Hospitals should quit alienating pregnant health care consumers


When Barbara (name changed) recently underwent her fourth Cesarean section, she was appalled by the care she received during her recovery.  Her catheter overflowed, and a CNA asked her to check her own incision.  When the CNA asked if she was breastfeeding her baby, Barbara replied tearfully that she couldn’t lift her out the bassinette.  Rooming-in is a great idea. Unless you’ve had a 36-hour labor or major abdominal surgery.

Pregnant women are vital health care consumers as they usually have a partner and one or more children who will presumably be accessing care in the future. However, many pregnant women still experience paternalistic attitudes when they come into the hospital.

“A birth plan?” a staff member might say sarcastically, “Well, that’s a guaranteed C-section!”  Refusing eye ointment for your baby because you’ve been married for 15 years? That will buy you a visit from division of family services. In the hospital to deliver a child, they themselves can be treated like a child who has to be told what to do. Pregnant women are routinely given non-evidence based instructions, often issued curtly in the middle of a contraction.

“You can’t VBAC.” “You can’t eat in labor.” “You have to be on continuous monitoring.” “If you haven’t dilated in 2 hours, you’re getting a C-section.”

Last time I checked, pregnancy does not preclude a woman from making her own medical decisions or from declining non-essential interventions.

Women who transfer into the hospital from home or a birth center with a midwife are often treated with hostility or skepticism.  If a transfer patient carries in her own prenatal record, she might be told that she must have all her blood tests repeated, since they weren’t drawn in the current facility.  Margaret’s (name changed) baby died in labor at home, and she was harshly informed by the on-call doctor that this was an expected result when choosing not to deliver in a hospital. Some women are actively treated like criminals and are forced to undergo court-ordered Cesareans.

By and large, most pregnant women have very strong beliefs about how they want to give birth. But the woman who wants an epidural as early as possible and the woman who wants to bounce on a birth ball to avoid pain medications should be treated with equal respect. Pregnant women hire their doctors and choose to spend their money at hospitals.  As such, they should be respected as valuable health care consumers, not treated as if they are doing the hospital a favor by being there.  Unhappy patients can and do choose to go elsewhere for medical care.  Their negative experiences can be quite persuasive to their friends and family.

There are signs of change. In February 2017, the American Congress of Obstetricians and Gynecologists released a Committee Opinion entitled, “Approaches to Limit Intervention during Labor and Birth.” This document was endorsed by the American College of Nurse-Midwives and stated that “satisfaction with one’s birth experience … is related to one’s expectations, support from caregivers, quality of the patient-caregiver relationship, and the patient’s involvement in decision-making.” In my community, there are two hospitals that have responded to the competition of two free-standing birth centers in positive ways.  One hospital has put in birth tubs and made changes to delivery rooms to make them more women-centered.  The other has hired their first midwife to try to meet the needs of patients who want fewer interventions.

Hospital administrators, patient advocates, and those responsible for staff training would be wise to make a patient’s experiences a priority to avoid entire families taking their health care dollars elsewhere.  This doesn’t mean bombarding patients with satisfaction surveys; it means prioritizing public relations, maintaining appropriate staffing, encouraging patient respect and autonomy during their hospital stay, and acknowledging that happy pregnant women will encourage the lifelong loyalty of multiple health care consumers.

Poppy Daniels is an obstetrician-gynecologist and can be reached @drpoppyBHRT on Twitter.

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