Healthcare decision making: choosing no treatment

There was a lovely article in this weeks Washington Post from journalist (and yoga teacher!) Carol Krucoff discussing why she had opted not to have treatment for a brain tumor for 10 years - until she started to develop symptoms and the cancer started to grow more quickly.   This meant coming to terms with the stress of not knowing. This watch and wait approach has become a big deal in medicine in recent years, particularly in cancer therapy, but has been slow coming to maternity care.

As a doula, I routinely hear from parents that they're concerned about "unnecessary" interventions during labor and birth.  It's clear to everyone that there's too much treatment; too much use of pitocin to augment labor, too many cesareans. It's NOT clear how to better target these interventions to where they're needed. These interventions are intended to prevent serious injuries to the baby or the mother and unfortunately, no one can predict with accuracy when injury is likely to occur. The decision to intervene is often based on a combination of risk factors and indicators during labor, such as slow labor or abnormal fetal heart rate.  This means a high rates of false positives - for example, it's estimated that roughly half of Cesareans for first time moms are unnecessary.

Ultimately, the decisions are up to the parents, in consultation with their care provider.  It's no wonder this is stressful for parents. We're not medical experts, and we want to be cared for during labor, no making decisions. We're also highly risk adverse -  though moms want to minimize interventions and avoid cesarean, none want to put their babies at risk. 

How can you minimize this stress and best prepare to make decision in labor? First, attend a childbirth class. If you know what normal variations of labor are, you're better able to resist pressure to hurry things a long. Labor can take a long time. It can slow down and then speed up again. Second, choose a low interventionist provider and birthplace. This means asking a lot of specific questions - and listening to how you feel about the responses you get.  Ask your provider how often they induce and why, or what they do when moms water breaks before her contractions start. Finally, when you're in labor, be prepared to advocate for yourself. It's okay to say no or ask for more time. If you need to make a decision, ask for time alone with your support people - or by yourself - to think it over.

If you decide to watch and wait - or to forego monitoring or testing -  there's stress in knowing, as well as in not knowing. I sometimes see moms in labor who get knotted up with worry when there's concerns early in labor, and stress and fear makes labor more difficult. No that monitoring is just that - monitoring. It doesn't mean that anything is wrong. Krucoff finds a mindfulness practice from yoga that helped her live with this tension:  "a central teaching (of yoga) is finding equilibrium — that steady place between effort and surrender — which is the key to watchful waiting." 

Read her article here:Why I decided to watch my brain tumor, not treat it right away