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 BY, Vivian Chen [陳培雯] via /CC BY-ND