Do you know your obstetrician’s birth philosophy?

If you’ve ever chosen an obstetrician, it’s likely you did it via a recommendation from friends. Or your GP may have given you a list of people to call once your pregnancy was confirmed. I have a few friends who called around and had the choice made for them simply by ‘who was available’.

And I have to say, this isn’t really the best way to choose an obstetrician!

Now, I’ll quickly note, this isn’t a comment on the competency of my obstetric colleagues. I don’t know any incompetent obstetricians. They are all professionals who will achieve the clinical outcome we all desire: healthy mum, healthy baby.

But, as I noted here, we now know a good birth experience is almost as important as a good clinical outcome because research has shown a link between a negative birth experience and increased risk of perinatal mental health issues.

What increases the chances of having a positive birth experience? Research indicates this is most likely to occur when:

• There is a strong, trusting relationship between the patient and their caregivers
• The ‘whys’ and ‘hows’ of any interventions are explained clearly
• The patient feels their concerns have been treated with respect (as opposed to being dismissed) and that they’ve had a say in any decisions being made

I will add one more item to the list above:

• A positive birth experience is more likely to occur when the birth philosophies of the patient and their obstetrician are aligned.

But how does a patient figure out if this is the case?

Well, they can do what one of my patients did with me a few weeks ago. On presenting for her first antenatal consult, she asked the question, ‘What is your birth philosophy?’ What followed was essentially an interview in which she asked me a series of questions about different scenarios and how I felt about each of them. I came away from the consult energised and confident that the patient and I were aligned in our approach to their forthcoming pregnancy and birth, and that it was the beginning of a relationship that will hopefully lead to a positive outcome.

To have this kind of conversation with their obstetrician, a patient obviously needs to understand what their own birth preferences are. Things like:

• How strong their desire is to have a natural birth as opposed to a caesarean
• What their feelings are about inductions
• How involved they want to be in the decision-making process
• What kind of pain relief they will prefer to call upon

I also think it would be really helpful for obstetricians to state their birth philosophies up front, maybe on their website or in an introductory document. In the interests of practising what I preach, here’s what I intend to state as my birth philosophy on my own website:

I believe in the importance of care being patient-centred and individualised to the patient’s unique needs. I place a high priority on education, screening and early intervention as this allows my team and I to be proactive rather than reactive in the care we provide. When it comes to specific aspects of my care:

• I believe in the importance of the patient being actively involved in their care, able to feel like they are fully informed and involved in any decisions being made
• I am a strong supporter of breastfeeding but advocate for patient choice regarding feeding
• Regarding induction, again I believe in patient choice. If an induction or any other intervention is indicated, it should be explained fully so the patient feels like they are making an informed and supported choice. All management decisions when it comes to interventions should be evidence-based and based on accepted best practice.
• I believe in the importance of birth mapping and providing the patient with the birth and experience that they desire.
• I believe in the importance of the team in the delivery of maternity care and as such, I work collaboratively will all members of my team to deliver the best possible clinical and experiential outcome for the patient.

I think we need to recognise that any single provider is never going to be the perfect fit for everyone, (in the same way we’re not going to have a great relationship with every single person we ever come across in life). Involvement in the care of a patient is a privilege and it is important that we spend time to ensure that we are compatible.

I think it’s time for maternity providers to consider what their birth philosophy is and encourage their patients to meet with them prior to committing to the relationship. If we want to truly improve the patient’s birth experience, we need to start by making sure that we are compatible from the beginning.