My first thought on reading that sentence was, “That doesn’t even make sense.” I’m familiar with abusive relationships, as well as with labor and birthing. This sentence, from an abstract of an article in the Journal of Perinatal Education entitled “Abuse in Hospital-Based Birth Settings?” piqued my curiosity with its deliberate use of a red-flag word.
I’m not sure if the word “abusive” is warranted for the doctor-patient dynamic in the L&D setting (certainly it hasn’t been within my experiences)–but I do feel, inappropriately enough, that the word “paternalistic” often is.
A bit about me: I’m a pro-epidural, pro-hospital kind of gal. Homebirth is not for me. I like the reassurance provided by instantaneous access to high-level medical care in the event of an emergency affecting either me or the baby.
That being said, I can see where the following sentences could hold true:
“The power of medical authority, the lack of accountability in the hospital hierarchical system, policies and protocols, and expectations of compliancy all make an environment ripe for abuse and present obstacles for both women and staff to recognize or stop abuse. Learning to recognize abuse and take effective action, and understanding the legal requirements for ‘informed consent’ can help, but ending abuse will require systemic change.”
I don’t feel that I have been subject to abuse in any of my four birthing experiences. I have, however, seen many women go into labor and delivery prepared to push, but not prepared to push on their own behalf. Pregnant women read up on how to be pregnant, on how to be a parent, but not on what is the most important element of the birthing room: how to be their own advocates.
A woman going into a hospital to have her first baby is implicitly saying to the doctors, nurses, and staff on call, “You know best.” You know what is best for me and my baby due to your medical experience and knowledge. And it’s true that all the Internet Googling I could possibly do would not make me better equipped to deliver a baby than my obstetrician.
But that does not preclude me from having a voice in the conversation, whether to better understand the choices made by my doctor or to cast my vote in those choices, on behalf of myself and my soon-to-be-born child.
“We’re going to have to do a C-section,” the doctor said at the birth of my first son. As I lay on the table, my water having been broken and my contractions becoming more and more heated, I asked, between grunts, “Why?”
I was told that it was because the cord might be around the baby’s neck, with a risk of strangling the baby.
“But isn’t that true in about 33% of babies?” I asked, tapping into my inner nerd and my memory. My memory fails me in every day circumstances like the supermarket (crap, forgot butter AGAIN) but in clutch situations like labor and the bar exam, it comes through. “If that’s the only reason, shouldn’t we hold out a while?”
My doctor looked at the fetal heartbeat, at the pace of my contractions, and talked to the nurses before concluding, yes, we could wait a while. And an hour later, my first son was born vaginally, as all his siblings have been since. I’m not sure if that would have been the outcome had I not raised my voice and asked a simple question.
According to Consumer Reports, “Pregnant women often undergo medical procedures and invasive interventions, including induced labors and cesarean sections, without fully understanding the risks or being involved in making decisions about their care.”
It wasn’t that I was unfailingly loyal to an imagined picture of how I envisioned myself giving birth–though I did certainly have that picture, and it wasn’t of me having a C-section. I knew that circumstances could render that vision untenable, and was prepared to defer to the doctor’s decision. I also was prepared to have a discussion with the doctor as to why we were proceeding a certain way.
To any woman entering the birthing zone, I’d recommend the following: Be critical. Be a consumer. Ask questions. If you do not get an answer, be persistent until you do. This is your baby and your body. Just like shyness about your body goes out the window the second you start labor (if not before!), so too should shyness about speaking up for yourself.
According to Consumer Reports, “Many women reported that they held back from asking questions because they were concerned about being perceived as difficult, they wanted maternity care that differed from what their health care provider wanted, or their provider seemed rushed.”
How you are perceived does not matter in this situation. You are your own advocate, and in the event that you are incapacitated, your spouse or partner or L&D helper needs to assume that role. Talk to your doctor throughout your pregnancy, and address your questions and concerns candidly and openly. Do not accept answers that you feel are dismissive of your concerns.
Being your advocate and your child’s is the most important lesson you can learn while being pregnant in terms of preparation for being a parent–it’s even more important than buying the right stroller.