As a therapist, I have heard hundreds of stories of women and parents not receiving proper prenatal care. As a mother, I have had my own experiences with poor prenatal and postpartum treatment. Unfortunately, we have many gaps in prenatal and postpartum care, which serve as missed opportunities to provide adequate support, conduct proper screening, or link patients with additional supportive resources.
Long wait times between appointments, quick and rushed appointments, concerns or symptoms dismissed, interventions done without consent, and poor bedside manner are just a few challenges many pregnant and postpartum families encounter.
On the same token, we have many excellent doctors who work tirelessly and are genuinely passionate about serving pregnant and postpartum families. Many providers go above and beyond for their patients and, quite literally, save lives every day.
Still, the facts are there. According to a 2023 survey by the CDC, 1 in 5 women reported mistreatment while receiving maternity care, 1 in 3 Black, Hispanic, and multiracial women reported mistreatment, and 45% of women held back from asking questions or sharing concerns during their maternity care.
Additionally, we know from research that pregnancy complications and mortality rates are higher for women of color, according to resources such as the CDC, National Library of Medicine, and the Maternal Mental Health Leadership Alliance.
While the changes needed in our healthcare system are vast and beyond the scope of this article, we’ve listed 10 ways to help advocate for yourself during your pregnancy and postpartum experience.
You Are The Expert Of You And Your Body
Doctors and healthcare providers are experts in their field, but only you are the expert of you. It is common, especially for women, for concerns or symptoms to be dismissed. It can be easy for women to convince themselves that maybe the worries they had aren’t that big of a deal, or perhaps the pain level isn’t relatively so high. Pregnancy, especially if it is the first, can be terrifying and confusing. First-time parents are at the whim of their doctor and their guidance; for new parents, it is unchartered waters. When providers dismiss, undermine, or brush off concerns, it is understandable that patients may hold back further questions and may not be as comfortable expressing themselves.
According to the CDC, some of the most common types of mistreatment reported were receiving no response to requests for help, being shouted at or scolded, not having their physical privacy protected, being threatened with withholding treatment or being made to accept unwanted treatment.
If recommendations are given that you do not feel are right for you, stop and pause and communicate your concerns. Permit yourself to express yourself.
Additionally, having a self-mantra to practice can be empowering and reinforce that you are the expert of you. You may find it helpful to practice statements such as, “I am the expert of my body”, “It is ok to ask questions”, or “It is ok for me to speak up.”
Write It Out
Have you ever had a list of questions for your doctor, and as soon as you are in the office, they magically disappear from your brain? It can be helpful to have a list of questions that you can use as a reference when meeting with your doctor. In the time between your appointments, if questions or concerns arise, jot it down so you have them all in one space.
If you have experienced poor interactions or poor communication with your doctor, write out assertive statements to practice. Bring this with you to the appointment to read from a script if needed. This can be especially helpful if being direct or assertive is challenging.
Examples include:
- “Can you please repeat what you just said? I am having a hard time understanding.”
- “I am not feeling heard”
- “I am uncomfortable with…”
- “I do not feel like my questions are being answered. I have a list of questions I would like to get through individually.”
- “When you say/do, I feel..”
- “If we do__what will the outcome be?”
- “Can you explain the reasoning for …”
Ask For Community Assistance
The hope is that doctors are correctly screening and asking their patients the appropriate questions. Providers need to have an accurate sense of their patient’s history or current needs. Many times, however, that is not the case. If you are in a position where you are experiencing financial hardships, food insecurity, homelessness, domestic violence, teen pregnancy or other challenges, there are resources available.
If you need extra support, ask your provider. Hospitals, birthing centers, and OBGYN offices typically have social workers and care coordinators to help link resources to patients. Local food pantries, free counseling, domestic violence advocates, nurse-family partnership programs, parenting classes, or resources to help with baby supplies, formula, or donor breastmilk are just a few examples of available support.
Know Your Medical And Mental Health History
Be vigilant about any health conditions or concerns you may have. Your doctor should gather a thorough medical history and hopefully review your medical record before each visit. However, sometimes, providers do not adequately screen or miss asking the appropriate questions.
Feel confident speaking up if something has been missed or not discussed. Ask questions about underlying health conditions and what to look for during pregnancy and postpartum. If a medication is prescribed, it is ok to ask questions. Pause and share your concerns if something does not feel right or make sense.
If there is a history of abuse or trauma, pregnancy and delivery can be triggering. Cervical exams are not pleasant, but if there’s a history of sexual trauma, these checks may create extra stress and traumatic responses. It is important to communicate this history with your doctor, so they are aware and sensitive to your care.
According to Postpartum Support International and The Maternal Mental Health Leadership Alliance, 1 in 5 women experience Postpartum Depression, and 75% of women experiencing maternal mental health conditions do not get the care needed for recovery. If you have a history of depression or anxiety, there is a higher chance of experiencing postpartum depression or postpartum anxiety. If your doctor is not discussing this with you, ask questions and learn the signs and resources for support.
Use A Doula Or Midwife
Hiring a doula or midwife is another source of support and another person in your corner to help advocate for you. There are differences between birth or postpartum doulas and a certified nurse midwife or licensed midwife, but each provides emotional support, can answer questions, and offers guidance.
