Bait and Switch
By Danell Swim
March 3, 2008
By Danell Swim
What is Bait and Switch?
The good ol’ Bait and Switch is something that’s occasionally mentioned in natural birthing circles, but not everyone is aware of the term, or even that something like it happens.
Essentially, the Bait and Switch is where a care provider tells a newly pregnant woman exactly what she’s been looking for. She can have a natural labor, or epidural, or deliver at 44 weeks if she needs. She can have a VBAC, no IV and have no external fetal monitoring. In other words, she gets precisely the birth that she’s been wanting.
Then, about 38 weeks into the pregnancy, her care provider looks over her chart and says “hmm… I think we have to schedule your cesarean (or other unwanted procedure) right now.”
Who does the Bait and Switch?
It’s most commonly used to talk about OBs or doctors in general, although midwives (even homebirth midwives) have certainly been guilty of it as well.
I’ve also heard of nurses who do something similar. They will tell a laboring mom that she’ll be free to walk around, eat, drink or some other comfort during labor, only to decide once the fetal monitors are in place that the Mama is restricted to bed.
How do I watch out for the Bait and Switch?
If you think your care provider may pull a Bait and Switch, consider asking for things in writing. Such as, if they tell you that they are fully supportive of VBAC in your situation, ask that they write it in your chart so that you have documentation of that.
Also, if they give vague answers, ask for details. If they simply say “I support VBAC,” persist with other questions.
“How far overdue are you comfortable allowing?”
“What if my baby is measuring large?”
“What if my baby is breech?”
These are all things that you should be aware of, and by clarifying the situation with your care provider, you can learn all sorts of things about their true beliefs. And, by pursuing answers to these questions, you illustrate to them that you are committed to the birth that you desire.
Any examples of Bait and Switch?
Stephanie told me of her OB who did this to her. He’d baited her along with talk of a VBAC until her 38th week, when he told her that her baby was too large to be delivered vaginally, and if she tried both of them would die. He told her that uterine rupture happened frequently in their area, and that maybe “it’s something in the water.” And so, with no professional supporting a VBAC, and a husband terrified to try, she consented to schedule the cesarean for a date convenient for the doctor.
Pam had another experience in her first birth. She’d switched to homebirth midwives in order to have a peaceful delivery. But two weeks before her estimated due date her midwives played the “big baby card” saying that she was at risk for shoulder dystocia and other complications, and had to be transferred to an OB who would induce her labor. The induction ended in a cesarean (as they often do), and suffered through more complications, surgeries and secondary infertility.
Denise had planned a VBAC with a doctor who “fully supported her,” only to find that her baby was still in a breech position in the third trimester. Rather than attempting a version which may have encouraged the baby to flip to an ideal position, he said that it was too dangerous for a baby “so large” (estimated 8 lb 5 oz) and insisted on scheduling a cesarean.
How do they get away with lying?
It is true that while every doctor has a right to only take those patients that he chooses, it is not ethical treatment to change the agreed upon protocol so late in the game. 38 weeks seems to be when most OBs and midwives will have a sudden shift in philosophy, possibly due to the fact that few women want, or are able, to find another care provider.
Often the tactic is used along with another ‘complication’ to justify their claims. So in the case of a desire for a natural birth, the birth process may be ‘too slow’ and they claim an epidural will speed it up. Or if a woman wants to go into labor on her own, they will insist on an induction because the baby is “measuring large.”
Because women will typically choose to go along with the unwanted procedure, it works! Not many wish to change care providers at such a late stage, and even fewer want to argue with their OB or midwife. They choose to continue along with whatever the care provider wants, regardless of what was told in the beginning.
Basically, no one calls them on it. It’s easier for them to do this than it is to be honest from the beginning. But they do it because they can.
What are other situations where they may pull the Bait and Switch?
For women with gestational diabetes, any promises of natural, unmedicated, normal birth can usually be thrown out the window. They can say that the woman is putting the baby’s life in jeopardy by pursuing anything that doesn’t fall in line with their practices.
