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Thursday
Jun162011

Who is responsible for "educating" pregnant women?

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 Guest post by Jennifer Zimmerman

This just in: pregnant women are completely dense, says recent study. Or, at least that is what this Los Angeles Times article seems to be implying.  Actually, the real title is, Pregnant Women Show An Amazing Lack of Knowledge About Childbirth Options, Study Shows. Who knew that pregnant women were so amazingly ignorant? Who’s fault is that? The article enlightens us on that very question. It is the women’s fault of course!

Apparently, pregnant women “appear to be quietly following whatever advice the doctor or midwife recommends.” Out of 1,318 pregnant women surveyed, “they found many seemingly unprepared to make their own decisions regarding childbirth options, such as whether to have natural childbirth or a Cesarean section.” And, “a shockingly high number could not answer basic questions regarding the pros, cons or safety issues associated with epidurals, episiotomies, Cesareans and other childbirth options.” The article quotes the lead doctor involved in the study, Dr. Michael Klein as saying, “[E]ven late in pregnancy, many women reported uncertainty about benefits and risks of common procedures used in childbirth. This is worrisome because a lack of knowledge affects their ability to engage in informed discussions with their caregivers.” And lest you don’t realize why it is incredibly dense of pregnant women to not know these things, the article states: “The type of provider mattered greatly in terms of what kind of care women received. The researchers published a related study in May in the journal Birth that showed younger obstetricians were much more likely to favor the routine use of epidurals and expressed more concerns about the safety of vaginal birth compared with older obstetricians. The younger obstetricians seemed to view Cesarean sections as the preferred option for childbirth, the authors noted. In the United States, efforts have begun to reduce Cesarean section rates. About one-third of all U.S. women have a surgical birth.”

So, basically the gist of the article is, “pregnant women don’t know anything. It’s really shocking how little they really know! Due to the fact that they are so completely ignorant about childbirth, they just submissively do what their provider tells them to. Therefore, they can’t effectively talk about birth interventions with their providers, and since many providers prefer doing cesarean sections, the ignorance of pregnant women is probably what is raising the cesarean section rate.” Isn’t it nice how journalists are always finding novel ways to blame women for the rising cesarean section rate? It seems pregnant women are supposed to be completely knowledgeable about all of the childbirth “options” they may be offered. The article would have us believe that lacking this knowledge is the pregnant woman’s fault alone, and may even be contributing to the rising cesarean section rate.

In reality, the issues involved are so much larger than pregnant women failing to take a good childbirth class. Informed consent is the legal right of every pregnant woman and it means that she will be told the risks, benefits, and alternatives to every proposed procedure and will have the right to choose or refuse the procedure. By the time she is late into her pregnancy, if she is not being informed adequately about birth interventions,  then shouldn’t we question why the provider is not granting women their legal right to informed consent?  If the provider does not have the time or the inclination to inform these pregnant women about common interventions, then why aren’t they offering a comprehensive childbirth education class where they can obtain the information the provider is legally obligated to give? Why is the article blaming the women for not seeking out adequate knowledge? How are women to know that there is information they don’t know?

It is common practice for maternity care providers to encourage women to listen to the provider’s advice alone over any other sources of information. They may even downplay the legitimacy of information that the woman obtains on her own. They may even discourage reading books, browsing the internet, or taking childbirth classes that are not sponsored by the hospital (and simply meant to teach women how to be good hospital patients, not actually provide them with the risks, benefits, and alternatives to common interventions). Most pregnant women simply are not aware that their maternity care provider may counsel her about her options with other motivations in mind aside from the health and wellbeing of her and her baby. Pregnant women are trusting of doctors. This is a culturally ingrained idea and I doubt it will be overcome by telling women how stupid they are for trusting the information imparted to them by a well educated and respected member of society.

 

 Photo credit: NBC.com (screencap)

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  • Response
    An excellent article by the Unnecessearean...   http://www.theunnecesarean.com/blog/2011/6/16/who-is-responsible-for-educating-pregnant-women.html &

Reader Comments (26)

"Most pregnant women simply are not aware that their maternity care provider may counsel her about her options with other motivations in mind aside from the health and wellbeing of her and her baby."

I agree with this...but at the same time...Do you walk into a car dealership & expect the salesman to tell you the truth about a sale? What about when you ask for a lower price and he "talks to the manager"? Before I bought a car...I found consumer reports...I looked at product reports...safety ratings...Government sites that had info. I pulled up websites for my local area that would show what the prices were in my area...to see if I could ask a nearby seller to lower their price to match an out of town seller.

