Improving offers twelve signs you can trust your provider is emotionally manipulating you

The Little Engine That Could

Improving Vice-President Christen Pascucci offers twelve helpful signs that your provider is emotionally manipulating you.

Of course she didn’t call it that. She called it Twelve Signs You Can Trust Your Provider.

Who is Christen Pascucci and how is she qualified to write about choosing safe, competent providers?

Duh! She’s a mother and a baby transited her vagina! That makes her qualified to opine on any aspect of obstetric care.

Before we review Pascucci’s Signs, lets step back for a minute and consider why you hire an obstetric provider in the first place. As I have written many times in the past, anyone can deliver a baby if there are not going to be complications. All you have to do is hold out your hands and make sure the baby doesn’t hit the floor. Dads, policemen and taxi drivers do it on a regular basis.

The reason to choose a professional provider is because childbirth is inherently dangerous and many complications do not announce themselves until they occur during the process of birth. You choose a provider to prevent, diagnose and manage complications, limiting the possibility of severe injury or death of the baby or mother.

What should you consider when determining if a provider is qualified to provide safe, high quality, evidence based care?

  • Education – In the case of an obstetrician, that means four years of college and four years of medical school. In the case of a midwife (and following the requirements for midwives in ALL first world countries besides the US) that means a college or master’s level degree in midwifery
  • Training – In the case of an obstetrician that means four years of additional training beyond medical school. In the case of a midwife, that means years of in hospital training preventing, diagnosing and managing complications
  • Credentials – For obstetricians, an MD and, preferably, certification by the American Board of Obstetrics and Gynecology; in the case of a midwife that means a certified nurse-midwife (CNM).
  • Ability and commitment to keep up with the obstetric literature on a monthly basis. New discoveries are being made every day and knowledge is constantly advancing. You cannot trust a provider who doesn’t personally read and analyze the major obstetric journals.

One of the ways that you can tell that Improving is substituting emotional manipulation for qualifications is that their list of twelve DOESN’T include education, training, credentials or fluency in the obstetric literature. That’s hardly surprising when you consider that the folks at Improving think that a vaginal birth qualifies you to provide medical advice to pregnant women; it’s obvious that they have no standards at all.

What does Pascucci in her infinite experience and wisdom consider to be important? Gems like these:

Your provider recognizes that you are the one delivering the baby. Sounds funny, doesn’t it? The truth is, women are the ones doing the heavy lifting in childbirth and care should be centered around them.


Your birth feels like a special event and not a drive-through service.

Or how about this?

Your provider uses language like, “We encourage you to…” and “We support you in…” —not “You’re not allowed” or “We will let you.”

And who can forget this?

Your provider believes in you, with a focus on wellness–what you can do, not what you can’t do.

Earth to Christen! Earth to Christen! These are not signs that you can trust your provider. These are signs that your provider is emotionally manipulating you, often in an effort to divert attention from the fact that she lacks the education, training, credentials and familiarity with the scientific literature to provide safe, competent care, protecting your health and life and your baby’s health and life.

Instead, Pascucci claims:

If a provider is great at what they do, they understand that women are strong and capable. You are no exception.

Improving apparently imagines that women are children who must be chivvied along by fulsome and entirely meaningless praise, ignorant enough and emotionally needy enough to be fobbed off with the obstetric version of the children’s book The Little Engine Who Could.

I suppose if you are a woman who imagines that the depth and breadth of obstetric care is best captured by “I think you can … I think you can …” you will be impressed by this. For women who are mature enough and educated enough to understand that professional training and credentials matter more than atmospherics you will recognize this for what it is:

It’s not a list of signs you can trust your provider. It’s a list of signs that your provider is substituting emotional manipulation for competence and praying you won’t notice the difference.

Hopefully women won’t fall for it.