This post is for the What Not To Say To A Pregnant Or Labouring Woman Blog Carnival hosted by Rebirth Nurse.
If there is one thing health care providers (doctors, nurses, midwives and, yes, even doulas) should never say to a pregnant or labouring woman is “I’m going to…”. *
If I can act like your doula right now, let me advise that you should be wary of when people tell you what they are going to do when you are pregnant or in labour. You should be screaming mad when they do things without even telling you! But, you should definitely expect to be asked every time anyone on your pregnancy and birth support team wants to do something to you.
Your body is your body. Your baby’s body is your body. You are in control of all decisions but the most urgent emergency care of yourself. And, that being true, your care providers should be asking you for your permission before they do anything.
All too often in my position as an observer at births, I hear doctors, nurses and midwives tell mothers “I’m just going to see if I can stretch your cervix” when they give vaginal exams. They tell mothers, “I’m going to break your bag of waters and get things moving along better, here.” “I’m going to put the pitocin up again.” “I’m going to order another ultrasound.” “I’m going to keep you on the monitor.”
It is exceptionally rare that I hear, “Can I?” “Can I stretch your cervix?” “Can I touch you here?” “Can I increase your pitocin dosage?”
There are a couple reasons for this. Some health care providers see so many women every day they all begin to blur together. They say and do the same things over and over so many times that pregnancy and birth care becomes routine to them. Watch how a nurse talks to you while you are pushing. Most nurses don’t usually look at you, their comments lack enthusiasm, they may give directions or words of encouragement when you aren’t actually doing anything and they repeat the same phrases over and over again. Some health care providers go on auto-pilot and stop paying attention to the mother and start only attending the monitors or the vagina.
Some health care providers believe, whether actively or subconciously, that women are not smart enough to make their own health care decisions. Some truly believe they are smarter than women’s bodies and the babies that are being born of them. Those health care providers often don’t think a woman deserves to be asked permission, that asking permission undermines their power over each woman or that they are above having to ask permission from mothers.
Finally, asking instead of telling means a health care provider must then explain whey they believe a procedure or therapy is beneficial. And, that takes time. And effort. And a a desire to empower the woman to make informed decisions. The pros and cons of a decision must be outlined and weighed. Most health care providers just don’t have the actual working time or the patience to do this.
When we don’t ask a woman’s permission to touch her body and to perform procedures we are doing her a grave disservice. We are controlling her. We are concealing information from her. We are taking her power away from her. We are stripping her of her individuality.
“Can I?” is such a profound improvement over “I’m going to.”
“Can I press on your tailbone? I think your baby might be posterior and a lot of women in your situation, feeling discomfort in their tailbone, really like the feel of pressure on that part of the body.”
“Can I stretch your cervix a little because you had a LEEP on your cervix that left a bit of scar tissue and I’m certain that if I stretch the cervix a little and break up that scar tissue your labour will start to progress at a much more efficient rate. Of course, on the down side, it will hurt a while I do it and if I don’t do it, I suspect it will take longer for your cervix to dilate than otherwise.”
“Can I break your waters? I believe at this stage of the game it’s the appropriate tool to augment your labour. It can increase your contraction strength which should move your labour along a bit faster and keep you in a steady labour pattern. But, if I do that, you won’t have a cushion of water to buffer the contraction because your baby’s head will be pressing directly on your cervix and we’ll be putting you on a theoretical clock and want to see this amount of progress in this time frame or we’ll have to consider further interventions…”
When heatlh care providers ask a woman for permission to do the things they believe are medically beneficial for a pregnant of labouring mother and baby, they participate with the mother in a conversation. The conversation is the process of health care, a process the mother has a rightful place in making the final decisions.
This approach to care also has another profound impact on mothers: it make them more confident. It tells them that they are smart, that they are reasonable and that they are powerful persons. Merely asking a mother for permission to do event the simplest things – “can I massage your hand for you during your next contraction?” – can put her in a mental place to meet and overcome the challenge of increasingly intense contractions where she may have cowered if treated as an object.
If you are a health care provider, challenge yourself to always ask permission when you care for women. Such a simple thing can have a positive effect on maternal and fetal health.
If you are a mother, be on the lookout for health care providers who ask instead of telling. And, if you find yourself being told, learn to say, “wait. Please explain this to me.” And after you get the information you need, you grant the care provider permission – or not.
*I’m pretty sure that I often fail to ask permission when I work with labouring mothers. I’m not perfect. I’m working towards perfection! And, the majority of birth workers I have come across are not out to strip a woman of her autonomy, certainly not on a conscious level. Most birth workers I’ve had the pleasure of dealing with have been very caring. But I definitely believe we can all improve the way we care for women at their most vulnerable time of life.
