I have talked n the past about the needs of a laboring woman. I have been thinking about that a lot lately, because, well, because it's my job - lol!

In the hospital setting, what is the most basic need of a mother?

Yes, mom needs quiet, and peace, and safety to do and be what she needs... Yes, she needs upright positions, relaxation, and support... but more than any of those things, she needs ADVOCATES!
"If you're going to the hospital for the birth of your choice, you're going to the wrong place...they don't sell that there." - Carla Hartley
The term advocate comes from two words:

ad : to
vox : voice
1: one that pleads the cause of another; specifically : one that pleads the cause of another before a tribunal or judicial court
2: one that defends or maintains a cause or proposal
: one that supports or promotes the interests of another
-Merriam Webster Dictionary

Literally, an advocate is one who acts as the voice of the mother so that she can be free to do and be what she needs to to have her baby. They defend her right to safe, effective, and evidence-based health care. They plead the case of mom to have the birth that she desires, regardless of location. They support and promote her interests to have a healthy mom, baby, and birth practice.

Who is her advocate? Ideally, it should be her significant other or personal support person, her doctor or midwife, her hospital, home, or birth center, her nurses, and her other support people (doula, mom, sister, etc...).

Significant Other/Husband - This role is key to mom's emotional support, but more than that, his/her acceptance and advocacy of her personal choices, needs, desires, and wishes will make or break her birth. Knowing that the person closest to her emotionally will also be her biggest advocate gives a woman confidence to walk Laborland without anxiety over who will, in the heat of the journey, stick with her and who will abandon her.

Doctor/Midwife - This role, in an ideal world, will be the woman's advocate. As I said, in an ideal world. The vast majority of medical professionals in a hospital setting are the advocates of their insurance carriers and their hospital policies, more than the health of the woman. Hospital based midwives often have to follow the same line of health-care as they defer to an OB or office of OBs. Home birth midwives, OTOH, have a much more balanced advocacy view. This is why being VERY selective in your health professional is so important, but more than that, the support of your loved ones to know the rights of childbearing women.

Place of Birth - Just as a doctor or hospital-based midwife will tend to be the hospital's advocate, a hospital is their own advocate - to instill and uphold practices that benefit them: their liability, their pocketbooks, and their files. They are not there to advocate the health of the mom, but of themselves. Birth Centers, when affiliated with hospitals, often share the same POV, though they are more willing to 'attempt' to be the mother's advocate. A home birth is the most mother-friendly setting in the U.S. today. In an ideal world, hospitals and doctors would work to be the mother's advocate and thus, win their trust and healthcare in the process.

Nurse - A birthing woman has no say in who is initially assigned to her room when she has a hospital birth. What many women don't know, though, is that if they have a pushy nurse, an argumentative nurse, or otherwise verbally or physically abusive nurse, they can request a new one. Nurses will have more interaction with the laboring woman, while she is in the hospital, than her doctor or midwife will, typically. Although nurses work for the hospital and thus, often advocate for hospital policy and doctor/midwife standing orders, they often range WIDELY in their 'true and personal views' regarding birth. This attitude can be assessed quickly at check in and a woman has the right to request someone more in line with her wishes, desires, and personality.

Doulas - a doula is a professional birth partner who supports a woman continuously throughout her labor and birth and offers intermittent advice and support postpartum. She can offer such comfort measures as: education to risks and benefits of procedures, interventions, and medications, suggesting positions and relaxation to facilitate a faster, safer birth, offer counterpressure, massage, and relaxation (sometimes including hypnosis) for comfort, and help facilitate open and positive communication with the woman's medical team and place of birth.

Other Support People - Other support people include mother's, mother's-in-law, sisters, best friends, and children. Support people should be honoring to the mother's wishes and desires, supporting her and advocating for her in word and action - never bringing negativity, aggression, or argument to the birthing room.

In an ideal world, a woman would be surrounded by advocates - from her spouse or primary support, to her doctor/midwife, to her place of birth. She would be supported and encouraged, kept safe and honored through this process of bringing life into the world. My job is to take one more step toward ideal. If you are primary support person for a woman during her labor/birth, that is your job as well. Take that responsibility with a good dose of respect and healthy fear that you have the power to harm her labor and birth journey - or the power to heal and help that journey. Don't take that responsibility lightly.

1 comment:

Sheridan said...

Great post! If all the people listed were truly the moms advocates, birth would be a lot better! Choose your careprovider well and your birth location too.


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