Some may claim that your pelvis is small, and that scheduling a cesarean would be best. However, there is no discernible evidence to merit a diagnosis of this magnitude. The pelvis widens during labor to allow for the passage of the baby.
You are “overdue” by going past 40 weeks. It is true that your estimated due date is 40 weeks from your last menstrual period, but the range of normal gestation is 37-42 weeks. Without other complications, the risk for still birth only increases after 42 weeks (post-dates) and only dramatically after 43 weeks.
“Advanced maternal age” (any pregnant mother over 35) can be another excuse for a Bait and Switch. In the beginning of the pregnancy they may tell you that you’re just another mother, but upon hitting that third trimester another story may be told. Induction, fetal monitoring, drugs and even scheduled cesarean may be insisted upon simply because of a mother’s age.
All of these warning signs can crop up late in the pregnancy, despite the fact that often the situations remain the same throughout. A woman with a ‘narrow pelvis’ has a ‘narrow pelvis’ her entire pregnancy. Yet if this were brought up early on, that same woman might choose to find a care provider that believed in her ability to birth. And so, one way to avoid that is to not mention it until it’s (seemingly) too late.
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5 Responses to “Bait and Switch”
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Your article rings true for me as well. I thought I’d get what I wanted with my first baby and the doctor said no prob. I wanted all natural labor– no pitocin, no IV, no drugs, but I ended up with all of it plus a c/s. Second baby I wanted a VBAC and foolishly trusted the docs when they said no prob. Then I was “late” with a “big” baby and told that they were trying to save me from a family tradgedy and that if I wanted to do a VBAC, they wouldn’t be my docs, and technically they had to give me 30 days, but no other doctor would dare take me. I feel like I knew better, but I was easy to take advantage of being a tired vulnerable woman who doesn’t want to be abandoned in the last days left of her pregnancy. I wish so much that I’d have known better about the ol’ bait and switch!
Terrific article! Yes it happens, and you gave some good suggestions on what to look for and how to deal with it. It’s never too late to change providers (what if you moved to another state in the last month of pregnancy - would a new doctor refuse you?). And if you are committed to your vision of what your birth will be like, you can insist on being heard and respected.
Happened to me with my first pregnancy. When I was carrying twins, Dr. Friendly (as I affectionately call him because he always said everything with a sparkling smile) was all over a vaginal birth. Too naive, I was convinced to be induced at 37 weeks when my BP was slightly elevated because “you’re already 37 weeks and that’s considered term for multiples”. I was promised at least 24 hours after breaking my water before he would even talk about a c-section. At midnight, it had been 18 hours and I’d only dilated to 3cm. “All the other moms who came in this morning are in their rooms holding their babies. I think it’s time to do a c-section.” And so he did. Two years later, pregnant with twins again, I had a successful VBAC with a different doctor, even though my BP did the EXACT same thing at 37 weeks. And I even had the added complication of a previous c-section. I wish I’d known how to see it coming the first time. At least I learned.
Ah yes, and some wait until you show up in labor before flipping the switch. . . preaching about how supportive they are, giving the ‘right’ answers. . . and then when you show up in labor, it’s all about what they say you ‘have’ to do, even if you were told you wouldn’t have to before. . . it’s particularly effective when they throw the ‘dead baby card’ out to a mom in labor, especially if it’s in front of her husband or family. . . *sigh*
Happens WAY too often, mamas. Get those interventions statistics, and get references from other women who planned to have the kind of birth you are aspiring to have with the care providers you’re using. . . and even when you have the best of plans laid, be prepared for a back up plan if they wait until labor to pull the ol’ bait and switch. . .
Great article!
This is SO true! I have seen it way to many times. I wish more moms would confront their OBs and let them know that they will not accept their scare tactics.
Here is a great example of a mom who did just that, with good outcomes.
http://hypnobabies.wordpress.com/2008/02/28/educated-and-empowered/
If moms do their research and stand up for their rights than hopefully things can chage for the better!