by: Kimberly Ambrose
of Open To Birth
I think most people don’t think about it. Before they are going to have a baby, I think most people think you just feel a crazy pain in your bottom area, you yell at someone that ‘it’s happening!’, you rush to the hospital breathing like a wounded bear, yelling and cussing at everyone around you, a doctor rushes in with gloves and a mask on, catches the baby while telling you to ‘Push! Push!’, and then you’re handed a slimy, crying, bundle of joy that you fall in love with. It’s not nearly as exciting and borderline slapstick as they play on T.V. The reality of it is that modern childbirth can take as long to plan as the pregnancy itself. There are so many options and ‘what-ifs’ to consider, you can get lost in planning and forget that birth is going to happen however it’s going to happen. You should learn all you can and plan for the ‘what-ifs’ to go into your labor prepared. But you can’t plan for everything, including being mistreated by your doctor, nurses, midwife, or doula. This is a reality that is all to common in maternal care the world over, including the U.S. Birthing women are being mentally and physically abused by their caregivers and have little options to help themselves during or after their births.
Your birth experience is supposed to be a special day. A lot of women imagine telling their children about how they came into the world and having a heartfelt story that’s intense and maybe even funny. No one imagines it being too traumatic to talk about or having a painful and embarrassing story where they were mistreated and disrespected. The Coalition for Improving Maternity Services at motherfriendly.org has come up with the Mother-Friendly Childbirth Initiative which helps Hospitals and Birth Centers, Ob/Gyn’s and Midwives make sure they are providing the best evidence-based care possible. Improvingbirths.org is bringing maternity care abuse to the spotlight while providing an outlet and source of advocacy for families who feel they have gone through unnecessary trauma. Women and men are stepping forward to share their experiences of being misdiagnosed, laughed at, judged, held down and violently examined, denied food, given incisions and stitches without anesthesia, given vaginal incisions and other invasive procedures without their consent, misrepresented in their medical documents, and receiving major surgeries so doctors can keep their social plans. After everything else you have to plan and prepare for, now comes the absolutely unfair heaviness that you may be abused by someone you are supposed to be protected by, someone who has your wellness in their hands. To feel helpless is one of the worst feelings in existence. To be bullied by an Obstetrician or Nurse or Midwife is inexcusable.
When you take your car to a mechanic and they tell you that you have to have some kind of expensive repair, you sigh and stress over spending the money, but you don’t ask for a second opinion, you usually get the repair. When a doctor tells you that you need a surgery, you get the surgery. The difference is that a car is replaceable and public transit is an option. When you are talking with a medical care provider you’re making choices that effect your life, and in the case of childbirth, the life of your child as well. Many women are afraid to be “bad patients” or “uncooperative” when they need to ask a question or say “I don’t want to do that”. The truth is that it is an abuse of the patient/care-giver relationship any time the client feels bullied or whenever their non-consent has been disregarded. Giving birth is the only time in life when we go to a hospital or see a doctor because something is going well. You are not injured, diseased, or malfunctioning when you go to a hospital to deliver your baby, everything is right on track. Some women do have to go to a hospital during birth because there is something wrong, like those who experience complications during their labor at a birth center or in their home. You would expect these Moms to be cared for even better by going to a hospital. Unfortunately, women and men all over the world, including the U.S, are experiencing neglect, physical and mental abuse during maternity care. Your doctor is not the health police. You get to decide what you do with your body for yourself. They are there to provide information to help you make choices for yourself and to carry out those choices such as medical procedures or administration of medication. You should always have consent for anything done to you and should be fully aware of the risks of each procedure or medication. Most people think their doctor is in charge of their health, that they are some kind of authority. You have choices, you have the power as a consumer of health-care.
Being able to choose where you spend your money makes you a consumer, in the economical sense. To consume means to take in, the way you consume air with your nose or consume information through your senses, but when it comes to money, having a choice makes you a consumer. By picking where you birth, and who cares for the health of you and your baby you are making consumer choices. If your health permits it you can also decide what drugs or treatments you do or do not receive. Even when it is not good for you, you have the right to refuse any treatment. It is your responsibility if you refuse a necessary treatment and experience negative outcomes because of that. It is your Doctor/Midwife/Nurse’s job to inform you of why refusing a necessary treatment could be harmful to your health and/or your baby’s health. It is not your caregivers job to pressure you, bully you, or berate you into making any decision, most especially if that decision is not necessary and can cause you harm. What can you do to protect yourself and what options do you have?
