I talk with a lot of women on a regular basis about all things pregnancy and birth. One comment I hear a LOT is “If only I had known…”. “If only I’d known that my private OB had a 70% caesarean rate”; “If only I’d known that my hospital wouldn’t support my birth plan”; “If only I’d known that my private midwife didn’t have a back up”. Women NEED to know things, things about you and how you practice, and they need to learn these things BEFORE they hire you…or at least before the fork out significant sums of money. And they also need to learn these things while they still have the option of interviewing other care providers. So here’s my little list of things you need to be telling women at the very first appointment.
1) You need to let her know what “routine” tests and procedures you recommend – throughout the entire pregnancy and labour. You also need to tell her the benefits, risks and alternatives to these so that she can make an informed decision. And then you need to tell her how you are going to react if she declines them. If you are going to withdraw care or remove her from your public program if she declines the GTT, she really needs to know this BEFORE she is just given a form for the GTT at 24 weeks. If you refuse or transfer care on the basis of women declining a recommended procedure you NEED to tell her. Don’t just assume she will consent – you know what assuming does!
Blood sugar testing kit. Image courtesy of Wikimedia Commons
2) Women really need to know what your intervention rates are. If a woman is planning a low intervention birth and you have an intervention rate of 95% then it’s unlikely that she will be happy with the care you offer. And if she is unhappy with your care she will tell everyone she meets that you, well...suck. If she is planning a vbac and you tell her that you support vbac and she finds out after being pushed into an elective caesarean that your vbac rate is less than 5% she’s going to tell people that you lied to her. If you tell her that you will support her low intervention birth and then push her into interventions she doesn’t want she will tell people that you are pushy or manipulative.
3) She needs to know your thoughts on going overdue. Current evidence shows that gestation lengths can vary by up to 5 weeks. It’s very common for women to gestate longer than 40 weeks. If it’s your policy to induce every woman who goes past a certain gestation, whether it be 40, 41 or 42 weeks, your potential clients NEED to know this.
4) If you are offering continuity of care, either as a private practitioner or as part of a public program, your potential clients need to know what sort of availability you can offer them. Are you planning holidays? What happens if you are called away or otherwise unavailable for an appointment or for her labour? At what point during labour do you show up? If you are not there for the whole labour, who is? Are you on call for her 24/7 or only during the week?
5) If you have specific “deal breakers” in terms of “allowing” vaginal birth women need to know. If you will recommend a caesarean for suspected big baby or breech or gestational diabetes or not following Friedman’s curve potential clients need to know so that they can decide how they feel about these prospects.
Sometimes a caesarean section is the safest mode of birth - but women deserve to know under what circumstances you'd recommend one. Image courtesy of Wikimedia Commons
DO NOT LIE to potential clients. If you do not support women going past 42 weeks or will not support certain aspects of birth plans don’t tell women that you will. If you tell them honestly what your limitations are they will simply go on and interview other care providers and likely won’t give you a second thought. If they find that you lied to them they WILL tell other women.
At the end of the day if women have a traumatic experience during their care with you they will share this information with other women. If you do not support a woman’s right to bodily autonomy or you bully women into accepting non-evidence based care they will tell everyone they can. And these days women have a wide audience! Facebook birth and parenting groups are HUGE with thousands of women participating and sharing information about care providers. It’s not just in women’s best interests to ensure that you are a good match for them, it’s in YOUR best interests as well. Honesty is still always the best policy.