or didn't do any research at all.
I've seen more women in recent years show up in labor with not a clue what to do. They read a few articles here and there, but not much else. They didn't think it was necessary to learn about all their childbirth options because they were happy to do whatever their doctor told them to do, as long as they got an early epidural. They weren't always quite so happy when labor turned out to be a totally different experience than they'd been prepared (or not prepared) for.
The LA Times article points out that a high percentage of women don't know the pros, cons and safety issues associated with different pain management options, episiotomies, C-sections versus vaginal births and other childbirth issues. This left them unprepared to participate in their own medical care and unable to make informed choices about how they would deliver their babies and what would happen to their bodies both in the delivery room and years later.
What's so bad about being uninformed? In any other medical situation where there are a variety of treatment options and care plans available, patients are encouraged to get a second opinion. This is especially true when surgery is involved. With labor and birth, there are so many options (some good and some not so good) that women have to provide their own real-time second opinions. They don't usually have the option of asking another doctor to come in to their labor room and give them advice on how to proceed.
The study says women who received prenatal care from midwives were better informed than women who saw obstetricians. That doesn't surprise me. Midwives tend to spend more time with their patients and education is a priority. The majority of women in this study, however, left all the decision-making up to their health care provider. In short, they did as they were told – no questions asked.
Does this doctor/patient dynamic sound like a healthy adult relationship or something akin to an adult-child relationship (the pregnant women plays the "child" here)? Is it a little weird that many women's first experiences as mothers place them in a submissive, obedient role where they give away their power? Heck yeah, it's weird and this is a "new generation" thing. Even as recently as a decade ago women came to childbirth knowing what to expect and how they wanted things to go down. They were well enough informed to voice their opinions about what happened to their bodies. Not so much these days. Too many women have become complacent, obedient and kind of gullible.
The researchers mentioned above published a related study, in the journal Birth that showed younger obstetricians were more likely than older obstetricians to be in favor of routine epidurals and express more concern about the safety of vaginal birth. Older doctors seem to be less afraid of vaginal birth. The younger doctors (whether male or female) tended to prefer C-sections as the better birthing option, even though studies show that increased c-section rates lead to poorer health outcomes.
This generational pro-C-section attitude may start in medical schools that aren't adequately teaching old-school vaginal birth techniques. It may be because C-sections are faster, easier and more predictable than vaginal births. Or maybe it's because too many doctors erroneously believe that C-sections prevent incontinence later in life (studies prove that's not the case).
It may also be because younger doctors are being educated in a climate of fear where lawsuit prevention and malpractice insurance dictates standards of care. Make no mistake about it, lawyers and insurance agents have strong influences over what goes on in medical schools and labor and delivery rooms and way too often, they're the most powerful voices in these rooms.
How do we change this power dynamic? By women having more to say about how their babies will be born. If women want their voices to be heard, they need to back them up with education, rather than blindly following orders.
Does it violate the doctor-patient "trust factor" to get informed and involved in your own medical care? No. Questioning your doctor's opinions and decisions just makes good consumer sense. Your doctor isn't your boss. He's a consultant hired to provide a service. If you want the best possible service, you need to know a thing or two about the product. In this case, the product is maternal/newborn healthcare. How do you get informed? By taking prenatal education classes, reading all the books and magazines you can and by asking questions. Lots and lots of questions.
This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.