Who is responsible for "educating" pregnant women?

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 Guest post by Jennifer Zimmerman

This just in: pregnant women are completely dense, says recent study. Or, at least that is what this Los Angeles Times article seems to be implying.  Actually, the real title is, Pregnant Women Show An Amazing Lack of Knowledge About Childbirth Options, Study Shows. Who knew that pregnant women were so amazingly ignorant? Who’s fault is that? The article enlightens us on that very question. It is the women’s fault of course!

Apparently, pregnant women “appear to be quietly following whatever advice the doctor or midwife recommends.” Out of 1,318 pregnant women surveyed, “they found many seemingly unprepared to make their own decisions regarding childbirth options, such as whether to have natural childbirth or a Cesarean section.” And, “a shockingly high number could not answer basic questions regarding the pros, cons or safety issues associated with epidurals, episiotomies, Cesareans and other childbirth options.” The article quotes the lead doctor involved in the study, Dr. Michael Klein as saying, “[E]ven late in pregnancy, many women reported uncertainty about benefits and risks of common procedures used in childbirth. This is worrisome because a lack of knowledge affects their ability to engage in informed discussions with their caregivers.” And lest you don’t realize why it is incredibly dense of pregnant women to not know these things, the article states: “The type of provider mattered greatly in terms of what kind of care women received. The researchers published a related study in May in the journal Birth that showed younger obstetricians were much more likely to favor the routine use of epidurals and expressed more concerns about the safety of vaginal birth compared with older obstetricians. The younger obstetricians seemed to view Cesarean sections as the preferred option for childbirth, the authors noted. In the United States, efforts have begun to reduce Cesarean section rates. About one-third of all U.S. women have a surgical birth.”

So, basically the gist of the article is, “pregnant women don’t know anything. It’s really shocking how little they really know! Due to the fact that they are so completely ignorant about childbirth, they just submissively do what their provider tells them to. Therefore, they can’t effectively talk about birth interventions with their providers, and since many providers prefer doing cesarean sections, the ignorance of pregnant women is probably what is raising the cesarean section rate.” Isn’t it nice how journalists are always finding novel ways to blame women for the rising cesarean section rate? It seems pregnant women are supposed to be completely knowledgeable about all of the childbirth “options” they may be offered. The article would have us believe that lacking this knowledge is the pregnant woman’s fault alone, and may even be contributing to the rising cesarean section rate.

In reality, the issues involved are so much larger than pregnant women failing to take a good childbirth class. Informed consent is the legal right of every pregnant woman and it means that she will be told the risks, benefits, and alternatives to every proposed procedure and will have the right to choose or refuse the procedure. By the time she is late into her pregnancy, if she is not being informed adequately about birth interventions,  then shouldn’t we question why the provider is not granting women their legal right to informed consent?  If the provider does not have the time or the inclination to inform these pregnant women about common interventions, then why aren’t they offering a comprehensive childbirth education class where they can obtain the information the provider is legally obligated to give? Why is the article blaming the women for not seeking out adequate knowledge? How are women to know that there is information they don’t know?

It is common practice for maternity care providers to encourage women to listen to the provider’s advice alone over any other sources of information. They may even downplay the legitimacy of information that the woman obtains on her own. They may even discourage reading books, browsing the internet, or taking childbirth classes that are not sponsored by the hospital (and simply meant to teach women how to be good hospital patients, not actually provide them with the risks, benefits, and alternatives to common interventions). Most pregnant women simply are not aware that their maternity care provider may counsel her about her options with other motivations in mind aside from the health and wellbeing of her and her baby. Pregnant women are trusting of doctors. This is a culturally ingrained idea and I doubt it will be overcome by telling women how stupid they are for trusting the information imparted to them by a well educated and respected member of society.


 Photo credit: NBC.com (screencap)