Midwives are medically trained and can deliver babies. Some families may choose to have a midwife over their OB or may have both a midwife and a doctor who collaborate.
While doulas are not medical professionals and do not deliver, birth doulas offer support throughout pregnancy and will attend the birth. Postpartum doulas provide a range of services for support in the early weeks and months after having a baby, such as coming to the home, helping with cleaning or cooking, helping care for the child, nighttime support, or attending appointments with you.
Both doulas and midwives serve as advocates for you and may be an additional source of support in between appointment times with your doctor.
Have A Support Person With You
Whenever possible, having your partner, trusted friend, or family member join you during your appointments can be helpful. Not only can it be comforting to have another person accompany you so you aren’t alone, but your support person may be able to help you remember the information discussed, take notes, or serve as another person who can provide clarification if there’s something you did not understand.
Unfortunately, some appointments are more challenging than others. When there is difficult news, a loss, or something doesn’t quite go as expected, the support person with you can be someone to offer immediate support, lend a listening ear or hug. Far too often, women are left alone after hearing difficult news or are quickly sent back to the waiting room. This can be extremely upsetting and stressful. Having someone else with you can help provide a sense of agency, advocacy, and comfort of not being alone in that experience.
Create A Birth And Postpartum Plan
Pregnancy and parenthood provide a lot of excitement and joy. But it can also be a rollercoaster of emotions. While there is no crystal ball of how pregnancy and delivery will go, creating a birth and postpartum plan can be extremely helpful in identifying needs and preferences. While it is unlikely that everything will go according to your birth plan, and it is essential to have realistic expectations, it can still be helpful to identify in the first place.
Prefilled templates can help trigger questions that you hadn’t thought of. It may provide some guidance on your preferences, goals, and vision. It can facilitate a helpful conversation between you and your doctor, as well as you and your partner or family.
Your provider may have their birth or postpartum handout to share with you. You can also find birth and postpartum plans online, such as this birth template provided by the American College of Obstetricians and Gynecologists or this postpartum plan created by Postpartum Support International.
Educate Yourself
As the saying goes, knowledge is power. Participate in birthing classes, postpartum preparation classes focusing on mental and emotional health during pregnancy and postpartum, and first aid and CPR classes. There are also options for classes specific to dads or partners. These classes can help students feel more prepared and in control. It also serves as an opportunity to connect with other parents, which may result in friendships and supportive connections.
Tour the hospitals or birthing centers. Tour the pediatrician’s office you are considering before just randomly picking one off the list. Consider meeting with the doctors, nurses, and pediatricians as an interview. You are interviewing them to ensure they will be the right fit for you and your family. And it is ok to shop around. Yes, there are time constraints to consider, and regularly switching providers is not helpful. However, if in your gut you do not feel like you can trust or are comfortable with the provider, permit yourself to find someone better suited for your family. Pregnancy and early postpartum can feel like a whirlwind of highs and lows, and having an attentive, supportive, and trustworthy provider is imperative.
Make The Call Sooner And Build Up Your Care Team
Many women cannot see their doctor for a follow-up visit after delivery for 4-6 weeks. It can take an extremely long time to receive follow-up care, especially if there are complications or health concerns. If you find yourself waiting impatiently for the next appointment, if you are experiencing ongoing pain, high levels of depression or anxiety, or if something does not feel okay, speak up and call your doctor. Share your concerns to be seen sooner. Some providers also have nurse lines you can call, which may also be an option to get your questions answered.
ACOG advises that new moms connect with their ob-gyns several times during the 12 weeks after birth, with the first check-up within 3 weeks.
These follow-up visits are a key opportunity for parents to advocate for themselves and their need for support, share concerns, and ask questions. You are not meant to have all the answers, whether you have one or multiple children. It is ok to reach out for support.
Additionally, this is an opportunity to advocate for building up your care team. Referrals for pelvic floor therapy or lactation counseling may be needed. Not every doctor discusses these options, so ask for a referral or more information if you have concerns.
Create Your Village
The saying “It takes a village to raise a child” is true. And it takes a village to support you, the parent. If you don’t feel like you have that village, go out and make one. There are many opportunities for pregnant and postpartum families to find circles of support and connections. If unsure where to start, ask your healthcare provider for resources. You can also do a quick Google search or use social media. Even Facebook groups for families and new moms can be a massive source of support.
Narrow your local pregnancy and postpartum groups or new parent support groups. Oftentimes, these are free groups offered through your hospital, library, or local pregnancy centers. Many groups, such as baby yoga, music classes, infant massage, or even your local story time groups, serve as opportunities for support and connection.
One challenge for postpartum families is the return home. It is an exciting time, but it can also be a scary time, especially if extra support is limited. We are social beings and are not meant to do parenting alone. Advocate for yourself by building your support group. This provides another circle of connection to ask questions, share joyful and difficult experiences, find supportive people with the challenges of postpartum and parenting, and reinforce “I am not alone.”
Finding the right group for you may take some time, but these groups can help foster close friendships and connections for you, as well as your baby and family.
The information provided is not intended to diagnose or replace mental health or medical treatment. Consult with your doctor if you have any questions about your health or are experiencing any medical or mental health emergencies.
