My thoughts on finding the best info for your hospital birth
I handled medical malpractice cases exclusively for several years before expanding my law practice to include other personal injury cases. This means I defended doctors, nurses, hospitals, and other healthcare providers when they were sued for allegedly malpracticing a case. I saw a lot of birth injuries and hurting families. I found in a surprising number of malpractice cases involving childbirth, lack of information—or lack of accurate information—often played a role in a negative outcome for mom, baby, or both. As a result, I prepared and gathered info differently to prepare for my hospital births.
In no way do I want to naysay a hospital birth. I never considered anything but a hospital birth for my four deliveries. All four children were delivered without any birth injuries or negative outcomes. Knowledge is power, and educating yourself with accurate information can help ensure that you get the best care possible. I do not recommend getting on Dr. Google or birth forums and reading other people’s horrendous birth stories and deciding that you are better off delivering alone in a field, pioneer-woman style.
Please understand this: No birth is completely without risk to one or both patients (mom and baby). Negative outcomes happen sometimes even under the best care with the most knowledgeable parents. I am not providing a “how to always have perfect labor or childbirth” manual. Instead, I want to share some ways to set yourself up for the best birth possible, armed with accurate knowledge to best advocate for yourself and your baby. To encourage you to seek reliable, medically sound information for the best possible outcome for you and your baby.
The Odds Are in Your Favor
I want to start with the good news for women in the United States: the odds are tremendously low that any harm will come to you or your baby during birth! (I limit it geographically because I have done no research concerning any other countries or regions, but I’d bet most developed countries are as good or better than US rates). We all hear horror stories, and we’ve all seen those commercials by lawyers talking about birth injuries or defects. Birth injuries are difficult to quantify. If you google it, you will see innumerable different “statistics” published by lawyers looking to make money. I checked.
Statistics are promising for the majority of births
In 2020, the CDC reported that only 3% of babies in America are born with birth defects. This statistic includes such birth defects as heart defects, limb malformations, cleft lip and cleft palate, and other non-birth related conditions. The odds that your baby will be born with a defect as a result of something you did not know or did not do are very small. Rest in that.
Further, the National Healthcare Quality and Disparities reports from the Department of Health and Human Services studied birth trauma and injuries to babies in 2016 and found that 0.469% of babies in their study had birth injuries. That’s less than one-half of a percent of babies born with birth injuries in 2016! I hope you can also rest in that statistic, as it was very comforting to me.
Most women have completely normal deliveries
Anecdotally, I delivered four babies in five and a half years. Each delivery was induced as a result of multiple risk factors. All of my deliveries were different. Each delivery was successful. Every delivery came with different questions and different issues. I am eternally thankful for my OB/GYN who gave me the information I needed, and the nurses who provided prompt care and kind explanations for my questions about what was going on at any given time.
Think about how many children you know. How many mothers you know. I am confident that the overwhelming majority of those people in your mind are healthy and normal. That’s because they had healthy and normal births. Please don’t get so caught up in the horror stories that you lose perspective on the odds.
The odds are very small of anything negative happening to you, but I hope sharing what I know might help one less injury happen.
Start by finding a good doctor or midwife
You can—and should—educate yourself and prepare to be your medical advocate and prepare to advocate for your baby prior to delivery. Start by finding a good doctor or midwife.
Get recommendations from people you trust
Ask your friends who they used for their successful deliveries. Ask such questions as:
- Did the provider listen to your questions?
- Did you have time to ask all of your questions?
- Were you able to guide your labor?
- Did the nurses say that the provider was a good provider (they’ll often mention it if they like the provider)?
- Was the provider trustworthy?
If you have any nurse friends, ask if they know anything about that provider. Nurses see and hear everything. If they won’t tell you anything specific, ask if they would use that provider to deliver one of their babies…the answer to that question (or the face they make) will usually tell you what you need to know.
Do your own research
Look up the provider online. Google them and read reviews (reviews are not always reliable, but see if there’s a pattern that looks concerning). Read their bio on their website if they have one. Read about where they went to school, did their fellowship, are they board certified? Board certification is not a guarantee of good care, but it does show a commitment to learning their particular field. Most importantly, every state has a governing body over physicians’ licenses and midwifery certifications. Please look on your state’s governing website and look up the provider you are interested in using. For people in Texas, the Texas Medical Board governs physician licensing. You can find your physician’s license information here.
