The Institute of Medicine defines patient-centered care as providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions. Even though the evidence or the provider’s experience may favor one treatment plan, you may not be comfortable with the plan or you may have different goals or aims for your experience and care. This gap between what the provider thinks is best or preferable and what the patient wants or feels is right happens in many aspects of care and is extremely common on labor and delivery. It is very hard for providers to be objective and sensitive to individual needs when years of practice have taught them to favor certain interventions and to refer to the literature to guide these practices. Questions regarding birth preferences such as elective induction of labor, elective cesarean section, labor augmentation, epidurals, and breastfeeding are all hot topics these days and many women feel as if their providers force their personal preferences on them or treat them just as a statistic. Even though a majority of women I care for end up getting an epidural at some point in labor, I have seen women successful with hypnobirthing and other natural techniques of pain management. Even though breastfeeding has numerous health benefits and is considered the preferred method by healthcare professionals, for some women this is not the best option and we must honor and respect their decision and help them find alternatives that work for her and her baby. All women should listen to themselves and feel comfortable with their care plan. When you do not feel that your needs are in alignment with the proposed care plan you should feel empowered to speak up. You are your own best advocate and know your body and personal values better than anyone else.
Sometimes listening to yourself and speaking up is more than advocating for your preferences or goals in care. Sometimes it is critical to your own survival.
I recently met a woman who honored me by sharing her birth story. She told me that after the birth of her baby she did not feel well when it was time to be discharged. She relayed this to her nurse who then checked her vitals. Even though her borderline blood pressure did not meet the technical criteria for high blood pressure in pregnancy she informed her care team that the reading was not normal for her as it was much higher than her baseline of 90s/60s. The care team dismissed her concerns and attributed her physical feeling and borderline blood pressure to exhaustion, fluid overload, and her chronic anxiety. In this instance not only were her concerns dismissed but her history of mental illness was used against her. Against her own instincts she went home as recommended to return shortly after with blood pressures in the 190s/110s, a severe range which meets criteria for hypertensive emergency and immediately after delivery gave her the diagnosis of preeclampsia with severe features. She required multiple blood pressure medications and days of anti-seizure therapy to prevent her from having a seizure or a stroke. You may be asking the same questions many would be asking these days due to the much needed conversations regarding health care disparities:
Is she a minority? Is she from a low socioeconomic class? Does she have medicaid or another poorly reimbursed insurance? Did she deliver in a hospital that is not used to dealing with preeclampsia or is underfunded and short on staff? No. She is a young white woman who is financially secure with great insurance and delivered at a top academic institution in Manhattan. On top of everything, she herself is a healthcare provider and very well educated in postpartum complications. Luckily because she is a healthcare worker, when she continued to not feel right at home she had the foresight to check her blood pressure and call 911 when it came back extremely elevated. If she did not have a medical background and access to a blood pressure cuff she may have felt shame and judgement for having anxiety and for making a bigger deal out of something her care team had dismissed as normal and not trusted her instincts. She could have died or had permanent brain injury. And tragically many women do.
This is my advice when you feel something is just not right:
Trust your body. Even when your providers, family, or friends dismiss your symptoms or attribute them to something else
Listen to your intuition. If you do not feel comfortable with the care plan or how you are being guided listen to this inner voice
Empower yourself to speak up. You are your own best advocate. No one else knows you as well as you know yourself. Trust this and find someone who will listen to you.
Enlist trusted friends and family to advocate for you. If you still do not feel like you are being heard or are having trouble getting your message across ask for help.
Don’t stop until you feel seen, heard, and confident in your care. You should feel comfortable with and be confident in your care plan and the team providing that care. If not, get a second opinion!
Most women have programming from their upbringing and societal influences that has taught them to be nice, submissive, accommodating, and selfless. We learn to be acquiescent and not contradictory. We learn to put our own needs behind those of everyone else we love. This is especially true during pregnancy, delivery, and motherhood when our primary concern is for the health and wellness of our baby. Never forget that taking care of yourself is taking care of your baby and the rest of your family. When you are physically, mentally, and emotionally well you thrive and so does your baby. I saw one mom die during my training from a very rare, serious complication called an amniotic fluid embolism. This complication can not be predicted and has a 50% mortality rate. Telling her partner that his wife had died and sending that baby home without ever knowing his mom is a haunting memory and an experience that I hope to never have again. It is tragic enough when it is a rare complication that can not be predicted or planned for, however when it happens to someone in which it could have been prevented, someone in which we should be paying attention to the signs, or even worse in which the patient felt or saw the signs that something was wrong before we did but we did not listen to them, it is beyond words.
Listen to your instincts, speak up for yourself, and be relentless when anyone else dismisses, judges, embarrasses, or shames you. Remember, you are the expert when it comes to your body!