Your Birth Your Way…?

I’ve had the occasion recently to travel north of Fort Wayne on I-69 southbound, and I’m troubled by a billboard I’ve noticed from one of the hospital systems in town (it doesn’t matter which one) reading, “Your birth, your way.” I like the phase, in general, as it suggests that a woman can experience her birth in a way that is consistent with her values, wishes, and preferences. Clearly, a woman’s birth should be experienced in the way she desires, not the way her nurse, or her provider, or the hospital desires. In my mind, that’s so obvious it’s unnecessary to voice, particularly on a billboard. Yet, I do like the phrase.

However, I think there is really much more to consider here than one might suppose at first glance. The more I’ve driven by the sign, the more frustrated I’ve become to the point I’ve resorted to using a two-word phrase I chastise my kids for using: really? Seriously? My frustration has nothing to do with the particular hospital that owns the billboard, it could be any hospital in any community across America, but rather with the concepts this phrase embodies.

The sign implies that a family should choose to give birth at a particular hospital because they will be allowed to have their birth their way. Hospitals don’t allow women to give birth in any certain way; they shouldn’t be allowed to allow anything. A woman and her spouse should experience birth in any manner they desire without ever requiring the permission of anyone. A family allows the hospital to host its birth and pays them handsomely for doing so. The sign suggests that the hospital is doing families a favor by allowing them to do something. Can you imagine having dinner at the most expensive restaurant in town and being told, “Here you’re allowed to eat anything you like?” It would be appropriate to respond, “I’m paying the bill, of course I’ll order what I like.”

What if your birth your way includes eating and drinking in labor? What if your birth your way includes remaining out of bed and walking in labor? What if you desire to give birth in a tub, the way women elect to give birth every day in far away exotic locations such as Methodist Hospital in Indianapolis? What if you don’t want continuous electronic fetal monitoring because you’ve read what the American College of Obstetricians and Gynecologists (ACOG) has published describing the absence of any benefit to its use in low risk labors, and the very real increased risk of cesarean section? What if you don’t want an IV placed because you have no need for IV medications? What if you want a vaginal birth and you’ve had a cesarean section in the past and the physician on-call for your physician doesn’t support VBAC? What if your birth vision differs or, more importantly, contradicts the hospital’s preference? Too often, women encounter the dreaded phrase, “That’s the way we prefer to do it here…after all, you want what’s best for your baby, don’t you…?” Is there anything more insulting to a mother than to suggest that she would want something other than what’s best for her baby? The reality is, and it saddens me to say, the billboard should probably say, “Your birth your way…as long as your way doesn’t interfere with our way.”

To experience your birth your way requires much more than catchy billboards and glitzy marketing campaigns. It requires a birth team dedicated to helping you achieve the birth you desire. It requires a team whose agenda is to serve the laboring woman’s agenda. It requires physicians, nurse-midwives, and nurses, and doulas to put aside what they want or feel is important, and focus solely on what is best for the woman, her baby, and her family. It requires a birth team to function as a team, with each member of the team bringing their individual skills to help the woman realize her vision. It requires us to understand that we, as providers, don’t allow anyone to do anything. Rather, we make suggestions based on our training and experience, while supporting families’ decisions, especially when they disagree with us.

If you want to experience, “Your birth, your way,” these are critical issues that you must discuss with your provider early in the pregnancy and often. Your birth, your way will not come easily. It will require considerable work. Your provider must be prepared to advocate for you and, in some cases, step in and oppose those who do not support your vision. Above all else, it requires relationship and mutual trust. Relationship requires time, considerable time. Trust requires repeated behavior over time. Time is the operative word in both of these requirements. Trust and relationship don’t spring forth from a five-minute prenatal visit when you’re one of 50 patients the provider is seeing that day. It doesn’t develop in a five-minute discussion in labor with a provider you’ve never met who is on-call for your usual provider. Rather, achieving your birth vision requires a trusting, respectful relationship with your provider and birth team. The individual provider may be sensational, but if they practice in a clinical model that makes your vision impossible, you need to determine this early in the relationship, and in some cases, change providers accordingly.

As I think more about it, perhaps the billboard should read, “Your birth, your way…to the extent that you have a provider and a birth team willing to walk with you, arms locked, through the myriad of decisions you must make to achieve the birth you want.” But I’m not certain that would work well on a billboard.