I read books about pregnancy...but none about childbirth. I didn't even ask my mother about it. I don't even think I really discussed it with my care provider. Just something like, "I don't want drugs...I won't do that." And when he nodded and said, "That's fine, that's your choice." I felt good that he "listened to" and agreed with me. Just like a salesman listens to you...and agrees you need a safe reliable vehicle to get your family around. Because they just want you to hand over the check & drive away.

Women HAVE to know more about what they're getting themselves into. YES, providers SHOULD BE MORE CLEAR about informed consent...about actually INFORMING when they're getting consent. But you can't rely on ANYONE ELSE to look out for you! They're not the ones invested.

June 16, 2011 | Unregistered CommenterMaegan

I agree with what you're saying...to a point... nobody is souly to blame here...and women DO have a responsibility to educate themselves on what is happening to their body and their baby. It drives me nuts that most people do more research when they are buying a car, tv, cell phone, or whatever else that requires cost comparison than they ever do picking out a caregiver and educating themselves on what is happening to their bodies. A copy of "what to expect" isn't good enough...that's like going to ONE dealership and not checking the rest of them out trusting that this one dealership that you walked into has the best prices in town. In all reality you cannot expect an obstetrician to sit there for hours on end explaining to a woman every intricate detail and options available during pregnancy, childbirth, and post partum. An obstetrician is going to tell the woman what he feels is best (whether best for him or best for the mother and baby is debatable) and move on to the next patient. That's what consultants do, they give their opinion and then YOU are the one responsible to make the final desicion. If you want complete informed consent, then ask the hospital for the registration paperwork ahead of time, ask them for the paperwork you'd need to sign if a c-section would become necessary, ask for a copy of hospital protocol. All hospitals DO have this information available to you, you just have to ask for it. This is a two way street. Women HAVE to do their research and doctors HAVE to be able to in at least one appointment sit down and discuss with the woman what her choices are. If you find that you and your doctor disagree, have different opinions on what should and shouldn't happen (just like you'd negotiate the price of a vehicle) then it's time to cut your losses and move on to a different caregiver. Above all women need to recognize that an OB is a consultant that they are paying for. You wouldn't let a home renovation contractor, or the sales person at the car lot boss you around and tell you what to do and expect you to just say "ok". No, you'd expect them to carry out your wishes to the best of their ability. Maybe if us women would hold our obstetricians accountable, the whole birth scene would be a bit different. After all...we didn't get the right to vote in this country without a fight.

June 16, 2011 | Unregistered CommenterEmily

I don't think the article is saying it's pregnant women's fault at all.
I think the article is indicitive of the trend of people to put blind faith in their doctors. They're doctors after all, they went to medical school, they're educated, they must know what's best.
I think women follow the advice of their peers and when the majority of their friends are having c-sections, they see it as "no big deal."
I had a friend who told me that C-Sections were safer than vaginal births. I pointed out that it was major surgery and there were all sorts of risks involved. "Oh, I didn't know that."
I had an aquaintence who is a new doctor argue with me that c-sections are by far safer than vaginal births.
The article is just stating truth.
Are there women who are proactive about their pregnancies and health care and investigate the options? Of course. And I would argue that those are the women that read this website and are not the subject of this article.
A friend of mine had her baby; a year later another friend was pregnant. When pregnant friend would tell us about things her doctor told her about her pregnancy, mommy friend would say, "oh, my doctor never told me that." or "Wow, i didn't know that."
How much of the responsiblity for YOUR healthcare should be left in other people's hands? Don't you think people should do their own research?
I am not pregnant, but hope to be soon. I've been learning about pregnancy and birth for the past year so that I can be prepared and make informed decisions and not just blindly accept what the doctors recommend.

Maybe the article is in part "blaming" expectant mothers--but it's also placing some of the blame on new doctors.

Perhaps instead of seeing article as "blaming" someone for the situation, it should be seen as an illustration of how today's healthcare is full of uninformed people and over-worked doctors who lack the time to explain the risks involved.

June 16, 2011 | Unregistered CommenterAndrea

Oh come on. Babies are not cars, and giving birth (or choosing a care provider) is not the same as buying a car.

For one thing, where is the Consumer Reports issues reviewing doctors? There aren't any. In order to rank one doctor against another, you would need data on their outcomes, as well as reviews by patients. That kind of data is not really available to consumers except through hearsay, although Jill and other bloggers do strive to archive and present the data that is out there. But most doctors are a black box to their patients; if they were found to be guilty of malpractice in another state, how would we know? They are not required to tell us.

