How Using Our Power as Consumers Could Change Maternity Care Forever

re-thinking maternity care- from patient to consumer

Right now, the cesarean section rate in the United States hovers around 30%.

Most women deliver their babies in the hospital.

Women are often let alone after they give birth while their baby is taken from them for washing and routine procedures.

All too often, women feel sad, scared, and disenchanted after they give birth, one of life’s most transformative experiences.

How do we change and improve maternity care so that babies and women are safe, and women enter their role as mother with confidence and joy?

There are many working to improve maternity care and they all find a path that fits their passion.

One way each of us can change and improve maternity care is with a simple paradigm shift.

Women must begin seeing themselves as consumers rather than patients.

Let’s look at the differences.

A birthing woman who views herself as a patient will:

-Believe that pregnancy and birth is inherently an illness.

-Rely solely on her provider’s opinion and advice.

-Use whatever provider is closest, most convenient, and cheapest for her to use.

-Be in a position without power, at the mercy of her provider, the expert.

A birthing woman who views herself as a consumer will:

-Understand that pregnancy and birth are normal bodily functions but will search for a guide through this process to ensure that things are as safe as possible

-Find comfort in her own inherent wisdom regarding birth and will take initiative to read, learn, and educate herself in her own birth care.

-Seek out a provider who is a good fit for her birth desires. This may require investing time, energy, money and crossing great distances in order to find.

-Be in a position of power where she can advocate for herself and make decisions along with her provider.

Can you see the difference?

Can you image the difference it would make in maternity care if women saw themselves as active, knowledgeable, and powerful players rather than weak and helpless victims?

I don’t believe that hospitals and care providers are simply money grubbing evils striving to make the biggest profit. I don’t believe they are the ever-present bad guy. Nurses and doctors are often bound by policy and policy is often based on fear. I am not advocating that we all go in, guns blazing, demanding better treatment.

What I am encouraging is a simple shift in the way we view ourselves and the way we view our providers.

Providers are providing a service: and an expensive one at that.

Don’t view your provider as your adversary or your savior, but as your care provider.

You are purchasing this service. And birth isn’t your run of the mill stereo or consumer item – it is a deeply important life event.

View yourself as someone shopping for the service that will most likely give you what you want from this experience.

If your provider or birthplace cannot meet your needs and desires, don’t get mad.

Move on.

Find someone that can.

Oh, and it might be good to mention WHY you are moving on.

A disappointed, “Oh, I found a different hospital because your policies are not mother or baby friendly. It is really important to me that I not be separated from my child after birth and that I have wonderful breastfeeding resources and support postpartum. Sadly, you don’t provide that.”

(Here is an overview of what mother-friendly care really means.)

This approach will be a lot more effective than trying to “convince” your provider that you should have your birth plan respected or “prove” to them with studies that you should be able to hold your baby immediately and during your postpartum recovery.

re-thinking maternity care- from patient to consumer

If you are arguing with your provider and trying to convince them you are a competent adult who can make autonomous decisions, then maybe they may not be a great fit as your provider, unless that is how you WANT to be treated.

Don’t fight.

Don’t yell.

Don’t be mean.


Make a decision and then don’t be afraid to move on.

We can strive for improvements in maternity care with laws and studies.

When it comes down to it though, hospitals are running a business. If people are not happy with what they are providing, leave negative reviews, or simply choose another business to give their money, they will change.

They will lose money and they will have to change.

Some women are aware of this. Sadly, it isn’t enough of us.

Women making different choices in maternity care are fringe.

If the hospital in your community with the worst cesarean section rate and the most baby unfriendly policies suddenly saw a 60% drop in their maternity clientele- guess what-they would change their care. They would have to or they would go out of business.

But if we keep going to that awful hospital and they keep making money, they will never change. They have no reason to.

The secret in maternity care is that women actually hold all the power. Not the insurance companies. Not the hospitals. Not the care providers.


You choose who you go to and who you don’t. You choose what care you want. You don’t get to choose in the moment by shouting that, “no, you don’t want an episiotomy!” You choose when you pick your birthplace and when you pick your provider because they don’t perform episiotomies.

A woman who is a consumer don’t just decide on a whim where she goes. She checks reviews. She talks to others who know what happens in this hospital. She asks her childbirth educator what hospitals can give her the type of care she desires. She asks her doula what hospitals she loves working in. She makes an educated, informed decision.

I know we all have limitations in this department. Insurance, money, and proximity all impact our ability to make choices regarding birth care. I know these choices are hard. Sometimes they aren’t the cheapest choices. Sometimes they aren’t the closest choices. Maybe you will drive an hour or two to a great birth place. Maybe you will choose someone who is out of network.

And sometimes NONE of the choices will be ideal.

I know this is the truth and it makes me incredibly sad.

I didn’t say this would be easy. Change isn’t easy.

If we all do it though, things will change.

They will have to. Because women ultimately hold the power to change in maternity care.

Photo credit: via / CC BY,  be creator via / CC BYVivian Chen [陳培雯] via /CC BY-ND

11 thoughts on “How Using Our Power as Consumers Could Change Maternity Care Forever”

  1. My generation changed hospital birth practices when we started having our babies at home. Before you knew it, hospitals were offering to let friends and family attend births, set up birthing rooms, allowed “rooming in” (instead of taking your baby away and putting him in the nursery), etc. This new generation is going to have to decide they are not going along with what the institutions have decided is the best way. Here in Northern California we have a lot of home births, and even mothers who have breech babies or had prior c-sections are having natural deliveries. You have to look at the statistics and decide how much risk you are willing to take. Childbirth is natural! Or should be….

