“I can’t believe that they’re not supporting you. They were so supportive of me and I achieved my vbac no worries. Maybe you just caught them on a bad day.”
I’m hearing this all the time at the moment. First, a vbac group that I’m in took the step of banning care provider recommendations. Then a client and I were discussing the fact that a friend of hers is feeling really well supported by the hospital while she isn’t. Then another friend and I were chatting about birth and she mentioned how she’s never had the experience that I have as she and her sister have always been really well supported by the local hospital.
We're all individuals - what one woman considers "supportive" another may not. Image courtesy of Wikimedia Commons.
Then I also see the hospital I had my planned vbac turned cbac at promoted as VBAC friendly. And it makes me want to scream! A hospital which tells you that you “must” have certain (non-evidence based!) procedures and “be prepared for another caesarean” are NOT vbac friendly. And if they tell you that they will be really sad when your (perfectly healthy!) baby dies because you decline a non-evidence based induction? Well...excuse me if I refuse to refer to them as "supportive".
But heaps of women do have experiences, with the same hospital, that they would consider supportive! How can this be?
A few things really need to be looked at when talking about whether a person was “supported” or not and whether their recommended care provider would be suitable for you.
1) Your expectations of birth Do you believe that birth is a normal physiological experience that requires no intervention (unless there’s an actual complication)? Do you feel that you NEED to have all the routine testing in order to have a safe pregnancy and birth? Do you believe that intervention is always good? Do you want all the drugs, some of the drugs or none of the drugs?
If you feel that you need multiple scans to feel safe then you won't feel supported by someone who refuses to do them. Image courtesy of Wikimedia Commons.
It’s very sad but: the lower your expectations of birth the more likely they will be met. If you believe that birth is a horribly traumatic, life threatening event then simply coming out of it alive will be considered a win. If you believe that birth can be a beautiful, empowering, transformative and amazing experience (as well as safe!) then just being alive at the end may not leave you feeling supported and cared for.
How you view birth will have an impact on whether you feel supported or not.
2) Your knowledge of birth and common interventions If you know that induction doubles your chances of needing a caesarean and increases the risk of uterine rupture and foetal distress then you might feel very unsupported by an OB who doesn’t mention this before trying to talk you into an induction. If you don’t know about these risks then you are likely to feel okay about your OB recommending an induction with no mention of them. You may even feel very supported by a care provider who is kind enough to offer you an induction (in your mind a risk free intervention) to get things moving along so that you can meet your baby and not be pregnant any longer than necessary.
Your knowledge will have an impact on whether you feel supported or not.
3) Your expectations of your care providers Do you expect that they will provide you with options? Recommendations? Choices? Information? Respect? Are you expecting that they will reassure you? Empathise with you? Be a friendly shoulder to cry on? Encourage you?
Do you expect respect from your care provider? Image courtesy of Wikimedia Commons.
I once spoke to a woman who was upset because her care provider kept telling her what her options were and giving her information but wouldn’t tell her what to do. I had to remind her that he wasn’t actually allowed to tell her what to do, but she was left feeling unsupported by him. On the other hand I’d have been pretty horrified by any care provider trying to tell me what to do!
4) Your care provider’s expectations of you Does your care provider expect that you will just come in and do as you’re told? That you will follow policy? Not ask questions? Does your care provider expect that you will be happy with whatever happens in your birth as long as you and bub are healthy? Do they have an understanding of birth trauma or other issues which may be affecting you?
My "supportive" hospital kept trying to bully me into an induction, all the while ignoring (or forgetting!) that I was completely traumatised by my induction experience during my first birth. No matter how many times I explained my trauma they just didn't get it. Their expectation of me was that I'd "remember that all that matters is a safe delivery" and would just be happy if we were alive at the end of it.
If your care provider still supports you when you decline routine interventions, like CTG monitoring, then you know that you are being truly supported. Image courtesy of Wikimedia Commons.
All of these things can make a huge difference to whether you feel truly supported. If you believe that “all that matters is a healthy baby” then you may feel incredibly supported by a care provider who offers all the tests and interventions under the sun and doesn’t allow questioning. On the other hand – your friend may feel that bodily autonomy and informed decision making are key points for her to feel supported. She’s unlikely to feel supported and cared for by the same care provider as you.
So the next time someone tells you that: You should go with Dr so and so. He really helped me get my vbac! Make sure you stop and ask a few questions so that you can ascertain if this provider will really be able to provide the support that you need. Listen to their birth story and see if it marries up with your expectations and knowledge of birth and vbac support. How many procedures did they decline along the way? What were they subject to on the basis of policy rather than health? What is going to happen if your birth plan doesn’t align with the care provider’s policies?
Because at the end of the day: If you are doing what your care provider wants you to anyway, then of course you are going to feel that they support you.
But a care provider who can make you feel supported as you decline procedures and question recommendations is a true gem.