Am I being reasonable?

I am having a baby, surely I just trust my care givers to help me have my baby. I don’t want to become some militant activist. Right? But birth rights aren’t about being antagonistic. Mostly asserting your rights is just a gentle nudge to an already caring profession to stop their automatic responses and deliver individual care. Knowing your birth rights gives you confidence to say, ‘I politely decline’, or to ask for something off the usual routine, and in nine out of ten times it will be met by an ‘oh, of course, let me sort that for you.’

Your body

Our society, our laws, and our health care system is based on the laws of consent, and of body autonomy. I don’t need to remind you that any fiddling with where we grow or give birth to our babies involves, not just invasion of our body, but of our most private and intimate places. Even if you think that you are happy to just let anyone do whatever is needed, it may work out fine, or you may find that you come away with feelings that are not dissimilar to sexual assault. The research is clear, women have a positive experience of birth when they feel listened to, know what is going on, are involved in the decision making, and treated with respect, irrespective of how much intervention occurred. Knowing your birth rights is about helping that to happen, not leaving with feelings of being swept away with the current or run over by a speeding train. Knowing your birth rights isn’t about saying ‘no’ to everything, it’s about knowing you are the one who gets to say ‘yes’ or ‘no’.

Now most health professionals you’ll meet want to support personalised care, they’ve just got used to doing things a certain way. It’s their daily job and they get into routines and use phrases without thinking sometimes; they’re human. Knowing your birth rights can reframe the conversation so that you are not a passive but an active participant in decisions about you. The NHS is right behind you on that. No decision about me, without me.

You might think that birth rights are not needed because surely there is one agreed, proven, best way of doing things, but there isn’t. We are all individuals. You might have read the list of questions in the paragraphs above and thought ‘well, of course I’d say yes/no to that, who wouldn’t?’, and the answer will be ‘lots of other people’. We all have our own ‘normal’. I see that when, as a doula and antenatal teacher, I help people draw up their birth plans. I might ask what they want in x situation, or what they want to put about y, and the woman or couple will say, well surely that goes without saying, or think there is no other option, and are then surprised by the examples I give of other options people have requested. We all make different decisions, even with the same situation/information. Just look at the variety of cars on the road.

There isn’t a proven best way either. Different doctors and different midwives have differences of opinion on the whole range of maternity care. You can see one doctor who recommends induction at x weeks, and another who looks at the situation and recommends a different path. Just like us, doctors and midwives do not just make decisions based on the facts and figures, but bring in their experiences, values, and individual viewpoints. There isn’t always the solid, conclusive, gold standard research to go on anyway. A review, in 2014, by obstetricians, of the guidance documents from the Royal College of Obstetricians and Gynaecologists, found that just 9-12% of recommendations were based on top quality research, and that 66% of obstetric recommendations/guidelines were only expert opinion or best practise, based on the experience of those on the panel, with no research behind them at all.

I don’t say these things to unsettle you, but to let you know it is okay to question, to not see things the same way as your doctor or midwife, and to make a different decision to them. Obstetricians and midwives are highly knowledgeable and skilled. Use their knowledge and skills to help you make your decisions. Ask questions. That’s what making an informed decision is about. But at the end of the day it is your decision. Your risk to take. Your body. Your baby.

Your baby

Of course a healthy baby is the most important thing. Nobody knows that more than the parents; it is highly patronising for a health professional ever to assert they have greater concern for the baby. Women will always put their baby’s wellbeing above their own. We can be trusted to make decisions, we are adults, parents; we are about to make decisions for our child for the next eighteen years. We can understand the issues, but also we know our own bodies, our family history and how our individual body responds. And research is backing up individualised decision making. The huge national maternity review report, Better Births, concluded “It is increasingly evident that personalised care means safer care and better outcomes.”

And a healthy baby is not all that matters. (Here is a great article which talks about this.) You are not merely a vessel to grow baby in. You are a dyad, you and your baby. Your baby cannot have maximum health if you are recovering from a traumatic birth where your wishes and your body autonomy were damaged. What’s good for mum is good for baby, and that’s good for dad, other mum, too. Health care often distils and simplifies the issues down to one or maybe two things, when in reality there are more factors to consider. For example, guidelines for vaginal birth after caesarean (vbac) are almost solely concerned with being watchful for uterine rupture. While that can be a life threatening situation, it is extremely rare. There is top quality evidence to say that the best outcome is a planned vbac that ends up in a vaginal birth. Yet every single recommendation for vbac is associated with increasing the chance of ending up with another caesarean, and there is very little, if any, quality research that shows the recommendations will prevent or help if there is a rupture. As a person, as the mother/father, you will be balancing a number of different factors to weigh up your decision. This is a useful article that looks at views of risk in maternity care.

You are not doing this alone. You don’t have to feel awkward. You won’t be the first to ask for, or decline, whatever it is; and you won’t be the last. There is a fundamental thread running through the NHS on consent to treatment, and informed choice, and this is strongest in maternity care. Wave after wave of reports and projects has emphasised ‘women centred care’ as being the gold standard. This is backed up by our legal system, and international human rights law. Yes, you can come across individuals or pockets that have forgotten this, but you will find people in the system to help you, perhaps the head of midwifery, or the consultant midwife, and the local PALS (see you hospital website for contact details). More on this coming up in this course.

In the vast majority of cases I have found that doctors and midwives have bent over backwards to accommodate individual situations. Simply knowing your rights can help you feel confident it starting to talk to your care providers about this.

As an antenatal teacher and doula I know that when a woman’s birth rights are respected, when she is making the decisions within a supportive team of professionals, the outcomes are better, for her, her baby, her partner.