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Building a dream team

Positive communication with your caregiver during childbirth

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Originally published in Today's Parent April 2007

The birth of Stephanie Grant’s first child did not go at all according to plan. First of all, baby Fiona was in a breech position and had to be delivered by Caesarean section.

But even after the infant emerged red and squalling, there was a flurry of activity as nurses hooked Grant up to various tubes and bottles. The problem: Grant had placenta accreta — a rare condition in which the placenta adheres too firmly to the uterine wall, causing hemorrhaging that can lead to death. “I lost three units of blood in about 10 minutes,” she says.

Even in the midst of the crisis, Grant, of Casselman, Ont., recalls her obstetrician, David McCoubrey, explaining to her what was going on. Although performing a hysterectomy is a common treatment for placenta accreta, McCoubrey listened when Grant told him that she wanted more children. He manually detached the placenta and then monitored her carefully well into the night to make sure the bleeding had stopped. The result: Grant, the mother of a healthy 18-month-old, is now pregnant again with her second child.

Grant’s experience graphically highlights the importance of being able to communicate effectively with your caregiver. Throughout pregnancy and birth, women face a host of choices about everything from whether to opt for genetic testing to the type of pain relief they prefer during labour. Sometimes, as in Grant’s case, those decisions have to be made quickly and under duress. Yet they can have very real implications for the health and well-being of both mom and baby.

A key concept in medical care is informed consent when doing tests and procedures. “It’s not legal — in fact, it’s considered assault — to perform a procedure on someone without consent,” explains Winnipeg obstetrician-gynaecologist Margaret Burnett. “Informed consent implies that the physician has asked the patient, ‘Is it all right if I do this?’ And the patient has said, ‘Yes.’”

But asking the question is just the beginning, points out Burnett. To make good decisions, women must have solid information about the benefits and risks of a test or procedure, as well as the benefits and risks of not doing it and the available alternatives. “Good communication is critical,” says Calgary midwife Meryl Moulton. Read on for how to develop a relationship with your caregiver that allows you to get the information you need:

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