“I didn’t know I was allowed to say no.”
“I didn’t know of any other options at the time.”
“Nobody told me about the risks.”
The amount of times I have either read or heard this statement after years of heavily absorbing books, podcasts, stories, and documentaries on birth often keeps me up at night. Women are not aware of their human right to medical consent, refusal, and alternatives during what should be one of the most empowering and joyful times of their life. The belittling and the disrespect of bodily autonomy on behalf of care providers – it is all a huge hidden epidemic in prenatal and perinatal care. It is very important to mention at the start of this piece that although certain aspects of this issue are worsening, the topic is not new and has been prominent since the mainstream medicalization of birth in the early 20th century.
The vast majority of mainstream prenatal care infantilizes women throughout the entire duration of their pregnancies. Very rarely are routine screenings and interventions presented as being optional or in a form where permission is asked for and respected. Pregnancy, for the most part in our society, is seen as a disease or some sort of compromised state.
As a result, when a woman exercises her lawful right to decline or at least call into question certain screenings and interventions – she is seen as being rebellious rather than as being an adult woman capable of risk/benefit analysis. She is often told that her preferences and decisions will lead to a “dead baby” – and how the hell is that any way to talk to a pregnant woman? She’s seen as being an irresponsible mother before her child is even born for not being a good girl and doing what *her* particular provider prefers. This is a very critical point to make, because practices and hospitals all operate a bit differently and may have slightly different policies; however, “policies” are not the same thing as laws and human rights.
What does this do to us as women psychologically? How can we expect empowering birthing experiences to follow when we have allowed so many choices to be taken from us during our pregnancies? It is no wonder that so many women express dissatisfaction with their birthing experiences. It is no wonder our society associates childbirth with suffering and agony rather than with joy and empowerment. It is no wonder that some even go on to experience actual obstetric violence, birth injury, forced medication, and sexual assault during labor. Many will then go on to suffer from PTSD and other postpartum mood disorders.
You may be wondering, what are some of the exact things women do not feel fully informed about during pregnancy and birth? This ranges from everything involved with prenatal nutrition and vitamins, the gestational diabetes screening, vaginal exams towards the end of pregnancy, having “low amniotic fluid levels” at the end of pregnancy, the many risks of epidurals and use of pitocin to induce or augment labor, use of the electronic fetal monitor during birth, nuchal cords (cord wrapped around baby’s neck) and presence of meconium in the waters (very rarely associated with emergencies, but often treated as such), how long a woman’s waters “should” be open before *considering* an intervention, the birthing position the laboring woman is encouraged to push in (which, very sadly, is often on her back), when she is “allowed” to push (I know – I can’t make this stuff up), medical induction if her pregnancy lasts beyond a certain number of weeks after her “due date” (even if mom and baby are doing perfectly fine), whether to have an IV during labor, vaginal exams to check dilation during labor (which are painful, invasive, and have shown to increase a woman’s risk of uterine infection – more here), early clamping versus delayed clamping of the umbilical cord (more on this here), rushed/medicated delivery of the placenta versus birthing the placenta naturally, the importance of the “golden hour” immediately after birth (skin-to-skin, early breastfeeding establishment), the increased risks that come along with a c-section, and the interventions and factors that increase a woman’s chance of having a c-section. The trust in the woman’s body is often stripped away at *every* *single* *step* of this process. Can you believe some hospitals are STILL spreading the misinformation that a woman should not be allowed to eat and drink during labor?
We are told that all that matters in the end is a “healthy mom and healthy baby” – but feeling ashamed, humiliated, powerless, violated, and full of regret is not healthy. Those feelings do not go away after birth. In fact, they often extend into parenting and interfere with our confidence to mother our children. It interferes with setting yourself up for optimal postpartum healing and bonding with your newborn. This surrender of power can also set the tone for interactions with your child’s future healthcare providers as well.
The truth is that our healthcare system is still very much rooted in patriarchy and the superiority complex of medical professionals. White coats trump the innate knowing and awareness a woman has over her own bodily functions and history. It trumps self-education and holistic assessment of various situations. It is reductionist, and treats women as though they are on an assembly line rather than taking the time to provide individualized care and understand individualized concerns. “Routine” does not always mean necessary and right for every woman, and oftentimes these interventions are not even evidence-based. Yet, state regulation and paranoia of liability leads to care providers wanting blanket enforcement of these procedures. Many women state that they experienced a very eerie feeling of “handing over their power” during pregnancy and birth.
Every woman is entitled to unbiased and holistic information on her options. Every woman has the human right to refusal and to determine what happens to HER body and HER baby at all times. At the same time, every practice and healthcare provider has their own policies, state regulations, agendas, and litigation fears. So, we’re at a bit of a crossroads here. It’s time to go back to the basics and ask ourselves: who owns birth – the woman, or the state? Who should ultimately take responsibility for the outcome of the birth, and why? What is birth – a medical emergency waiting to happen, or a physiological event that should be allowed to unfold naturally and remain undisturbed until an actual evidence-based concern arises? Even then – are we presenting interventions as a recommended option, or as an obligation which strips the woman of bodily autonomy and consent? Regardless of the risks that mom and baby may indeed face by choosing to opt out of an intervention – it is still HER right to choose at the end of the day, and the way in which this makes a healthcare provider *feel* is irrelevant in comparison to that human right.
Until the system puts its patriarchal ego to the side and places the power of pregnancy and birth back into the hands of its original owners – birth trauma remains. PTSD remains. Sexual assault during delivery remains. And until prenatal care becomes woman-centered rather than litigation-centered – coercion, fear-mongering, and high c-section rates will follow.