If you have done any amount of digging into the birth-y blogosphere, you have probably come across the phrase “informed consent” in regard to interventions that may be offered to you during your pregnancy and birth experience. Informed consent is a bit of a buzzword right now, and for good reason. There are countless stories of women having things done to them, especially during labor, that they may not have agreed to had they been given all the facts and been explicitly asked if they wanted it.
However, I would like to take it just a little step further and suggest that even more than informed consent, it is vital that women practice informed choice. Informed consent implies that after having the facts explained to you and being asked if you want whatever is being suggested (both really important things!) that you then, well…consent. Using the phrase “informed choice”, while it may seem like simple semantics, is important if we are going to step out of the dominant cultural paradigm that says our care providers are the final (and often only) authority on our bodies and babies, and stepping into a new paradigm of recognizing that in pregnancy and birth, no one knows us like we do.
Informed choice can be scary for some people, because it also puts the ball back in our court in a lot of ways. We are so used to letting the “experts” tell us what to do and when to do it, that we have lost some of our ability to tune into our own bodies, do our own research, and take responsibility for our own decisions about how our babies come into this world. It also takes work to be informed! Most hospital and birth center providers can’t possibly take the time to describe ALL of the risks and benefits of every single thing that may or may not happen during your labor. It’s just not practical. Which makes it that much more important to utilize our resources, ask questions, learn about what normal birth looks like, and go from there.
So, you’ve become well educated on the birth process, you know what you know about your own body and baby, and it’s time to make some choices about the practicalities of how this will all play out. It’s time to assert the right that you have to say “No.” And that is your right. Hospital, Birth Center, or Midwife policies never – let me say that again – never trump your autonomy as a human being. It’s also your right to say yes, of course. But since saying “no” is harder and will definitely bring more resistance in most cases, that’s what I’ll be focusing on.
First, if you are someone who resonates with the idea of an undisturbed or very low intervention birth, you may first consider where and with whom you are choosing to give birth. Are you already dreading having to fight your care team to be heard and to get what you want? Then you might need to at least consider that maybe you aren’t choosing an environment that is suitable to your desires. Talk to more types of providers. Consider your options. Be willing to ask the tough questions, like who you want or even if you want anyone there at all while you birth your baby. Ask yourself if you are giving up the experience you feel would be best for you and your baby due to a preconceived notion of where you have to be or what you have to do to give birth.
Second, if you are in a situation where you anticipate needing to strongly assert your rights, consider having a doula there who is on the same page as you. Having another set of eyes in the room might be helpful in allowing you to let yourself get into “labor land” and not feel that you have to be as much on high alert to anyone doing anything you didn’t want. Make sure you communicate extensively with your partner and/or doula about why you don’t want certain things, what you believe to be true about your body and birth, and how you would like to be supported in your decisions.
Third, learn about the things you may need to say no to. Many, many things are done so routinely in hospitals (and even birth centers and home births), that no one will think twice unless you bring it up beforehand or give a strong “no” in the moment. These things range from vaginal exams to whether or not your baby will be given a hat to wear. To make it less overwhelming, start with what you want your birth to look like, because this will automatically exclude a lot of the things you don’t want. Here’s where, again, educating yourself on what a physiological birth looks like is really helpful. And remember, this is your birth. If there are some things you don’t really care about, that’s okay! But getting clear on the things you do care about is really important.
Fourth, practice saying “No.” For real. Out loud. In the mirror or using role-play with a friend. Often when you are in labor someone might say something like, “After this contraction, I’ll check your cervix.” Practice hearing something like that and responding, “No, thank you. I don’t want that.” Or, “I won’t be accepting any cervical checks today.” Or even just, “No!” Practice going back and forth with someone a couple of times, so you feel confident not only saying no, but asking clarifying questions. If a care provider suggests something and you aren’t sure why (and you’d like to know), practice saying something along the lines of, “Can you explain why you want to do that?” Or, “Please explain that more.”
Above all when it comes to informed choice and asserting your rights, it’s important to remember that no one knows your body, your pregnancy, and your baby like you do. You have the intelligence to learn about birth, you have the choice to give birth where and how you want (even when your options might seem limited), and you have the right to choose what things to say “no” (or “yes”) to! You are powerful!