"Maternity care is a key area in which women's ability to exercise real choice and make informed decisions is limited... women's autonomy continues to be violated through both quite subtle and overt discourse and practice." --Journal of Advanced Nursing
Advocating for yourself in today's medical system isn't easy, but it is key to having an empowered pregnancy. That doesn't mean you're on your own, though.
Our PUSH team has developed tried-and-true strategies for finding a provider you trust, getting answers to your questions, and ensuring your voice is heard - and we've packaged them all up for YOU!
Download our comprehensive PUSH Questions to Ask Your Doctor list (PDF) here!
Note: We're in the process of assembling some new features for this section, including a user-submitted database of recommended medical providers and a Rapid Response Team to help you push hard when you're not being heard. But in the meantime, please don't hesitate to reach out if you need help! You're not alone, parents. We've got you.
WHY YOU NEED TO ADVOCATE
It seems counterintuitive and even ironic, but paternalism is a very real problem in prenatal care today - and you don't have to have a male medical provider to experience it.
As a result, women are often dismissed, talked down to, and not given meaningful choices in their prenatal care. For example, we hear every day from (or have experienced ourselves) parents who:
are vocally concerned about altered fetal movement (see #MovementsMatter) but receive minimal follow-up
raise concerns (“Something doesn’t feel right”) but are dismissed and told not to worry (see #KnowYourNormal & Preeclampsia)
are given minimal or no choices regarding the timing of their baby’s birth
are not informed of stillbirth risks because they are deemed unable to "handle" this information or doctors do not want to "scare" the patient
are denied requested fetal monitoring and ultrasound scans, even when they suspect their baby may be in distress (see #AlwaysAsk)
are not offered adequate pain control medications after a C-section
are refused requests for non-standard practices, even when clearly informed of risks & benefits and backed by science (see CMV, EPV & Cord Screening)
have mental health symptoms (postpartum depression and anxiety, PTSD, etc.) that are overlooked or brushed off as "baby blues" (see Maternal Mental Health)
ask for details during an ultrasound scan, and are met with vague answers out of concern that an actual answer would "alarm" the mother
question inaccurate data in their medical chart and find it very difficult to get the errors in their medical records amended
In this environment, it's absolutely critical that every pregnant person is empowered to speak up and, if necessary, fight to be heard. We love the hashtag #UseYourMomVoice, which was coined by the Preeclampsia Foundation but is applicable to SO MANY aspects of pregnancy.
There are not many situations in life when decisions are literally life and death - but pregnancy is one of them. You are your baby's best advocate! Do not EVER hesitate to #UseYourMomVoice - doing so could save your baby's life or your own!
BEING PROACTIVE: WHAT YOU CAN DO
While there is no silver bullet to address these issues, there are things you can do to self-advocate and help make your voice heard:
1) Take notes & track data at prenatal appointments & beyond
Show up to your doctor's office with an app open on your phone, or good ole pen & paper. Did your doctor measure your baby's fetal heart beat or your blood pressure at your appointment? Great! Write it down. Having a high risk pregnancy and monthly growth scans? Record your baby's growth, amniotic fluid measurements, biophysical profile scores, NST reactivity, and other data each appointment.
This shows that you are paying attention, so they should be too. Ask about things you do not understand, and make it a point to go home and learn more. An informed patient keeping notes of what is going on will get better care, and it may be less likely that something will be missed. If you note anything concerning or that doesn't make sense, speak up!
And remember, staying aware doesn't stop at home! Keep track of your baby's movements because #MovementsMatter. There are many great free apps, but use whatever works for you! And if anything concerning arises, show your doctor the data you’ve collected. (But of course you don't need concerning data to seek care. Go in anytime something doesn't seem right, no matter what any app tells you. See #AlwaysAsk)
2) Ask, ask, & ask: Ask questions, Ask for your records, and Ask for the care you need!
Always come to your check-ups with questions. Here's a great list to get you started, but don't hesitate to add to it. The more you know what's going on in your pregnancy, the better.
Next, you have the right to ANY of your medical records. Do you want to see the scans from your ultrasound? Wondering what your doctor wrote in your chart after your last visit? No problem! Request your records (for free) and learn what is in them. Sometimes a provider will write something in a patient’s medical record, but fail to actually tell them (or, maybe you just didn't hear - bringing a friend or family member as a second set of eyes and ears to can help!). Miscommunications can be avoided by reading your records for yourself.
And if you want something different than the "standard" just ask! For example, you may prefer to see the same prenatal care provider for all or most of your appointments (also called "continuity of care"). Or maybe you want extra ultrasound scans. Contrary to what patients are often led to believe, there are few hard and fast rules about prenatal care. You are totally within reason to request more, less, or different types of monitoring during your pregnancy.
3) Know the landscape.
We all want to be able to take our medical providers' word for gold, but it's important to remember: healthcare professionals are human, and they are doing their best within a flawed system.
