What to know about advocating for yourself before, during, and after birth


The maternal mortality rate in the United States recently hit a 58-year high, according to a recent report from the Centers for Disease Control and Prevention (CDC). 

The data is sobering, but also very telling of the state of our healthcare system. What it suggests, in part, is a larger problem around how families access care. How do we ensure that there are consistent quality standards across our country?

How do we make sure that regardless of your background, regardless of what financial resources you have access to, regardless of what your race or ethnicity is, or what language you speak, everyone has the ability to have a safe birth? 

As the maternal health advisor for Cradlewise, I am passionate about the health of women and families, supporting parents to be able to make the best decisions they can for their children and for themselves. 

Here’s how parents can advocate for themselves before, during, and after labor for the best possible outcomes.

1. Know that unfortunately, it is the responsibility of families to be advocates for themselves

This is an unfortunate reality — because really, everyone should get the same standard of care in our system, without having to speak up for themselves or be a squeaky wheel.

That’s not how the US healthcare system works, especially if you represent a demographic that has been systemically marginalized.

2. Build a strong relationship with your provider

The biggest, most important factor in ensuring safe, effective, reliable, quality care is your relationship with your provider. Whoever you choose to be your OB-GYN or midwife is going to be critically important to how everything goes during labor.

Does this person understand what your needs are, what your preferences are, and how you receive information? Do they give you information in a way that you can understand? Do they want to build trust with you? Do they want to give you choices?

Do they tell you what you can do to mitigate risks? And do they give you a preview of what’s ahead, so that you can really be prepared for all the events around labor and birth?

3. Research your birth facility options

You have a choice not only between providers but between facilities where you can give birth safely — facilities with lower c-section rates or birth intervention rates, for example.

Depending on where you live, that data can be accessed online, on LeapFrog or the California Maternity Quality Care Collaborative for example here in California.

Researching what’s important to you can help you choose where you should give birth, and you can then find a provider that has privileges at that facility. 

4. Have a birth partner who can effectively advocate for you in the hospital

A lot of first-time parents may have never been admitted to the hospital before. If you’ve never had a hospitalization, labor may be the first time you’re interacting with nurses and techs and physicians, and all sorts of healthcare professionals that you may not be familiar with.

It’s important that you have a person at your side — your partner, your sister, your mother, your friend — who can be your voice. Someone who really understands what you want, and what informs your decision-making. This person can help gather information as needed and be your eyes and ears in the process.

5. Consider a doula

An even more effective advocate would be a doula if you can access one. We know that doulas actually reduce unnecessary interventions to help women have a more comfortable birth, and help women and families have the best possible health outcomes. 

Some hospitals provide doula services, but at most hospitals, you have to bring your own doula. Doula services are typically paid for out of pocket, but they can be reimbursed through an FSA or an HSA, for example. And there are doulas in the community that provide services on a sliding scale or in a more affordable way. 

A doula is trained to be an advocate around the time of labor and birth, but they’ll also work with you before and after you give birth. Your doula will check in on you postpartum to make sure that you’re getting all the services that you need, and make sure that everything’s going the way that it should.

And if you end up needing labor interventions that you didn’t anticipate, like a c-section, they’ll be there to help make sure that you are getting all the information you need to make that decision well. 

6. Be vocal about your postpartum support needs

After birth, I think what’s really important to know is that a lot of care falls off. You’ll be sent home with your baby, and then all of a sudden, you’re just on your own.

You may have a couple of pediatrician appointments, and you may have your appointments with your provider two weeks and six weeks after you give birth. But there’s a lot of silence in between that. 

Pay attention to how you’re feeling and speak up and get care if you don’t feel like things are going well for you. Whether it’s trouble with breastfeeding, continued bleeding, or any pain, fever, or chills — anything that feels off to you, those are reasons to get care. 

The postpartum period is a vulnerable time for women and birthing people. Certain complications are more common after birth and can lead to pretty significant illnesses or potentially, deaths.

This is a time when the healthcare system is really not meeting the needs of families — which unfortunately means you need to be even more vigilant about the things you’re experiencing

Speak up, get care, go to the emergency room, call your provider, ask friends — make sure that you have people around you that can help you get the postpartum care you need and deserve.

7. Focus on building your support system

Particularly in the United States, I feel like we have this notion that every family’s kind of on their own island. But in fact, community is so critical to not only getting through the prenatal period, birth, and postpartum but also becoming a parent.

Setting up those networks beforehand can be really helpful. Do you have a group of friends, for example, who are all parents, who you can get on a text thread with, so you have a place where you can drop questions and comments and concerns and just vent? That can be so therapeutic.

Just having a place where you know there are people that have gone through something similar is really, really helpful. We have the ability to access technology to be able to build that support, so use it. 

Engaging with professionals who are well-versed in all the different aspects of that journey to parenthood is also really, really helpful. People that are experts in breastfeeding, sleep, mental health, or just supporting you around the house after you have a baby — there’s nothing wrong with building that team, and if you have the means, paying for that support.

Because even if you use it for a couple of weeks, it will make a tremendous difference in your life to know that you’re not alone. That’s what actually helps you build that confidence and maintain your own well-being, to be able to be the parent that you want to be. 

Meet the Author

Dr. Chitra Akileswaran”

Dr. Chitra Akileswaran MD, MBA, is a board-certified OB-GYN and the proud mother to her son, Prem. She is currently the President and Chief Executive of the Alameda Health Medical Group, a 300-provider multi-specialty physician organization serving Alameda Health System in Oakland, California. She holds a faculty appointment at Harvard Medical School and is also the co-founder of Cleo, a venture-backed digital health platform.


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