Choices

Coke or Pepsi? Fries or salad with your sandwich? Beautiful but overpriced shoes, or an RESP for your children? Highway or surface route to get the kids to their appointments on time? Isn’t it great to have choices, and to know that we can make them, and then can change our mind if needed? Each and every single day we make choices - about the foods we eat (or do not eat), the amount of water we consume, the things we say to our spouse, coworkers and family. Why is it then, that many women are left feeling like the do not have choices when it comes to their fertility or pregnancy, let alone during the process of childbirth, or later during “routine” childhood health care?
Recently, I had a newly pregnant mother arrive for an appointment. Although she was clearly excited about being pregnant, she was overwhelmed (or perhaps underwhelmed) by the information and care she received at her first visit with her OB. After a cursory exam (blood pressure, blood glucose and an offer for IPS testing), she mentioned that she was hoping to work with a midwife, but had been placed on a waiting list. In response, the obstetrician relayed that he felt that midwives lacked in experience and didn’t offer complete care. When she asked what the IPS testing was for, he noted that it was a test to determine if her baby had Down’s Syndrome (failing to explain that it actually was a measure for risk of having a baby with a number of congenital health concerns). This ended the visit in less than 15 minutes. Her perspective was that he was quite negative about her preferred choices, provided very little in the way of resources, reading materials or education, and perhaps more importantly -was less than enthusiastic about sharing her journey in pregnancy. By the time she arrived for her appointment with me, she was clear that regardless of whether she worked with an obstetrician or a midwife, she knew she did not want to work with him.
A few months ago. a very long term patient of mine found out that she was finally pregnant - she’s been reading this paper for years, and she and her partner (and I) are thrilled that she has finally conceived. In the course of this particular appointment, I asked if she had any questions about next steps, or about working with a midwife versus working with an obstetrician. She seemed to become a little bit anxious and then quickly and quietly said that she wanted to work with an obstetrician so that she could have an epidural. I told her that was great - and she seemed shocked by my response. When I questioned her a little bit further she noted that she was worried that I wouldn’t be supportive of her choices because I seemed to only prefer working with midwives. I was shocked to learn that she was worried that I wouldn’t be supportive, but it was a great learning experience for me, because it underscored a few things:
1.  Health care providers should be clear with their patients and clients that they (the patients) are the drivers in their health care journey, and we (the health care professionals) are along to provide gentle navigational support, as well as moral support,
2.  Informed consent is only possible if health care providers actually INFORM and educate our patients, and ask for their consent or non-consent
3.  Very few people are well versed in advocating for themselves in our current health care system - and are often afraid to express their views / fears / concerns / choices if they believe that their health care providers may be offended, or may not be supportive of them.
The take home message here is this - you and you alone are in charge of your health care - and you have the right to work with as many or as few health care providers as you would like. You can stop working with health care providers that don’t respect your decisions, and you should never feel as though you cannot ask questions. If you are unhappy with proposed strategies for care - ask for options, or a second opinion - it is your right.
In our publication From Belly to Baby our mandate is clear - to provide information and resources so that our readers know that they do have choices when it comes to their health, as well as their family’s health. So, if you have any questions you would like to see us address, or if you are looking for guidance to help you make a decision - let us know. We will be happy to help.
Best of Health!