We’re taking a break for a bit as I’ve been up to my ears in clients and classes. Decided I’d take September as my month for personal development so that I can serve my clients better - do some reflection, online classes and well, add some credentials to my CBI Birth Doula certification.
So, I had a conversation just this morning with the hubby as I was reflecting on the first gynae we had our daughter with (she’s our first). What sparked it off was a dental visit we had arranged for our eldest. We didn’t quite like the previous one and although the one I chose looked a little pricey, I thought no harm trying as it’s pretty popular and crowded on weekends. I was attending a course for work all of Wednesday through Friday so he had to take our girl to the dentist. He was apprehensive at first but he soon texted me saying, “Let’s change the dentist to this guy.”
Now, my husband is a better judge of character than I have ever been. Getting past this guy is difficult and he can see right through a person because he's usually busy observing while I'm networking or making connections. I’m the extrovert in our relationship while he’ll watch from the corner and when he’s sure, he’ll open up.
When I asked him what was it about the dentist, he said, “Bedside manners and he wasn’t pushy.” Upon pressing further, he said it was the bill size that made all the difference - that the dentist was affordable. A very practical answer from my extremely practical other half.
I then asked further (as I was curious), “What about our current gynae versus the one we first had?” To which he replied specifically that he only agreed to the first because the price was right. To give you a bit of history, when hubby and I first started out, we weren’t earning much. When I chose to birth in a private hospital with a single bedded room, it was a stretch but my loving husband gave in because he knew I wouldn’t feel comfortable sleeping next to a stranger. I feel so loved and blessed as I type this. The purpose of telling you this is so that you understand why the price of the package with the gynae we chose mattered. Something had to give. Had I been wiser, I would’ve spent more on the gynae and less on the hospital. More on this later but what got me thinking was what the hubby said next:
“We weren’t given more options because we couldn’t afford it. When we had deeper pockets, we had more options and we could exercise our rights and choose what we wanted.”
This statement he made really got me thinking.
Does that really mean then that a couple who has less to spend are left with less choices?
My thoughts brought me to the following questions:
Does a good gynae mean I have to go private?
Doesn’t any couple, regardless of financial standing, have the same rights and choices as anyone else?
Some may deem me a purist and an idealist when I say not all good gynaes are in private practice and yes, EVERYONE has equal rights. As for my response regarding choices, I may need to take out home births and water births before saying that yes, there are as many choices for everyone as well.
So, from this point forth, I’m gonna write about how you can absolutely have the freedom of choice and a gynae you can connect with, on a shoestring budget.
1. Empower Yourself
Attend a birth class. There are online ones too these days, more of them have popped up like daisies since the start of this pandemic. If the options I've suggested are above your budget, try looking at the ones offered by the hospital. If that’s too expensive, make trips to the library and read up. The internet is also a great place to read up on procedures (e.g what is an episiotomy, how is a C-section carried out, etc). Don’t just find out about what it is, find out how it affects you - if it’s a procedure that involves recovery, how long is that recovery going to take? If you’re opting for an epidural, find out the numbers - how effective it is, what kind of epidural local hospitals offer, what happens when you opt for one (e.g. you won’t be able to walk about, you won’t be encouraged to eat, etc). What about how it affects baby - if baby may be a little sleepy at birth (as most drugs used during labour have some amount of effect on baby) are you okay with that? This is why birth plans are important.
I have a bone to pick with some people who say birth plans aren’t necessary but I’ll save my breath for another day.
Birth plans help you to make that list of what your positive birth looks like. We are all humans and we cannot remember everything we’ve read or learnt - can you imagine remembering all of that when you’re in labour? Writing it down helps - it helps you, helps your spouse, helps your medical team to remember what you want. This is especially essential if you're opting for subsidized care in a government hospital where the doctors not only change at the start and end of every shift but with every doctor's visit as well. It helps you to visualise better how your birth might go, the options you have, the options that you may be offered and how you’re going to deal with them. It’s about managing expectations, not just having them. I’m sure you would agree that there’s a big difference between being briefed on how a game is played before hand and being asked to play the game without being given any instructions prior to. The same applies here.
Along the way, ask the questions you need to ask when you're at your consultations. That's what your doctor is there for - to not only provide the best care possible but to ensure that you understand everything that's going on with you and your baby and share their knowledge with you.
This is why I’ve called my birth classes ‘Birthing in Abundance’ - because it is in gaining that knowledge that you are no longer just making recommended or advised choices because you don’t know - you’re making informed choices because you do.
2. Find Your Voice
Everyone has a voice and believe it or not, yours is the most powerful one in any birth room. As a doula next to you, I’d be the one helping to remind you about the choices you made previously and perhaps bring you through your choices or thoughts when needed but ultimately? Only you can make the final decision and voice it out to your medical team.