  2. Thank you for your beautiful commentary on the importance of the consumer voice. This shift is crucial to changing the climate of maternity care. But there is an applied assumption here: that women can just walk away and find a different provider. That women will always have other other options. That women can take a whole day to drive 2 hours each have way for appointments. These options don’t always exist. I believe respectful, evidence based care should exist for every woman in all settings regardless of individual circumstances (read socioeconomic level). Consumer shift is crucial. Walking away and clearly stating why is crucial if you can. If you have no other options, demanding your rights to I formed consent and respectful treatment, right where you are, is also crucial. Holding the provider you are utilizing -hospitals and caregivers-accountable is an equally important part of change. And if need be change the laws. Together, women can change maternity care.

  3. This is a beautifully written article. I am a labor and delivery nurse in a small hospital with 8 labor and delivery rooms. I wish more women saw themselves like this sadly they give their providers all the power and don’t know they have a say. That’s where I come in I always encourage them to listen to their inner voice and know that it is ok to say no. Nurses in the hospital setting are sometimes the only ones who can give their patients the strength to say no and become empowered. At my hospital we are baby friendly and baby goes skin to skin immediately after birth and stays there until the mother desires weight and measurements, it’s usually several hours after delivery. The baby never leaves the moms room except for emergencies or parental request which we discourage! Birth is so beautiful and natural and empowering. I hope this article helps empower more women to actively participate in their selections with confidence! Thank you for writing this!

  4. We traveled from Cambodia back to Portland, Oregon to give birth to our second baby. There are a number of reasons why including a high maternal and newborn death rate in Cambodia, being told by doctors in Bangkok, Thailand that I was too big to deliver naturally (I gained the same amount of weight for both my pregnancies and my children weighed nearly the same), but Portland over other places we have lived in the US was because I knew I would get the birth support I desired including having family close by to entertain my three year old. Soon into my labor of my son, we learned that the cord was wrapped around his head and that he was experiencing rapid heart deceleration. It was an intense period where we weighed many options, but things were happening fast. What struck me about the whole process was the respect paid by the OB to our midwife team. The OB respected that our midwife was running the show and jumped in when it was absolutely necessary; the OB gave me a one minute marching order before foreceps would be used -we took full advantage of my last contraction and avoided a forecep delivery. I appreciated this because the person we trusted most – our midwife, who we had been communicating over email with for eight months prior to arriving in Portland and with our routine prenatal care once we arrived leading up to the birth, was given the respect necessary, which in turn kept us calm enough to get through the process. If there was more obvious challenges particularly of hospital hierarchy in the room, it would have only stressed me out more. Granted, they might have been having words in the hallway or do during routine case review sessions, but the level of respect demonstrated in the delivery room was fantastic. It is absolutely worth the investment of time to find a provider that fits your needs (I started looking into it when we moved to Cambodia – nearly three years before the birth of my second) and traveled over many time zones to get what I wanted. In the end it was the best investment of time and money, I have ever spent.

  5. My hospital (I am an L&D nurse) is almost nearly certified as Baby-Friendly and I am excited for us to complete that journey. I have to take issue with one half of what you told women to shop for: the cesarean rate. In our community, women are often going about conceiving outside of themselves, an unnatural method, which often leads to unnatural delivery methods. So I just want to point out that while providers can be all for vaginal delivery, sometimes circumstances arise necessitating a safe delivery versus a vaginal delivery. Also, many women using advanced technology to get pregnant, also are in their late 40’s and beyond and pushing the body is not always an option. Just have to speak up for our excellent institution.

  6. I know this written from the perspective of the American maternity care but it is so valid for all women. I have really enjoyed reading this perspective and I will share this article and definitely continue to encourage and support women. Thank you.

  7. Unfortunately, as a labor & delivery nurse for over 17 years, institutional change takes time… A LONG time…
    While progress is being made, it is PAINFULLY SLOW.

    Additionally, MANY “consumers” are women of lower socioeconomic class, young mothers, or immigrant women who are on Medicaid, so their “choice” of providers is EXTREMELY limited…. They are also often bullied by OBGYN’s to OBEY, and COMPLY. I’ve WITNESSED it, MANY times!

    There are also MANY cultures that put physicians on a pedestal, and they listen to and do WHATEVER THEY SAY, because they’re the DOCTOR.

    MUCH education is needed, ESPECIALLY for those who don’t have access to “choice” or “knowledge.”

    Fundamentally, the view of pregnancy and birth needs to be shifted from a culture of illness to a culture of support and “informed decisions.”

    Finally, the general “culture of liability/litigation” in the USA, ESPECIALLY surrounding birth injuries and trauma, is a MAJOR roadblock to institutional change…. Policies are put in place to “protect the patient,” but as more lawsuits are being brought regarding “traumatic birth,” “birth trauma,” “PTSD,” and breach of “informed consent,” I believe the pendulum may just be STARTING to swing in the other direction.

    Only time will tell, but we’re on the right path! TAKE BACK BIRTH!!!!

  8. Love this! The only problem is changing hospitals is not always do-able. I already travel a great distance to maternity care and hospitals that provide it are large distances away. I simply can’t afford to switch hospitals. I can definitly see why some women choose home birth and would never judge someone for doing so

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