In addition, leaving a doctor mid pregnancy is both trying (especially since many doctors's offices are downright recalcitrant about handing over your records) and risky; how will you know if the new one is any better? You don't.

And then of course, even a carefully-chosen doctor may not be on call when you go into labor, and instead you get their partner, who you've never seen before but you're in labor, what are you supposed to do, demand three references between pushes?

I'm not throwing up my hands here, but honestly, to gloss over the difficulties in evaluating whether a given doctor will treat you well and competently when the chips are down is to miss the point entirely.

June 16, 2011 | Unregistered Commenteremjaybee

Interesting that we're bemoaning the fact that women "aren't informed," but if you are informed, *they* don't like it most of the time. How many women have been told to shut up and listen to me already I'm the doctor? Quite a few more IME than I'd expect. I found it unusual and refreshing in my last birth when I went to the hospital arguing for a breech VBAC that the resident considered it and was positive (once I outlined my reasons that I thought it was a reasonable way to go at that point...of course this changed when the baby started ascending and I rethought my decision).

This resident's attitude shouldn't be the refreshing exception, it should be the norm. Moreover, doctors/midwives should be presenting options, not decisions...if the care providers would ask the women to decide, the women would probably real quick get up on the research. But instead so many of them just tell you what to do and get defensive and bossy if you dare question it. They say "how many years of medical school have YOU had?" And then we wonder why women are not informed....they are actively discouraged from being informed by their care providers.

My $0.02

June 16, 2011 | Unregistered CommenterAnne

“Isn’t it nice how journalists are always finding novel ways to blame women for the rising cesarean section rate?”

Hmm, I honestly don’t really see journalists ALWAYS blaming women for the rising cesarean section rate. I’ve seen it mentioned mostly as a contributing factor, but ALWAYS? Nope. I’ve seen plenty of mainstream news articles questioning the doctors that perform those cesarean sections. Plenty of blame to go around here, place it on the women that take no active role or a submissive one AND the doctors that schedule for convenience.

“It seems pregnant women are supposed to be completely knowledgeable about all of the childbirth “options” they may be offered.”

Well, quite honestly – yes. They should. It’s called personal responsibility. (And no, not completely knowledgeable, but well informed and educated: YES – and it’s a woman’s responsibility to herself and her child to go out and make that happen, not wait around for a doctor or any other care provider to hand her that education. Again, it’s personal responsibility!
We have a cultural phenomenon in this country where we put an astounding amount of blind faith in our doctors and care providers. But guess what folks? We simply SHOULDN’T. Those care providers are human, they make mistakes, they get rushed, they don’t care, or they care too much and force their opinions on their patients, they push their own agendas, and they have their own histories and opinions that influence how they treat their patients and how they interact with them. Women should take a more active role in their health care (actually, this goes for men too) and participate. Ask questions, read on your own, weigh your options, talk to other women. Ask questions. Ask questions. Ask questions. Read independent and varied sources of information, and then – THINK about all of that information. Then – go ask more questions.

June 16, 2011 | Unregistered CommenterMegan K.

Anne, I completely agree with you.

And again, I think this is just a small slice of how today's healthcare works--pregnancy or not. It's a multi-faceted issue and no one side is to blame or right or wrong.

June 16, 2011 | Unregistered CommenterAndrea

I really like this post. It's disappointing that so few people see how inappropriate it is to blame women for not defending themselves adequately from their own health care providers. This probably isn't the best analogy, but what popped into my head is that we might as well blame a woman for being robbed at gun- or knifepoint for not carrying a bigger weapon than her attacker, as if her lack of ability to fight back with equal force is the actual crime instead of the robbery.

June 16, 2011 | Unregistered CommenterMelissa Cline

Without power to act on it, knowledge is a curse.

June 16, 2011 | Unregistered CommenterCato

Wow, I find the comparisons of OBs to car salesmen to be very interesting. I know that when I walk into a car dealership that the salesperson's primary goal is to make the sale and get paid. But should that really be the primary goal of a medical professional? I would HOPE that when I walk into a doctor's office, the first thing he sees is not dollar signs but a human being. And I would hope that his or her primary goal would be to provide me with safe and adequate medical care. That's the difference between a salesman and a medical professional, or at least, that's what the difference *should* be.

June 16, 2011 | Unregistered CommenterAshley
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