Not comfortable with a certain procedure being performed? Ask why it’s necessary, what it’s for and if there’s an alternative. Why would you sit in your hairdresser’s or barber’s chair and keep quiet if you were being given blue hair when you asked for honey brown or shaved bald when all you wanted was a trim? Don't get me wrong - I'm not suggesting that you fight tooth and nail with the nurses AND your doctor till there's more bloodshed in the room than just the placenta that you birth. Remember that at the end of the day, you still need the nurses to be on your side and the expertise of your medical team. Your question may then be: How do I then find a balance?
I find this acronym is extremely useful when finding your voice - use B.R.A.I.N
B - what are the BENEFITS of this procedure and how can it positively affect baby?
R - what are the RISKS to consider? What other procedures may follow this? How will this change the way I labour?
A - what other ALTERNATIVES do I have? Are there other options?
I - what does your INTUITION or your gut tell you? How does your partner feel?
N - what if we choose to do NOTHING? Can we choose to wait and see or make a decision in an hour?
This gives you a list of question starters - just to get you warmed up before making your choices. I also find that role playing with your partner in a game of what if, helps to prepare both of you and what you’d say in a given situation. You could ask each other, “So what would you say if the doctor said he’d like to propose breaking the water bag because dilation is happening too slow?” Rehearsing always makes for a more confident couple.
I also find that it’s useful for couples to have their own password for when mama isn’t comfortable with whatever is being done to her or asked of her. Mamas can use a code word or a certain action to draw the attention of their birth partners or spouses to them so that they can communicate that they're being put on the spot. Getting your partner to advocate for you in the birth room can be a very valuable asset - especially since with all the hormones at work in labour and birth, we usually adopt a "Tend and Befriend" stance where we take care of and are friends with everyone. This means we would say yes to anything being asked of us which may veer us away from what we want for ourselves rather easily.
3. Listen To Your Instincts
If every bone in your body is telling you that something is wrong and it's not settling or going down well, then you're probably not okay with it. Sounds like a 'duh' statement to make doesn't it? But, humour me for a minute - how many times have you shut your instincts or gut feelings out just because you were sitting across from someone whom you thought knew better than you?
It is no fault of doctors that we trust them so much. We give them credit which is due - I mean, they have spent years mastering their craft and as with any profession, their experience and knowhow is what we pay them for. But a doctor can only diagnose and treat from what he or she sees and observes. Doctors may miss how you're feeling - if you're anxious or worried or even confused. They will only know of your thoughts when you communicate them. So, if you already have a plan in mind regarding the birth you want, communicate that to your doctor - talk about your concerns. For instance, tell them you're concerned about having a C-section and you really don't want one unless it's absolutely medically necessary - and if you do need one, you want a gentle C-section. Or perhaps, that you'd like to have that option of an epidural but you'd also like to labour at home a little longer and discuss what your options are from there.
In the delivery room, if a doctor poses you options that you don't feel right with, use B.R.A.I.N to guide you through. Ask the questions you need to ask and take the time to decide and explore your options when you need to - because this is what many birth companions feel is one of the deciding factors between a birthing mama having a positive birth and a traumatic one. Give yourselves that space. I promise you, those extra minutes of being left alone to talk it out will make a difference. Birth may not always go according to plan. I will be the first to admit that many surprises have sprung up on me in my journey as a birth doula. Most of the time, the trauma comes from being unprepared - from being rushed and pushed into something that the couple weren't given time to ponder over.
If you think about it, all the options that will be presented to you in labour and birth are the same - regardless of how much you have in your pocket. Birth is a physiological process. The interventions are all the same. While I will admit that there may be a few more options for those with deeper pockets (e.g. a private suite, better food, an extra bed for your partner to sleepover, etc), there is still so much power that you have over your birth.
So, to you I say: nope, you don't need to be rich to have the birth you want, you just need to work a little harder. The journey of your birth will be that much sweeter because you went through the process of understanding the time your body needs, the space you needed to give each other as a couple, the conversations you've shared, the thought you gave, and most importantly, the love you put into bringing baby into the world and announcing the birth of you - as a new mother and/or as new parents.
But of course, if you need a doula to consult, I'm always here [Wink!]
PS: Some additional tips which I thought would be useful to share -
1) Ask the hospital about their protocols upon your arrival at the delivery suite. Do they ask you to change first, put you on a monitor or CTG first? This helps so that you can pre-empt the events on the day of delivery and advocate for yourselves if there’s something else you prefer. For example, some mamas dislike donning the hospital gown and much prefer wearing their own clothes. This helps to comfort them and give them a sense of security which helps encourages oxytocin to flow and surges to build, thus moving labour along nicely.
2) Many parents depend on reading online articles and forms regarding costs but nothing beats making time for a financial consult with the hospital. Ask them to break down the cost of each item for you - better yet, let them know that you‘re on a tight budget and some of the staff may even provide you with inside tips to help you save on a few frills here and there.