Monday, August 31, 2009

Care providers are creatures of habit

How I wish I could explain this to women who are pregnant or planning a pregnancy. There is a huge need for women to understand:
  1. care providers are creatures of habit so you need to find out what they do through habit (which is not a bad thing necessarily!) rather than just what their philosophy is;
  2. care providers are not going to change their way of providing care, just because you have a birth plan that says you don't want something they usually do;
  3. some care providers can't remember your name, your preferences, your due date or your birth preferences and don't care about them either because it's all there in your file;
  4. having an obstetrician does not guarantee you continuity of care or carer; and
  5. care providers provide care in a system that does not know you exist and don't care specifically for You as a person.
This means:
  1. Asking questions can be really hard, because unless you know people who have previously used that care provider, then you have no examples to go by. But ask questions from the beginning about how they'd manage something or advise you on something, and see what that says.
  2. Again, it's hard to find out the information you need but an open, honest conversation about something that you do or do not want (cord clamping, episiotomy, induction before 42 weeks, breastfeeding support, injections, scans, etc etc) can tell you a lot about their approach.
  3. This may or may not bother you. Work out if it does. If it doesn't, maybe ask yourself why it doesn't matter to you that your care provider remember who you are, even vaguely. Are you not worth that much of their brain time? If it does, work out if it's something that you want to face for the next year or so.
  4. On so many levels, I understand why women assume this. It doesn't mean that your ob cares about you or remembers you (see #3 above). It also doesn't guarantee that they'll be there for your birth. And if you want any mother craft advice, they are also not going to give it to you. They are experts in gestation, and surgery. Pregnancy and birth are not the same things as these! You may birth when they're busy, out of town, at a conference, or with another patient. And how they are in clinic may not be how they are at the birth. It also comes in to #5.
  5. The care you receive during your pregnancy, birth, post natal period and early motherhood should have everything to do with each other. But if you have an obstetrician, it won't. They will see you a couple of times postnatally but you'll be in the hands of the hospital you birth at, and basically without support for the rest of the time. If you go through a public antenatal clinic, it also won't. Same with a public system birth of most kinds - you'll be without support once you leave the hospital.
This post is brought to you by the gnashing of teeth responce I have every time a young, healthy woman signs up with an obstetrician for continuity of care or carer, without asking any questions or trying to see the bigger picture. And I am yet to work out how to say these things face-to-face without looking (more) like a weird midwife hippie.


Georgie said...

yes, yes, YES.

I had my first in the public clinic system, team midwifery. Second baby, we had a bit more money to play with, and private health, and I really wanted continuity of care, so I went with an OB. The good: she was really *nice*, and always remembered my name. The bad: she wasn't a fan of going "overdue" or "big babies". Plus, of course, she played about 5 mins' role in the actual birth. *sigh*

Not that i got continuity of care in the third, despite it being a big promise of the community midwifery program *grumble grumble*

daharja said...

Is there any way you can provide a "FAQ to ask your carer" sheet or similar? To at least get women thinking about such stuff!

I'm still amazed not at how poorly women get treated during the whole pregnancy/birth experience, but at how unproactive they are. They just don't ASK, and assume that nothing bad will happen to them, because they're with "experts"!


It's so sad.

Kel said...

They are experts in gestation, and surgery. Pregnancy and birth are not the same things as these.


sadly it often after having their first baby that women actually 'get it' up until then women live with hope and expectation

Katy said...

It is very hard to know these things with a first baby unless you work in or know someone in the system - a FAQ sheet woould be a great idea - I know when I had my daughter (first & Only baby) I felt like I was an idiot and a hypochondriac throughout most of my pregnancy x

Hua said...

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This information is very helpful for women who are pregnant or planning a pregnancy.

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Director of Blogger Networks