Of course your provider wants the best for you and your baby. But like anyone else, they are still subject to implicit bias and conflicting incentives - especially the fear of litigation.
Did you know that obstetricians pay some of the highest medical malpractice insurance premiums in the industry? Prenatal care providers know that if they practice medicine the same way as their peers, this is protection in any potential lawsuit, even if they know there are things they could be doing better in their practice. In the current system, groupthink and standardization is encouraged; sadly, incorporating new research and tailoring care based on individual need is not.
However, you have every right to speak up and ask for what is best for you and your baby! If you want placenta measurements, ask! If you want the umbilical cord to be scanned, ask! If your gut is telling you that your baby needs to be delivered NOW, don't take no for an answer! Sometimes what you need may not (yet) be standard in prenatal care, but we believe pregnant people should be given real choice, especially when informed about the risks and benefits of these tools.
When you ask for something outside the norm, your doctor will likely tell you that they practice evidence-based medicine (which is great!). But you should know that many aspects of prenatal care are actually NOT backed by gold-standard randomized controlled trials (for many reasons). As a result, there are many aspects of prenatal care that we just don’t know enough about, and often providers are left to rely on observational studies and their best judgment to make decisions.
4) Don't hesitate to #UseYourMomVoice and #UseYourCURSEWords
If you are not being heard, there are steps you can take that might help get your provider's attention.
First, be upfront about your level of distress. Stop and ask yourself: if my doctor says it's fine and sends me home, will I be reassured, or will I keep worrying about this? If it's the latter, listen to your gut! Instead of asking, "Do you think this is okay?" TELL them, "This is distressing me. I am not reassured. I know you are not seeing anything wrong right now, but please keep looking. Something does not feel right."
Use your "CURSE" words - this handy tool (inspired by AHRQ's "CUS Tool") is intended to help you remember what to say to effectively express your level of distress to your providers in a way they are trained to hear and take seriously:
"I am Concerned"
"I am Uncomfortable"
"I am not feeling Reassured"
"I don't feel I and/or my baby are Safe"
"Can you please Explain your findings to help me understand?"
You can foster further discussion by asking your doctor for their differential diagnosis. For example, you could ask, "Can we go through the differential diagnosis for my [headache, abdominal pain, ultrasound results] together?" This will prompt your provider to share the different causes for your symptoms that they are considering, and in turn, you can share any additional information about what you are experiencing that may help them reconsider a diagnosis or order more tests. If you don't understand, just ask! "I respect your medical expertise and am trying to understand - could you please explain again what evidence you are seeing for and against these different diagnoses?" Find more suggestions of phrases to raise questions with your doctor here or watch this informative panel discussion.
If your concerns are still being dismissed, consider sending a written, electronic message to your doctor with your requests or concerns, instead of verbally raising them at appointments. Electronic messages are automatically saved as a part of your medical record and less open to dispute; verbal requests or concerns may never be documented and can be forgotten. Putting your requests in writing shows that you are serious about them.
And in the worst case, if you don't feel that you can trust your medical provider to respect your intelligence and your intuition, vote with your feet. You are not obligated to stay with the same provider, even in the last weeks of your pregnancy. You deserve a provider who is responsive to your concerns & needs.
If you ever have urgent concerns, remember that you can go to ANY emergency room in the US and you cannot legally be denied treatment - even if you can't pay for it!
Always in self-advocacy, be polite, be open to learning new things, be kind - but also, be firm and be persistent. You are a good parent for seeking out the very best care for yourself and your baby. Do whatever it takes to advocate for yourself! And remember: we've always got your back.
FURTHER LEARNING
Respected organizations and individuals across the maternal/fetal health space have created many fantastic resources to help pregnant and birthing people feel empowered to advocate for themselves.
We highly recommend you check out the following:
Top 5 Questions for Your Healthcare Provider to Ensure Collaborative Care from Dr. Terri Major-Kincade (PUSH Medical Advisor & badass warrior mama and equity champion!)
Top 5 Tips for Celebrating and Empowering Your Pregnancy Journey also from Dr. Terri Major-Kincade (note: this list was written for BIPOC parents, but is applicable to any pregnancy!)
Choices in Childbirth from Every Mother Counts, a free library of inclusive, engaging, and empowering educational content (videos, articles, interactive tools) to help you make informed choices and advocate for yourself during pregnancy and birth
REMEMBER: No one knows your baby or your body better than YOU! Trust your instincts, and when in doubt, get checked out.
Did something you learned here empower you to speak up? If so, we want to hear all about it!
Go to pushpregnancy.org/safe to share your #safearrival story - we'll highlight it to encourage other parents to follow your lead and advocate for themselves and their babies. #unitedwepush
READY TO LEARN MORE? There's plenty more #empoweredpregnancy goodness where that came from! Head back to the Empowered Pregnancy Overview to for even more empowerment. #UnitedWePush