Your body. Your birth. Your baby.
You are not just a vessel carrying your unborn child. You are a thinking, feeling human being with agency and bodily autonomy. You deserve and have a right to respectful maternity care. Numerous international healthcare experts, including the World Health Organization, agree on this.
Informed Consent (and Informed Refusal)
You have a right to informed decision decision making – informed consent or refusal – about what’s right for you, your baby and your family.
Informed consent is an ongoing process that requires dialogue between you and your caregivers. Your caregiver has a legal responsibility to outline to you the benefits and risks (both of them, not just one or the other) of any recommended procedure, intervention, test or course of treatment, as well as the alternatives.
Any form you may have signed does not strip you of your right to change your mind, and from a legal standpoint does not outweigh your verbal retraction of that consent. You have the right to change your mind at any time.
The decision is YOURS
Choices about your healthcare and that of your baby are ultimately yours to make. Remember – this is your body, your birth and your baby.
Try this mental trick on for size. Consider anything your care provider says to be a question – even if it’s posed as a statement. For example. “We’re going to start you on pitocin now” becomes “do you consent to pitocin for your labour?”
Evidence Based Care
Sounds good, right? But what exactly is that? And how do you know if you’re receiving it?
There are 3 elements of evidence based care:
- You need full, accurate information to make your decisions.
- You need a clinical caregiver who pays attention to the evidence, which includes their own clinical experience.
- You need care that is tailored to your needs and preferences.
If you’re unsure about a recommendation or information from your care provider, ask “what’s the evidence for that?” You have a right to receive and your caregiver has a responsibility to provide you with the information you need to make the choices that are right for you, your baby and your family.
Evidence Based Birth has phenomenal resources for expecting families, sourcing the best quality, most reliable research out there on a variety of topics relating to pregnancy and birth, in plain language we can all understand.
Use Your B.R.A.I.N.S.
This is a great tool to help you focus your questions and conversations with your care provider:
- B – What does the evidence show are the BENEFITS of this procedure or test?
- R – What does the evidence show are the RISKS?
- A – What are the ALTERNATIVES?
- I – What is my INTUITION telling me is the best choice?
- N – What might happen if we do NOTHING?
- S – ” ‘SCUSE US, my partner and I need a little time to decide.”
Risk assessment.
Risk is relative and also subjective. Each person in the birthing room has a different agenda. room is differently invested in the birth. The risks for each one of those people is also different. For those reasons, what is and is not an acceptable risk may differ for you, your partner, your caregiver, and the institution where you give birth.
There can also be competing risks within the same situation. Which one is the most important to avoid is a personal decision that only you can decide.
How to advocate for yourself
Speaking up for yourself can be easier said than done, especially when we may be feeling vulnerable during labour. What makes it easier to flex this muscle?
Be an active participant in your care. The reality is that no one is as deeply invested in your birth and your baby as YOU.
Get informed. Knowing your options and what’s normal will give you much greater confidence in the delivery room. Take a childbirth education class. Read some (evidence based) books.
Partners – you are the birthing person’s most intimate and powerful advocate. Believe it!! Forget those Hollywood depictions of bumbling dads in the delivery room fainting. You are uniquely positioned to speak on her behalf. What you have to say carries a lot of weight legally and ethically. When you speak, caregivers listen.
Hire a doula! She’ll point you in the direction of reliable, accurate resources and information, and share options you may not have known you had.
“Will my doula advocate for me?”
Just what advocacy means for doulas is a hotly debated topic in the doula world. Positions on the matter range from, “speaking on my client’s behalf takes away her voice and is disempowering”, to “I will say or do anything to protect my client’s stated wishes.” My best advice is to ask during your initial consultation before hiring your doula just what their take on advocacy is. How will she amplify your voice? Do you feel comfortable with the ways she is prepared to support you?
When care is not respectful
Unfortunately, disrespectful maternity care does happen. And the evidence shows clearly that birthing people who are already marginalized due to such often intersecting identities as race, gender, sexuality, religion, disability, economic status or culture are at higher risk for obstretrical violence.
As a doula, hearing the words “let” and “allow” are big red flags for me. “They won’t allow me to eat anything during labour.” When I hear careproviders dictating treatment, instead of engaging in informed consent, I will often turn to my client and say, “do you have any questions about that?” It gives an opportunity to open up that two-way dialogue between caregiver and birthing person.
If you’re planning for your birth and not getting the communication you deserve from your care team, contact your hospital’s patient relations or patient advocate team. They can get very effective in getting your voice heard within the system and your needs put into your medical chart.
You have the right to decline any procedure or test.
You have the right to say “no”.
You have the right to say “stop”.
If disrespectful, abusive or violent treatment continues, the most important words you (or your partner) can use are: “I DO NOT CONSENT”.
Anyone witnessing such treatment can confirm that the care providers have heard this statement: “Doctor/Nurse/Midwife, did you hear her say she does not consent?”
If you have a traumatic birth experience (or if you’ve been witness to one), there are many compassionate professionals ready and qualified to help you on your journey to healing. You deserve to be heard, seen, and your feelings validated. Yes, even if you have a healthy baby. You are worthy of being happy and whole. Seek out a mental health professional or therapist who specializes in working with the postpartum period. Or feel free to contact me – I’d be only too happy to refer you to my trusted contacts.
What an empowering article. As a first time mother this makes me feel much more in control and gives me confidence that I have a right to stand up for myself and say “no” if something doesn’t feel right.
Thank you very much for sharing.