Work with a care team you trust – This may mean you have to make a lot of doctor’s and/or midwives appointments. You may have to interview and be seen by a lot of people before finding the right care-provider for you. You may have to travel quite a distance and plan for the travel time to get the care you feel safest with. You may meet with someone, love their prenatal care and then start to not like what you hear as the birth gets closer. Your care giver may start going back on promises they made or becoming more restrictive with your options for your birth. Seek a second opinion. If they agree with that care-giver, seek a third opinion. If they agree with the first two, then you have to face the realities of your medical situation and make the best choice you can from there, but if one obstetrician says one thing and another one says something different, you should work with the professional you trust the most. A medical professional’s job is not to tell you what you want to hear, but it is also not to bully you into cutting corners on your wellness so that they are more comfortable. If you are having twins you may have to travel far and wide to find an Obstetrician or Midwife with the training to vaginally birth twins. It’s hard work, but finding the right care-giver or a couple of different care-givers who can work with you so you feel you will not receive unnecessary invasive treatments or other abuses is the foundation for a safe and healthy birth experience.
Make your backup plan just as important as your initial plan – Let’s say you plan for a birth center birth with a rotating team of midwives that you trust to be highly trained as well as caring and compassionate. A complication arises during labor and you all agree it’s best to transfer you to a hospital for additional help. This could turn a positive birth with a complication to a traumatic experience. You were aloud to eat when and what you wanted at the birth center, now you can only have water and ice chips. You were aloud to move around the room as the baby’s head descended, now you are connected to monitors and made to lay down with little options for movement. You were involved in your medical care with your midwife and now you are having things done to you without your consent and even, as you are telling them “no”. Any situation like this one, where you are changing locations or changing care-providers can be frightening as things are not going as you planned and you’re worried about the health of your baby. Add to that stress, the fact that your wishes to not have an episiotomy or frequent cervical exams will be ignored or openly denied and you could be in a bad situation. Making a strong backup plan can help you to advocate for yourself if the time comes. No one can guarantee you the birth that you want, but you are able to put things in order so you can feel safe in your first plan, second plan, and third plan.
If it becomes necessary to use any kind of medical intervention, you should never put your health or your baby’s health at risk only because you would prefer to avoid medical assistance. At the same time, you should never feel pressured into changing your labor to suit your medical staff. One way to avoid unnecessary intervention is to ask the following questions about any intervention being offered to you, from anyone on your care team:
Good Questions To Ask Your Caregivers:
- Is this an emergency or do we have time to talk about it?
- What are the benefits of doing this?
- What are the risks?
- If we do this, what other procedures or treatments might I end up needing as a result?
- What else could we try first or instead?
- What would happen if we waited an hour or two (a day or two, a week or two, etc) before doing this?
- What would happen if we didn’t do it at all?
You always have the right to ask any questions you need answered at any time.
You should never feel pressured to do something that is not absolutely necessary. You should never be laughed at or feel judged by your medical care staff. You should in no way be physically restrained or held down by another person unless you are a direct and provable threat of harm to yourself or others. You should not receive ANY medical treatments that you have not consented to, so long as you are conscious and able to mentally represent yourself. Always ask what you are signing before you sign anything and have someone fully explain to you what you are agreeing to, don’t sign your rights away without knowing it. You can always ask for another opinion. You can, at any time, ask to have new Nurses, a different Obstetrician or Midwife, a different Anesthesiologist, or another Doula if one is available to you or you can send your Doula out of the room. You should never put yourself in danger in order to avoid medical care, but you have rights as a patient of medical practice and as a medical care consumer. Hiring a Doula can help you make decisions and advocate for your wishes. A Doula can not make decisions for you or override your decisions for yourself, but can work with you to represent yourself to your care-team. By coming up with a birth plan you can more easily communicate your preferences and by making your birth plan simple you can reiterate your preferences whenever there is a Nurse’s shift change or if you work with an Ob or Midwife you haven’t met yet. Letting your Husband, Partner, Baby’s Father, or other family members who are going to be a part of your support team know which preferences are most important to you will give you the support you need to advocate for your preferences when you are busy coping through labor. Having support means so much more than having people there to yell ‘Push!’ and “Breathe!’. Being supported means that everyone caring for your health and for your individual experience has given you the promise that your wishes will be heard and taken into consideration when making choices during your child’s birth.