Texas has a couple of ways for midwives to be certified or licensed to practice. They are either Certified Nurse Midwives (CNM) or Licensed Midwives (LM). Either of those can identify as a Certified Professional Midwife (CPM). CNMs are governed by the Texas Board of Nursing. LMs are governed by the Texas Department of Licensing and Regulations.
While researching your provider, look for a history of reports of malpractice and discipline, and read any reports. I say that with a caveat: just because a provider has been sued for malpractice, or has even been disciplined for an infraction, does not mean that he or she is a horrible provider. What it means is that they are human and have made at least one mistake in their life—like all of us have. But it is something you should know about and be able to discuss with the provider before deciding if you feel comfortable putting yourself and your baby in that provider’s care. See if there were exceptional circumstances, or get a feel for the provider’s version of the events. If the explanation makes you comfortable, great! If you have any doubt, find another provider.
Schedule a meeting–an interview
Then go meet the provider. If you are not already a patient of your favorite provider, schedule a transfer of care visit to establish care, and go ask all of your questions that you have right now. See if the provider will answer them. Pay attention to whether the provider treats you like you’re wasting his or her time. See if the provider is invested in you as a person rather than just the uterus carrying a baby.
Ask if the doctor is pro- or against episiotomies (not a discussion to have when you’re 7 cm dilated!). Ask the doctor’s position on inductions and c-sections. Does the doctor foresee any issues right now with you for either of those? Will the doctor agree to explain to you—if time safely allows for explanation—why you need an induction or C-section? See if the provider makes you feel respected and treats you with dignity during an exam.
If ever a provider makes you feel uncomfortable or is rude or inappropriate, please go find another provider. YOU DO NOT HAVE TO EXPLAIN OR APOLOGIZE. Find a provider who you (and your spouse if possible) trust and feel comfortable going through this process with for the next nine months.
Get an idea of the way the practice works
Find out what happens if you go into labor while the provider is out of town.
- Is there a call group or group of providers who will step in to cover for the provider if that provider is unavailable?
- What other providers would potentially see you? Research those providers as above.
- If there is a provider you do not feel comfortable using, is there a backup provider on-call who could be called?
- Some practices have a rotating provider schedule, such that whichever provider is in the clinic that day sees all clinic patients. Is this such a practice?
- Is there a specific hospital this provider uses for deliveries? Check into the reputation of that hospital.
Your medical provider should give you some brochures or a book regarding “what to expect” during pregnancy. Read the information. You can ask for information about labor and delivery as you get closer. Read that. See if the doctor has any recommendations for resources that are reliable and medically accurate to answer general information questions. Since you’re reading this, I can assume that you feel comfortable gleaning information from the internet. The American College of Obstetrics and Gynecology (ACOG) sets the standards for appropriate medical care. Look for information backed by ACOG—it’s what your medical provider should be following.
Disclose everything
PLEASE BE SURE that you always notify all healthcare providers about any health conditions! If you have a heart problem, blood disorder, osteoporosis, rash, asthma, anything, tell the provider in the intake paperwork. If you’ve had an abortion or prior miscarriage, tell the provider. Notify the provider of EVERY SINGLE THING YOU TAKE, including supplements, diet pills, drugs, cannabis, CBD oils, essential oils, everything. Disclose everything.
Tell the provider if a weird symptom comes up during pregnancy (you will know it is weird because you read the information about what to expect, so you know what is normal and what is not). Make sure that your provider knows everything. It often feels strange to list off every physical issue even if it seems unrelated to baby, but please know that every provider I’ve ever met would rather be the person to filter out unnecessary information than to trust their patients to do proper filtering.
I once had a case where a medical doctor—an M.D. doctor!—decided not to tell the treating physician about a medication the M.D. was taking because the M.D. did not think it was related to treatment, with life-threatening results. It doesn’t matter how educated you are, how much you think you know, please tell your provider everything. Let the treating provider have a complete picture and let that provider decide what is important or not.
