Helping expecting mothers advocate for themselves

Vital Signs Spring 2023 - Women's Health
Dr. Aparna Sridhar speaks with a patient
Dr. Aparna Sridhar speaks with a patient. Photo: Courtesy of Dr. Sridhar

Pregnancy marks a significant time of change in the life of a woman, one that requires reflection and planning before the baby arrives. That eagerness to prepare, however, often collides with a reality that obstetricians know all too well: pregnancy can be highly unpredictable.

A major goal of obstetricians and midwives is to help each patient achieve the pregnancy the expecting mother desires while navigating some of the inevitable twists and turns. “A solid doctorpatient relationship is the key to empowering patients and helping them enjoy the journey,” says OB-GYN physician Aparna Sridhar, MD. “Every pregnancy is unique in its own way. The best thing a patient can do is to get information to prepare, but not indulge in too much comparing with others.” Pregnant patients often enjoy talking to other women about their experiences and sharing information, often via social media. Moreover, expectant mothers are bombarded with media, ads and unsolicited opinions of acquaintances. Such information can be overwhelming and make it hard for pregnant patients to know their own mind, Dr. Sridhar says.

She recommends that expecting mothers begin a conversation as early as possible with their health care provider. “Even prior to becoming pregnant, speak with your provider about your medical history, surgeries, allergies, medications, cultural values, mental health status and social life,” Dr. Sridhar says.

“It is equally important to partner with a health care provider who listens to you, respects your cultural values, believes in a shared decision-making process and earns your trust," Dr. Sridhar advises. Think about if you would like to see one provider during the entire pregnancy and childbirth or if you wish to see a group of providers. Do you want to work with a doula? Where do you want to deliver, and what is that facility like? “You really need to understand what the prenatal care is going to be and where you are going to deliver, so there are no surprises during late pregnancy and delivery,” Dr. Sridhar says. “It is good to establish trust between the provider, or providers, so you have the ability to express your concerns.”

Write down your questions before each prenatal visit and participate in prenatal education through classes, books or online educational materials. Pre-planning is important, Dr. Sridhar says. “Tour the faciilty you plan to use; take classes in birth preparation, breastfeeding and infant care.”

While preparation will help put you in control, the key to a fulfilling pregnancy journey is to expect the unexpected, she adds. There is only so much you can prepare for. The rest can be a surprise. “I prefer the term ‘birth preference’ to ‘birth plan,’” Dr. Sridhar says. “Speak up about your preferences and cultural values but also have realistic expectations. Autonomy is what we are striving for when we give care. But we should set realistic expectations about the unpredictability of this process.”

When something unexpected arises, seek information, she says. Women who do so feel empowered. “Ask about the risks and benefits of an intervention. What are the alternatives?” Dr. Sridhar says. “Then make an informed choice.”