How to Be Heard in the Delivery Room
Photo by Camila Cordeiro on Unsplash
This is a part of our Better Care Series, short blog posts aimed at informing women about best practices in reproductive healthcare. Each post explores a challenge that women may encounter during pregnancy, delivery or postpartum and offers up actionable, evidence-based solutions. No fluff. Just the info you need.
The Backstory
A piece published last year in the New York Times examined the bias that affects women, and pretty much anyone who isn’t wealthy, white and heterosexual in healthcare settings.
There are countless examples of society’s inherent distrust of women. It’s a bi-product of living in a patriarchal society. So, it’s not surprising that when it comes to pregnancy and childbirth, two occasions that are inherently unknowable to men, that women’s wishes and inherent wisdom would be questioned or outright discounted by their practitioners.
Distrusting Women to Make Good Decisions
Throughout the rise of western medicine, there has been a sort of “masculinization of childbirth” as coined by the French Obstetrician Michel Odent in his book Primal Health:
We live in a society dominated by the male, where the model is a masculine one. Such a society devalues those things which are specifically female…it is through the medical institution that men have taken control of childbirth most powerfully…Not only has medicine increased its control over childbirth itself, but during the twentieth century it has also wanted to teach women how to give birth. Lamaze wrote that a woman must learn how to give birth in the same way that one learns how to swim, read or write!
What Odent is pointing out is that modern medicine has had the indirect effect of minimizing women in their own experience of birthing a child. Instead, it places the responsibility for childbirth in the hands of professionals who must intervene in order to ensure things go according to plan. This is disempowering and reflective of our larger societal distrust towards women.
The book, Expecting Better , by Brown University Economist Emily Oster, provides a detailed investigation into the established research behind pregnancy do’s and don’ts. In it, Oster reveals a number of surprising things about the research or lack thereof for a number of things that women are warned not to do. For example, there’s no research suggesting that a modest amount of coffee or even alcohol have detrimental effects on fetal development despite decades of harsh warnings from practitioners.
So, why did Oster’s investigation reveal different findings then the medical establishment? One reason she cites is the over-interpretation of flawed research studies, but the other reason is more subtle:
…The bigger thing, I think, is the concern (which was expressed to me over and over again by doctors) that if you tell people they can have a glass of wine, they’ll have 3 (or one giant “bowl-o-wine”). Even if one isn’t a problem, three are. Better to say you can’t have any, as that rule is easy to understand.
This is pretty explicit in its lack of respect for women, their ability to understand facts and then to make sound decisions for themselves. Sadly, this dynamic plays out in countless instances throughout pregnancy and childbirth.
One final example of this inherent distrust comes from the rise of fetal monitoring technology.
Specifically, the Owlet Band, dubbed the world’s first consumer pregnancy monitor. Developed by four, male Bringham Young University graduates, the device tracks the baby’s vitals throughout pregnancy using a form-fitting band containing a network of sensors.
The product is trying to appeal to maternal anxiety by offering women reassurance that their baby is healthy during pregnancy. But, we have to consider this technology in a larger cultural and political climate which is making every effort to limit and control women’s reproductive autonomy.
This device feeds the narrative of “fetal personhood” which positions the mother and unborn child as separate entities, each deserving of equal rights, but sometimes possessing conflicting agendas. Owlet Band differentiates the unborn baby and the mother and then positions itself as a solution to communicate what’s really going on to the parents and anyone else who may have access to the data.
Technology like this runs the risk of undermining women’s innate abilities to develop and birth a healthy child without outside intervention and becomes most apparent in the delivery room.
You Are in Charge
We often forget that as patients we have the right to decide what clinicians are and are not allowed to do. As a pregnant woman, just like anyone else in the United States, you are the only one who can make decisions about your body and your baby.
Informed consent is not a grey area. The American College of Gynecologists and Obstetricians states this very clearly:
The freedom to accept or refuse recommended medical treatment has legal as well as ethical foundations. . . In the obstetric setting, recognize that a competent pregnant woman is the appropriate decision maker for the fetus that she is carrying” (ACOG Committee on Ethics Committee Opinion No. 390 Ethical Decision Making in Obstetrics and Gynecology; Dec 2007, reaffirmed 2013)
According to the Listening to Mothers III report, one in four women who underwent labor induction or cesarean surgery reported being pressured by their healthcare provider to comply.
As Cristen Pascucci, founder of Birth Monopoly and Vice-President of ImprovingBirth.org says,
When women have been given messages all along that they are not the authority in their own childbirth, it’s easy for a care provider to make a unilateral decision about surgery. What woman, who has experienced nine months of language like “we can’t let you” and “you’re not allowed” is going to suddenly have the wherewithal to refuse an unnecessary surgery — or to even know she has the right to do so?
Birth Monopoly provides some deeper explanation around how and why this arises and what you can do about it in the article cited above. A few simple actions that can make a difference:
Look out for language that implies you are not in control like “allowed” or “not allowed” and firmly call attention to it.
Inquire about this when interviewing your caregiver asking for their point of view. Their response will reveal a lot.
Educate anyone that will be present during your birth so that they can serve as an advocate.
The key takeaway here is that you’re in charge and no one can do anything to you in a hospital without your express consent.
Have an Advocate Present
Whether it’s your partner, parent, birth doula or someone else — having someone that understands your wishes throughout your pregnancy and during your birth is critical.
The need for an advocate has led to the rise of midwives and doulas — individuals who have extensive experience with births and can protect the interests of the mother when hospital protocols take priority over the woman’s well-being. These individuals can also assist in helping to articulate the ideal birth experience through the creation of a birth plan.
This person should be engaged, assertive and prepared to have crucial conversations with medical staff, if needed. In some cases, your partner can play this role by themselves. But, this can be an unfair expectation of anyone going through this experience for the first time. It is up to you to assess whether additional support would be beneficial.
Suffice to say, research clearly shows that continuous labor support leads to better outcomes including shorter labor, reduced likelihood for an unplanned cesarean and a more positive overall experience.
In Closing
The examples we provided earlier are intended to show how the distrust of women can play out in subtle ways. They are not intended to stoke anxiety that everyone is out to get you. On the contrary, they show how bias can occur even when we have the best intentions and in ways that many of us are totally unaware of.
We’ve found in our practice that being aware of how bias and distrust occurs, knowing that everyone in the delivery room answers to you and that being supported by an engaged advocate can go a long way in ensuring that you have a successful and empowering birth.