Patients' Rights

Here is a great article on patients' rights (focusing primarily on childbirth) that I recently read. This has a lot to do with what the Utah Medical Association is trying to impose on us as citizens of the state with the proposed midwife amendments bill. I have thought a lot about the topic and have been asked recently why I made the decision to give birth at home. Stay tuned for a series of blog entries on how DH & I came to the decision and then the birth stories of our four kids. In the meantime read this article for some food for thought:

Consumer First, Patient Second
Finding the right care provider for your pregnancy and birth
By Sherry L. Payne RN BSN

I had a long conversation with my friend, Pam, the other night. She is in her final month of pregnancy, with her first baby, who is in breech position. Her physician is suggesting a cesarean. If attempts to turn the baby are unsuccessful, she will consider a homebirth in order to avoid the surgery. I urged her to let her doctor know her thinking. Woman are often unwilling to have a frank discussion with their caregivers about their wants and desires. I reminded my friend that she selected this provider (or group of providers) and that she is paying them to be competent partners in this process. During a crisis is not the time to start doing things behind their backs but tell them exactly what you plan to do and why and listen to their feedback (but take it with a grain of salt- they don't have the final say- you do). I think this approach is important because it preserves the integrity of the relationship. Physicians and midwives are not mind readers. They need to know and understand what type of care clients desire, or what they don't want and why. Otherwise they'll just continue to think women are happy with the care they are getting.
Think about this question: What is the role of your pregnancy and birth care provider? Is it to manage your pregnancy, labor and birth for you? Is it to take care of you during pregnancy and birth? Is it to deliver your baby for you? Is it to ensure that you have a healthy baby? May I make the audacious statement that all these things are in your own power to do. When I hear statements like, “my doctor won’t LET me do that” or “my doctor says I can TRY that and see how it goes” it tells me how out of balance the care provider is with the care receiver. It is not the proper role of any physician or midwife to tell you how to have your baby (or where, or when). Receivers of health care must adopt a more pro-active consumer role in their own healthcare delivery. Nowhere is this more obvious in healthcare than in obstetrics where as a labor and delivery nurse, I have seen care providers of all types routinely bully, control, and dominate their patients. Your care provider should be a competent guide through the process. He or she is not your daddy. They can’t tell you what you will or won’t do throughout your pregnancy, labor, and birth. They can suggest what they think is best, but the final course of action should be up to you.
This does not mean that a caregiver does not have the right to define their parameters for care. If a midwife only wants to take vegetarian mothers as clients, that’s her prerogative. If you happen not to be a vegetarian and really want this midwife to care for you, then you have a choice to make. The same is true for physicians. If their parameters of care include routine epidurals, episiotomies for all their patients, routines IVs, etc. then that is their place of comfort in giving care. If you don’t want any of those things, you’d be much better off finding a different physician than trying to convert this one to your way of thinking, because you’re asking them to take themselves out of their comfort zone to care for you. It’s important that as consumers of healthcare, women understand the pressures that come to bear upon care providers.
Consumers greatly underestimate the role litigious threat has had on healthcare. One of the reasons obstetrics has become so defensive in practice is because the threat of a lawsuit hangs heavily over their heads. Now some medical lawsuits are well deserved, others frivolous, yet taken together their impact has changed healthcare, and not for the better. Obstetricians are more likely than physicians in any other specialty to be sued for malpractice. This alone has changed the way they approach birth- the way they approach you. Midwives don’t get sued nearly as much, but they are still confronted with the ever growing threat. If you think your relationship with your caregiver is built on trust- well, this may be an idea whose time has passed. Trusting patients is a luxury most physicians find they can no longer afford. Many malpractice attorneys and nurse-attorneys make their livings teaching healthcare professionals how not to get sued. It boils down to defensive practice. This translates into taking all precautions, ordering all the tests, acting the moment something appears amiss. If all else fails, there is always the ultimate medical intervention for a birth at risk- perform a cesarean section. This, among other reasons, is why the cesarean rate has risen to 30% and above. Birth has not suddenly become more dangerous, the practice of delivery babies has.
This is why it is so important to know your own philosophy of birth AND your care provider’s philosophy of birth. It will be far more productive to find a caregiver that agrees with your philosophy of care than to try to convert someone because you like them. Don’t just hope you’ll be the exception or that things will go well- you won’t be and they won’t. Liking your caregiver is not sufficient criteria for choosing him or her.
As consumers you’ve got to do your homework. Get referrals from friends and family, asking them WHY they think this person is so great. Listen to their birth stories- do you want yours to mirror theirs? Google them and find out about them, go to those rating sites and see if someone has left comments about your particular caregiver. Ask your caregiver directly for client testimonials or references. Ask directly for their cesarean and induction rates. (If they won’t give them to you, that’s a red flag). Your ultimate goal should be to find the caregiver, be it physician or midwife, OB or family practice, that is right for you.

Sidebar
Questions to ask your potential care provider
What is your philosophy of birth? (They may have it in written form-even better.)
What are your practice protocols? (What do they do routinely for every patient?)
How many births do you do a month? (Will they be available for you?)
Do you attend your own patients or do I get whoever is on call for your practice group? (This is more the rule now than the exception.)
Will I have an opportunity to meet all the physicians and or midwives in your practice?
Will they abide by any agreements made by you and I?
Which settings do you practice in? (Hospitals, home, birthcenters, etc)
How do you feel about ____________________ (epidurals, episiotomies, routine IVs, or conversely birth balls, squatting, or loud verbalizations – you’d be amazed by how many providers think the birthing woman should be quiet)
What are your parameters for inductions? (What medical or non-medical criteria do they use to decide?)
How available are you (or your staff) for questions between and during appointments?