The amount of times I have read or heard statements like these about giving birth — especially after years of absorbing books, podcasts, stories, and documentaries on the subject — often keeps me up at night:
“I didn’t know I was allowed to say no.”
“I wasn’t aware of other options at the time.”
“Nobody told me about the risks.”
Many women today are not aware of their human rights to medical consent, refusal, and alternatives during pregnancy and birth — times that should be the most empowering and joyful of their lives. The belittling and disrespect of bodily autonomy by health care providers is a huge hidden epidemic in pre- and perinatal care. It’s not new and has been prominent since the medicalization of birth in the early 20th century — and certain aspects of it are getting worse.
A woman’s trust in her own body has the chance to be stripped away at every step of the childbearing process.
The majority of mainstream prenatal care infantilizes women through the duration of their pregnancies. “Routine” screenings and interventions very rarely are presented as optional and at times don’t even involve a request for permission. Pregnancy, for the most part in our society, is seen as an illness or a compromised state of existence.
When a woman does exercise her right to decline or at least call into question certain screenings and interventions, she can be cast as rebellious rather than completely capable of risk-benefit analysis. She may even be told that her preferences and decisions will lead to a “dead baby” — which is no way to talk to a pregnant woman — or be judged as an irresponsible mother before her child is even born for not obediently doing what the health care provider prefers. And while practices and hospitals all operate differently and have different policies, it’s imperative to realize their “policies” are not the same thing as laws or human rights.
What does this do to women psychologically? How can we expect people to feel empowered during birth experiences when we have allowed so many choices during pregnancy to be taken away? It is no wonder that so many women express dissatisfaction with the process, and it is no wonder much of our culture has associated childbirth with suffering and agony rather than joy and fulfillment. Women today are experiencing actual obstetric violence, birth injury, forced medication, and sexual assault during labor, and many then face post-traumatic stress disorder (PTSD) and other mood issues postpartum.
The things women do not feel fully informed about during pregnancy and birth are broad. They range from prenatal care like nutrition and vitamins and gestational diabetes screenings to having vaginal exams and checking “low amniotic fluid levels” at the end of a pregnancy. During labor, there is confusion about the risks of epidurals and using drugs like Pitocin for inducing or augmenting the birth timing, whether electronic fetal monitors need to be hooked up, and the actual dangers involved with nuchal cords around the baby’s neck or the presence of meconium in the waters. Providers may have opinions or dictate how long a woman’s waters “should” be open before considering an intervention, the woman’s birthing position (sadly, often on her back), when she is “allowed” to push (I can’t make this stuff up), and medical induction if the pregnancy lasts a certain number of days or weeks beyond her “due date” — even if the mom and baby are perfectly fine.
There are unquestioned protocols for whether to have an IV during labor, vaginal exams to check dilation during labor (which can be painful and invasive and may increase a woman’s risk of uterine infection), early versus delayed umbilical cord clamping (more on that here), rushed or medicated delivery of the placenta versus passing it naturally. Parents may not get to decide about the “golden hour” immediately after birth for skin-to-skin contact and early breastfeeding establishment. A woman may even not be totally aware of the risks that come with a cesarean section or the factors that increase the chance of needing one.
A woman’s trust in her own body has the chance to be stripped away at every step of the childbearing process. Can you believe some hospitals still maintain that a woman should not be allowed to eat or drink during labor?
It’s time to go back to the basics and ask ourselves who owns a birth — the woman, the medical provider, the state? Who should take ultimate responsibility for the outcome of the birth and why?
We are told that all that matters, in the end, is a healthy mom and healthy baby — but the results of feeling ashamed, humiliated, powerless, violated, and full of regret are not healthy. And those feelings do not go away after birth. In fact, they often interfere with parenting and the confidence of mothering our children. It can weigh a woman down when she should be setting herself up for optimal postpartum healing and newborn bonding. This surrender of power can even set the tone for interactions with the child’s health care providers as well.
The truth is that our health care 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 leaves little space for self-education and holistic assessment of various situations. The effect is reductionist and treats women like they are on an assembly line rather than providing individualized care and understanding highly personal concerns.
“Routine” is not always necessary and right for every woman, and some interventions are not even evidence-based. Yet state regulation and liability paranoia cause health care providers to push for blanket enforcement of certain procedures. And this approach has left many women saying they’ve experienced the eerie feeling of handing over their power during pregnancy and birth. Every woman is entitled to unbiased and holistic information on her options and should have the human right of refusal and to determine what happens to her body and her baby at all times. At the same time, health care practices and providers have policies and procedures and states have regulations, and some of them are based on nothing but agendas and litigation fears.
So, we’re at a bit of a crossroads. It’s time to go back to the basics and ask ourselves who owns a birth — the woman, the medical provider, the state? Who should take ultimate responsibility for the outcome of the birth and why? Is birth a medical emergency waiting to happen or a physiological event that should be allowed to unfold naturally until an evidence-based concern arises? Even then, are interventions presented as recommended options or as obligations that strip the woman of bodily autonomy and consent?
Regardless of the risks that a mother and baby may face by choosing to opt out of an intervention, it is her right to choose at the end of the day. The way that makes a health care provider feel is irrelevant in comparison to that 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 will remain. PTSD will remain. Sexual assault during delivery will remain. Until pre- and postnatal care become woman-centered rather than litigation-centered, coercion, fear-mongering, and unnecessary procedures will keep happening.