"Ask an OB" is a weekly series with Dr. Maude "Molly" Guerin, MC, FACOG. If you have a question for her, please share it with us here.
How can you make sure you are on the same page, specifically regarding risk, with your midwife/OB? For example, is it appropriate to say, "I would like to do my best to birth this child naturally but if you can tell that the baby may not make it, or I am to blow out my body, that is where I draw the line." How do you draw lines with them? Is this a conversation you should initiate during prenatal classes? Should you say, "I am all for candles and bathtubs, but ultimately I am here for the outcome (i.e., healthy mother and baby) and am willing to sacrifice the process (i.e., uninterrupted birth) to get there. I need you to help me identify when our health is at risk." - Okemos Mom
I badly need a crystal ball. When they invent them, I get it first! If I could peer into it and see a 30 hour labor, 4 hours of pushing, a C section, a stay in the Neonatal Intensive Care Unit for the baby and a blood transfusion for you . . . I would do a C section before labor and skip all that! If I could see a baby that comes out and doesn’t breathe, has Apgars of 1 and 4 . . . I would labor you in the hospital, on continuous monitoring, and do a C section if things looked bad. And you would gladly forgo the “candles and bathtubs,” I’m sure! If I was worried a VBAC would rupture your uterus with a trial of labor, but could use my crystal ball to see a 3 hour labor, 2 pushes and a happy baby and mom, we wouldn’t even talk about all the bad things that can happen! Unfortunately we don’t have that crystal ball. Therefore you DO NEED to have that conversation with your partner before you decide where to have your baby. Then you need to be explicit with your provider. Here are some examples of ways that you can set clear expectations:
• “We are committed to a natural labor and delivery at almost all costs. We accept some increased risk for low Apgar scores, neonatal seizures, and a long labor – in hopes of reducing our risk of a C section. Unless you have clear incontrovertible evidence that my baby or I WILL have irreversible damage, I want to continue with no intervention and accept the outcome.”
• “We sincerely hope for a low tech, ‘hands-off’ labor and an unassisted vaginal delivery. Please stand by and let us know if you see warning signs of trouble for mom or baby…we would like to discuss options for intervention in that situation, and have a time line for decisions.”
• “We want as close to a 100% guarantee as you can give us that our baby will be under absolutely no stress during labor and delivery. If things aren’t going perfectly we want a C section immediately.”
Writing your feelings down is always good, too. I would much rather see an essay on your risk tolerance and the strength of your desire for no intervention than the list of “do’s and don’ts” that make up most birth plans. So my advice is yes – please talk talk talk to your provider about risk and how you want to handle certain situations. If your provider has her/his own agenda about these things, you need to know that up front and decide if you can live with that.
Finally, I find the last sentence of your question critical. “I need you to help me identify when our health is at risk.” Honestly, this is not your job, it is our job. Your job is to be strong, to be thoughtful, to climb the big mountain that is labor. Our job is to be nearby spotting you. When you veer off the safe path, we notice, we shepherd you back. Sometimes we yank you back! “Hey your baby is in trouble – get into the O.R. RIGHT NOW!!” You shouldn’t have to worry about identifying when your health is at risk, you have a huge job to do just getting through this (it’s called “labor” for a reason!). If you are second guessing your provider and don’t trust that they will be able to “identify when your health is at risk”, you are in the wrong place for care.
You can read more about Dr. Maude "Molly" Guerin, MD, FACOG, right here.