If the doctor says your trial of labor has failed, and you need a C-section
Ideally you will have a conversation about C-sections—when your provider finds them necessary, whether you are a likely candidate, etc—prior to labor and delivery. In the midst of labor, if someone tells you that you will need a C-section, it is okay to ask what criteria has been met to indicate that need. This question should not take long to answer. Surprisingly, sometimes your provider may not be the person to deliver the news that you need a C-section. Oftentimes during labor, the provider is seeing patients in the clinic, tending to another patient, at home nearby, sleeping somewhere in the hospital, or anywhere else besides your room. Sometimes, the baby shows signs of distress on the fetal monitoring strip, the nurses see it, call the provider, and get orders to prep you for surgery to save your baby’s life.
It is okay to ask the nurses if there is time to explain what they are seeing or if the provider will be in to explain prior to going to the OR. Sometimes, the provider will give you time to think about it: go ahead and talk to friends and family, but at the end of the day, it is your baby and your body, and your provider is responsible for both.
I understand the desire to have a vaginal birth, a natural birth, or a whatever you had envisioned, but sometimes, medical experience tells a provider that it is safest for both mother and baby to perform a C-section. If a C-section is needed, it is not an indication of a failure on your part or any negative reflection of your efforts to that point. C-sections are major abdominal surgeries which are properly performed to improve the health of one or both of the doctor’s patients. It is okay to trust your medical providers and let them help you and your baby be healthy.
Epidural Caution
If you decide to get an epidural (I did all four times, and loved being able to finally sleep before the big show!) or a spinal, then please listen to the anesthesiologist or nurse anesthetist. Do not move when they are placing the needle!
I had a weird case which I can’t discuss in detail because the details are so specific to the case, but I promise if you decide that moment to be dramatic and jump when the needle goes in, it can result in a very uncomfortable birth experience and possible repercussions after delivery. You’re a tough Mama for getting all the way through pregnancy, you can hunch over a pillow and grit your teeth one more time to hold still while somebody puts a needle in your spine. The relief was absolutely worth the initial needle pain for me!
Be an advocate for yourself and your baby
Growing up with southern ideals taught me to avoid making waves whenever possible. Go along to get along. When it comes to your health and the health of your baby, take a stand and get some answers whenever you have a concern. You do not have to be rude or belligerent to be an effective advocate.
Technically, nurses are supposed to be the patient advocate, but in reality, nurses have lots of patients and are human. You be your own advocate and your baby’s advocate. It is important to be courteous and kind because these people are humans worth courtesy and kindness, but you are also a human worth attention and answers regarding your own body and your baby.
Ask questions until you understand
I’m not saying you should call the nurse hotline in the middle of the night because you got some hiccups—use some judgment. But if you feel like something is not right in your healthcare, it is always okay to request answers. If the answer you get does not make sense to you or does not answer your question, ask for someone else to explain it to you. Find a nurse supervisor, a second opinion from a different doctor, a patient advocate in the hospital, whatever you need to get the answers you need to feel comfortable with your care.
The caveat to that is if a provider tells you that there is an emergency, get as many answers as you can in the time allowed, and then you may have to default to the fact that you chose that provider because you trust him or her, and go with what they need to do to save you or your baby.
It’s okay to question the nursing staff
When a nurse comes in the room and starts adjusting your IV, pushing pillows under you, or wants to do anything with you or your body, ask them what they’re doing and why. What medication are they giving you, and why do you need it? What does that medicine do? Does that medication have any side effects? Why do they need to check your cervix again if the doctor was just in? What does that beeping sound mean? Whatever questions pop in your head, ask the nurse. They should be able to give you an answer. If you haven’t seen a nurse in a while, and you feel something is unusual, go ahead and push that call button. If you need help, or think that you might need something in the next thirty minutes, push the call button. Be sure that you understand and feel comfortable with everything happening.
There are such low chances of you or your baby being injured during birth (see statistics above again for more reassurance), but for the mom who holds tight to forewarned is forearmed, I hope you choose to seek reliable information, ask questions, and be an advocate for yourself and your baby. I believe that because I had lots of information, I felt confident in moving forward with labor and delivery. If that’s you, I hope this helps you find reliable answers. If that’s not you, post your additional questions below!
New to pregnancy? Read my 6 tips to get through the first trimester while working!