Making Empowered Medical Decisions: Tips for Assessing Risk of Hospital Procedures for Pregnancy

We’ve probably all heard someone say, “My doctor says I should (fill in the blank).”  In an age when science and technology is the norm it can be easy to accept the advice of those that we see as professionals or authorities on a subject.  This is especially true when we perceive our own health or wellbeing is at stake.  There is a problem with this.

We forget that health care is an industry–a multi-billion dollar industry.  This means that we are “consumers” of health care just as we are consumers of the automobile industry, the appliance industry, or the tourism industry.  Many people spend more time making a decision about the color of their next car than the health care decisions they make because we trust so implicitly that our doctors only want to do what’s best for us.

I do not wish to demonize doctors or medicine.  There’s no doubt that the knowledge and training of doctors and the invention of medications or medical technologies has improved and saved the lives of millions.  However, as consumers of health care products, it is important to recognize that that when health care providers make suggestions for treatment such as a medication or a surgery, etc., they are suggesting that you buy-in to a medical industry product or idea.  Often those suggestions may be influenced by pharmaceutical company marketing, ability to make money from a procedure, trends or competition with other health care providers or a doctor’s own bias for or against certain approaches to treatment.

Hospital Procedures for Pregnancy

Maternity care is one of the biggest costs you will ever encounter.  From the medical industry point of view then, hospitals make big money on maternity care.  Hospitals can and do provide valuable services to pregnant women, but they are also big business.  This means they are selling you products that can have major consequences for you and your baby’s wellbeing.

I read a recent Consumer Reports article detailing many common hospital procedures for women giving birth and the associated risks and/or benefits from accepting those procedures.  In summary, the article provides recent, evidence-based research reminding us that despite our astronomical spending on maternal and fetal health care, the United States has one of the highest mortality rates for mothers and babies of all industrialized countries.

Studies suggest that one of the main culprits contributing to this higher than desirable mortality rate is an astoundingly high cesarean rate.  Cesareans, when used appropriately, can save the lives of moms and babies, but it is a major surgery and comes with all of the risks of a surgery such as infection, bleeding, complications from future births or cesareans, etc.  What many women don’t realize is that MOST cesareans are preventable by avoiding other types of labor interventions.  (The article does a good job discussing these other interventions as well.)

Overall, the Consumer Reports article is an eye opening look at the maternity health care picture in this country and I strongly encourage every pregnant woman to read it.  While the tone of the article’s title may sound somewhat alarmist (Top 10 Pregnancy Procedures to Reject), it is important to remember that hospital safety is a consumer and public health concern that is worth our attention.  For women who DO choose some of the procedures outlined in the article, we should not demonize them for their choices.  However, I think it’s important that women have all the information about a procedure or intervention before making her own choice without feeling pressure from health care providers.

Tips for Assessing Hospital Procedure Risks:  Use your BRAINS

Whenever your health care provider suggests a procedure, you have the right to make a fully informed decision prior to consenting or declining that approach.  For instance, if you are 40 weeks pregnant and your doctor suggests an elective induction (which has been linked to high cesarean rates especially for first time mothers), it can be hard to stop and think through the decision.  Naturally, you want to meet your sweet baby as soon as possible and you are so ready to be done with pregnancy!–but I strongly urge you to remember this little acronym:  BRAINS.

B:  Benefits

First of all, find out the benefits of a procedure.  Is my health or my baby’s health in danger if I don’t do this?  Will it improve the outcome?

R: Risks

Could choosing this procedure cause harm or could it have consequences down the road that might not be apparent at first?  Could the medications or procedures affect my baby?  Could it impact bonding or breastfeeding?

A: Alternatives

Are there any alternative approaches to this particular procedure.  Can we try something else first?

I: Intuition

What does your gut tell you after reviewing the benefits and/or risks?  Careful–try to separate your emotions/feelings from what your brain or intuition is telling you.

N: Not Now, or Do Nothing

Do you have to make this decision now, or can it wait?  Can you choose to do nothing instead?

S: Second Opinion

You may love your doctor to pieces, but if she or he suggests an approach that just does not sit right with you, remember that you are a health care consumer and have the right to ask for other professional opinions.  (Many of us ask our girlfriends for a second opinion about switching to a different product, so why wouldn’t you ask another doctor for a second opinion about a medical procedure?)

It’s great to have a collaborative relationship with your health care provider, but know that you are in charge of your own health care decisions.  Use your BRAINS to help you make empowered and hopefully safer decisions for you and your baby.

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