April 4, Playing with the Big Dogs

When you enter the birthing system by visiting your OB, midwife, or going to the hospital, you are joining the play of a complex game and probably don't even realize it as a first-timer.

An expectant couple ranks as novice playing a round of "manage the birth" with seasoned experts. (I hate to say "against" as that is non-productive.) The pros have the medical knowledge and hands-on experience, of course, and that is what we depend upon. However, there is a lot more to the game than meets the eye.

In fact, the players actually have different goals.

Parents' Goal:
Maximize points by producing a healthy baby and mother.

Practitioner's Goal:
Maximize points by
* Ending with a healthy baby, and bonus points for a healthy mother too
* Avoiding lawsuits
* Keeping malpractice insurance
* Keeping medical licenses
* Working within practice and hospital policies
* Following medical insurance company regulations
* Maximizing profits
* Dealing with a hectic schedule of many patients
* Protecting personal time
* more...can anyone name some more?

I can't even begin to guess at all the rules OBs are under to satisfy parties other than parents and baby, but you can feel them at work if you are aware enough.

Let me make it clear that I am not trying to paint a devilish mustache on every OB who plays this game. They are required to do it. I am sympathetic to some extent that OBs often have to make decisions that go against their medical expertise in order to please all of these parties in a severely flawed system. More on this on another day. However remember - you are playing to achieve your goal, not to help the OB. His or her external constraints are frankly not your problem unless you fail to realize how they affect you.

In order to manage your birth, doctors use many techniques. Consider what techniques they might employ to max out points shown above (e.g. keep labor short, follow a birthing protocol, offer pain meds, overly conservative advice, schedule inductions, etc.) To manage you, they need to manipulate you. Selective factual information might be offered to influence you to take a test, have a scan, accept a drug or procedure, be induced. Resistance, delay, or questions require emotional manipulation which is very hard for parents to counter. The bag of tricks includes silence, closed gestures, frowning, worrisome stories, horror stories. My OBs were never shy to pull out "you might want to do this or your baby could die". This one efficiently disarms parents' critical thinking skills whether at an office visit or worse while you are tethered to monitors and IVs in the hospital after a few hours of labor. One of them said this to me at an office visit in front of my four year old daughter who eagerly awaited the birth of her little sibling. I was livid but decided not to choose that battle at that moment.

There is an enormous doctor-patient power differential and OBs deftly use it to get whatever result they want. They are very good at the game. And please remember, they want a healthy outcome for you and baby, but they don't get enough points by satisfying only you. They must satisfy all the other stakeholders who control their livelihoods. Your goal is much simpler - you get maximum points for healthy baby and Mom, and you might need to play hardball to make it happen. It's stressful, but worth it.

You cannot become an expert in any of these areas before your baby's birth. But you can become aware that you are indeed in a game, and you must be ready to play it or simply be a pawn. Research, questioning, thinking, and heart to hearts with your mate about your comfort level and values will help you navigate this system with better results.

Here's a highly respected book you can get online or in your library. There is a section on power differential.
The Thinking Woman's Guide to a Better Birth, Henci Goer

Have a good game,
Shari