The New Birth Plan – Birth as a Feminist
Jennifer Elliott, May 8, 2016
Quiet confidence in one’s unique convictions,
the will to chart an original course,
the strength to challenge the status quo
Marcy Axness, Parenting for Peace
I am disturbed by the lack of respect for women’s choice and autonomy in some hospital labour rooms. Women have received vaginal exams without full permission or explanation, their waters have been broken without their knowledge and they have been instructed by nurses to behave in certain ways – to put on a gown, lie down in the bed, get into a certain position for pushing and even to be quiet. Women have told me that a nurse scolded them for their timing in coming to the hospital. Scolded a grown woman? Too often labouring women are ordered about as though they are children. Too often women are not treated as mature, autonomous individuals.
And Birth Plans just don’t seem to be making a difference to the care women receive. They are often long and easily hidden in a bunch of other paper. While one caregiver may read it, the next may not see it. And birth plans may delineate their choice about procedures but less often describe how they want to be treated as human beings.
More than 10 years ago, I researched the College of Physicians and Surgeons of Ontario (CPSO) approach on Consent to Treatment. Today it still reads: “Physicians must obtain valid consent before treatment is provided” and “When obtaining consent the College requires physicians to engage in a dialogue.”
This dialogue should include the reasons for the recommended test or procedure and the risks and the benefits. So I created buttons for my clients which read: Informed Consent Requires Dialogue. While this may have created a small ripple in prenatal classes, not surprisingly women did not wear their buttons to the hospital.
The lack of “Patient autonomy and respect for personal dignity” which the CPSO says ”are central to ethically sound care” continues to distress me. So now I am thinking of a new tactic. It has always seemed to me that the bed is the focal point of the birthing room. (I know, you were thinking the focus might be on the labouring woman.) So, the obvious place for a message to caregivers is on the wall above the head of the bed. A client who had her first baby born with the aid of forceps planned to put a notice above her bed during her second birth announcing, “I plan to push this baby out by myself.” It was succinct and I like that she was taking responsibility for the result.
My suggestion today is to be a little less specific, but perhaps more provocative and more empowering. Consider a sign that reads, “I am a feminist.” Imagine how a caregiver might respond when seeing this in bold letters above the birthing woman’s head. Imagine how you might feel as that labouring feminist.
Pause and really imagine it a moment. (I am not asking you to hide your smile. I am enjoying the moment too. But let’s be serious for a moment. I don’t think we should leave feminism in the boardroom.) Feel yourself in your body and in your power.
It is hard to think that the words, I am a feminist, would not result in dialogue and/or a little reflection on the caregiver’s part. A feminist expects to be treated as an adult with rights. Consider all it implies. Feel the strength of those words proclaiming our right to be treated with respect – respect for our choices, and for our bodies. The feminist is going to make her own decisions and expect to be treated as an equal, not someone junior who can be told what to do. The feminist will only spread her legs for a vaginal exam if it is in her best interest. The feminist will only allow herself to be touched if she gives permission. The feminist, in labour or otherwise, is not easily distracted from her purpose.
Think of it as a short – very short – Birth Plan.
It is time we all saw ourselves as feminists as we birth. Strong, autonomous women, not subject to the expectations of others. It might even become a birthing mantra! I am a feminist. Say it in your head and feel the strength and determination that come from it. Say it out loud and draw strength from all women before you who have stood up for themselves and their rights. Dare to proclaim yourself as a feminist and experience your personal power. Imagine yourself standing in the shoes of someone you know who speaks up for herself and commands respect. I feel so fortunate to know that person. I hope you do too.
Perhaps it is how we should introduce ourselves to our caregivers at first appointments and in the labour room. “Jennifer Elliott, feminist,” accompanied by a very firm handshake. I am an admirer of women with a very strong handshake. I sense their inner power.
I am fully aware that declaring, “I am a feminist,” may not feel comfortable for some of us. That’s OK. Just feel it and behave accordingly. And if that mantra doesn’t suit you, find one that does, one that you can repeat in your head whenever you need to hold onto your power: ‘I easily recognize what is best for me and give my energy to those thoughts and actions.” Being assertive is not always easy so you might find it helpful to use your baby as a motivator: I make wise and healthy decisions for the best possible experience for both my baby and me. Or I keep my baby’s needs and experience uppermost in my mind in pregnancy and in labour.
It is easy to feel unassertive in an unfamiliar situation such as a hospital room. We are in someone else’s territory. And we are among unfamiliar people with unfamiliar roles who are very comfortable in those roles. Give yourself or your partner permission to become familiar with the labour room, just the way you would familiarize yourself with a hotel room. Check out the bathroom and shower or tub. Play with the controls on the bed. Open the cupboards and find what might be useful – towels, gowns, blue absorbent pads. Play with the lighting and adjust it so it suits you. This includes opening or closing blinds or curtains. Dim light is generally most conducive for the internal work of labour.
Once you are more comfortable with your environment help others to recognize it as your space. When someone enters your room your labour companion might move towards them, introduce him/herself and then find out who they are. It is not enough to know their name or even their title. Find out what role they will play in your birth. We don’t all know what an intern or resident does and we shouldn’t be guessing. Play music or affirmations that personalize the atmosphere for your unique birth.
But back to your written message. I think a message above the bed is probably the best way for getting the attention of caregivers. In the past I have also suggested, “Welcome to the birth of _______ and ______. Please introduce yourself.” But if it is dialogue we want, leading to an informed choice, it might be as simple as, “Welcome to the birth of ________and ______. Let’s talk.” That will alert caregivers that you are expecting dialogue. And I am aware that, Let’s Talk is a phrase used by a mental health awareness campaign. That association might be helpful. How we are treated affects our mental health. Perhaps a message letting all caregivers know that you are a survivor of abuse would increase their sensitivity. Something like: “I am a survivor of sexual abuse. Please touch me only with permission.” Or to borrow a phrase from the CPSO, “Welcome to the birth of ___ and ____. Thank you for respecting my autonomy and personal dignity.” (Much as I like using the words of the CPSO, I think “Thank you for your patience and respect” sounds better.)
Let’s get thinking about what matters most in our birth experiences. Decide to act the part of the autonomous feminist. And decide what you want your caregiver to know about your expectations for your care. Then plan how you want to communicate those expectations clearly and succinctly and perhaps in a very visible way.
I’d love to hear your thoughts and the message you want to share with your caregiver.
Jennifer Elliott, feminist
N.B. Here is what the College of Physicians and Surgeons of Ontario (CPSO) says about Consent to Treatment: http://www.cpso.on.ca/policies-publications/policy/consent-to-medical-treatment
Anyone who was not given the opportunity to give consent to a procedure or was not treated with respect for their personal dignity might want to inform the hospital’s Patient Relations Department. When you speak up for yourself you speak up for all the women who come after you.