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From the moment you get pregnant, you face a seemingly endless series of choices. Some you make alone or with your partner, such as when to share the news or what color to paint the nursery.

Other decisions – those of the medical variety – will happen in consultation with your health care team. For example, is genetic testing right for you? Do you want to try for a vaginal birth after a previous cesarean birth? Should labor be induced, and if so, how? Yes, your ob-gyn can recommend medical treatments and outline their risks and benefits. But only you can express your personal desires for health care and come to the decision that is right for you.

Doctors sometimes call this “shared decision making” – and it’s especially important during pregnancy.

An evolution of care

Many people were brought up to believe that doctors get to say what’s going to happen, and patients have to go along with it. That’s how things were when I started practicing, back in the early 2000s.

Today, two-way patient–physician relationships are the norm in obstetrics, gynecology, and other health care fields. When I first meet with a pregnant patient, I start by saying: “I’m here to give you the birth experience you desire, and to help make sure that it’s safe.” I follow this with, “What questions do you have for me?”

When it comes to making medical decisions, I’ll explain my recommendation and the pros and cons. Then the patient has her turn to express what she wants, and why. If the choice isn’t urgent, and I sense she isn’t ready to decide, then I’ll suggest she take more time to think it over. And if we disagree, we keep talking until we come to a safe plan together.

This is the pattern you should expect from your prenatal care (and really, all health care). Think of it as one long conversation with your ob-gyn, midwife, nurses, specialists, and other members of your health care team.

How to be an empowered patient

Some patients, and even some doctors, struggle with shared decision making – the older way of thinking is sometimes still engrained. Here’s how you can make sure your voice is heard:

  • Bring backup. Bring your partner, a family member, or a friend to your appointments. Or you could have them on the phone or a video call during the visit – a good option while the coronavirus is spreading. They can take notes, ask questions, and help voice support for what you desire.
  • Share your vision. I find my patients often have very clear ideas for their pregnancies and birth experiences. It’s important for your ob-gyn to know what that vision is, so they can align your care with your wishes. Remember that you and your ob-gyn have the same goal: a safe delivery and a healthy mom and baby. Still, you should be prepared for changes to your birth plan as your pregnancy and labor progress.
  • Come with questions. Don’t be afraid to talk with your ob-gyn – it’s what we’re here for! If you’re nervous, try writing down your questions in advance. If something comes up between visits, connect with your ob-gyn through email, phone, or video chat.
  • Gather information. Pregnant women have access to more information than ever before, and there’s an enormous sense of empowerment that can come from doing your own research. Go ahead, look things up online (for example, this website you’re reading is a great resource). Then take that info to your ob-gyn for further conversation.
  • Find the right fit. If your ob-gyn practice doesn’t offer what you desire, or simply isn’t a good personality match, then find one that is. You have the right to feel welcome and heard at your ob-gyn practice, and to actively participate in your prenatal care.

April’s story

I was on call the night when April came to our hospital with concerns about her pregnancy. (April’s name has been changed.) She wanted to consult with an ob-gyn who manages high-risk pregnancies, like me, because she had been told her baby would be born with a significant heart condition.

The health care team knew the fetus was unlikely to survive a vaginal birth. Even a cesarean birth would not help the baby live more than a few hours. This left us with few options. We suggested that April might want to have a vaginal birth, as many women do not want a cesarean scar to remind them of such a traumatic experience.

April was not most women. She immediately spoke up: “But that is not what I want. I know he isn’t going to survive, but I’m still a mother. I want to hold my live baby.” In fact, she had traveled hundreds of miles to our hospital believing we could help her achieve this.

With those words, April changed all our minds. At 3 am we carefully performed a cesarean delivery, intent on giving her those brief moments with her child.

April’s baby survived for 6 whole days – time the family may not have gotten if she hadn’t advocated for herself. While her story is heartbreaking and rare, it speaks volumes about the benefits of shared, compassionate decision making. I’ll never forget it.

Working together

As the patient, your responsibility is to share your concerns and ask for your health care team’s best advice for your situation. In return, we listen carefully and strive to help you achieve the pregnancy, labor, and birth experience you’re looking for. These days, that’s the goal for patient care.

Published: October 2020

Last reviewed: October 2020

Copyright 2020 by the American College of Obstetricians and Gynecologists. Read copyright and permissions information.

This information is designed as an educational aid to patients and sets forth current information and opinions related to women’s health. It is not intended as a statement of the standard of care, nor does it comprise all proper treatments or methods of care. It is not a substitute for a treating clinician’s independent professional judgment. Read ACOG’s complete disclaimer.

About the Author
Tamika C. Auguste, MD
Dr. Tamika C. Auguste

Dr. Auguste is an obstetrician–gynecologist at MedStar Washington Hospital Center in Washington, DC, where she serves as Vice-Chair of Women’s and Infants’ Services, among other leadership roles. She is a professor at Georgetown University School of Medicine and a member of the American College of Obstetricians and Gynecologists’ Executive Board.