When I delivered my firstborn six years ago, I knew very little about advocating for myself in childbirth, and it had a profound effect on my early experience as a mother.
As an impressionable, first-time mom, I did what I was told throughout the prenatal process. I took my folic acid supplement. I enthusiastically attended every doctor’s appointment, eager and willing to have blood drawn and to pee in a cup. I tried to remain side-lying during sleep, though I found it super uncomfortable.
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All throughout my pregnancy, my role was clear: I had to participate in the partnership with my provider to safely get to delivery day and meet my daughter. My OB, whom I loved, always treated me with respect and kindness. She treated me like my feelings and desires mattered in pregnancy and birth; it just so happened that I did whatever she told me to, so we never butted heads.
When I arrived at the hospital almost two weeks past my due date, I was a bundle of nervous energy. My OB wasn’t on call, but I assumed the same type of care and concern would carry on through the hospital staff. After all, they helped bring babies into the world every day. Surely they’re well-versed in caring for soon-to-be mothers. I had no reason to think otherwise—until I did.
The initial point of contention came when I had my cervix checked for the first time. It was an excruciating experience that left me tense and beyond doubtful I could handle birth. The nurse performing the check was not gentle in touch or tone. She was vocal with me for making it “difficult” to reach my cervix, as if I was trying to prolong the procedure.
In that single moment, I started to not trust my body and its ability to deliver my baby. I tear up even writing this because I felt broken and wrong and afraid. I felt like I was already failing at something that was both intimate and foreign at the same time. I was confused and upset.
My reaction to the cervical check was so strong (and consistent) that the nurse asked me if I was being abused by my husband when he went to the restroom. A year or so later, I learned that a traumatic episode with an IUD prepregnancy caused my body to develop vaginismus, a condition that causes involuntary muscle spasms (or closures) when anything tries to penetrate the vagina. This condition, in combination with the poor bedside manner of my nurse and my inability to explain my feelings and needs, left me extremely vulnerable. I remember feeling like it was important to not aggravate the hospital staff further and be an easier patient.
After my daughter was born, I struggled to feel confident breastfeeding. The same nurse with a horrible bedside manner also provided additional commentary that was anything but encouraging. Instead of “You can do this. You’re doing a great job,” I got a lot of, “You need to try again. Move her head this way. Let the tension out of your shoulders.”
For some, this seemingly cut-and-dry approach is fine, perhaps even preferred. But for me, after I felt stripped of my power as a new mom and a woman, it felt like salt on a wound.
As I transitioned into early motherhood, I carried that sense of feeling inferior, confused, and intimidated. While most parents feel they don’t know all the answers, I was certain I knew absolutely nothing. I abandoned my natural instincts to know and believe in my heart that I could best care for my baby because I was her mom.
It’s almost as if I took on the role and responsibility of motherhood without allowing it to fully penetrate my identity because I didn’t feel worthy.
If this all sounds intense, it’s because it is. But it’s not uncommon. According to a study from the National Library of Medicine, up to 45 percent of new mothers have reported experiencing birth trauma. The study sought to determine the levels of posttraumatic stress, core belief disruption, and posttraumatic growth in women after traumatic birth. It explains that traumatic labor and birth have “ever-widening ripple effects for mothers which childbirth educators need to be aware of. The few minutes of hours that a woman perceives she has been traumatized during birth can be likened to a pebble dropped into a pond resulting in ripples spreading out in the water … impacting mothers’ breastfeeding experiences, and their subsequent births.”
I felt those ripple effects, and it taught me that how we give birth matters, and how we feel about our birth experience matters, too.
According to Elizabeth Ford of Queen Mary University of London and Susan Ayers of the University of Sussex, the effects of birth trauma have a lot to do with a woman’s perception of what they went through.
“Women who feel lack of control during birth or who have poor care and support are more at risk of developing PTSD,” the researchers write.
It matters that we feel in control during the process and can trust our instincts. It matters that our providers take those same instincts into account, as well as our thoughts and feelings, so that decisions can be made with the mother, not to the mother.
There’s a lot you can do to protect yourself and the integrity of your birth, whatever that means for you. The first place to start is acknowledging that these unfortunate circumstances do happen, so it’s important to have a plan in place to safeguard yourself and your future as best you can.
I say all this knowing that health care provider-patient relationships are not one-size-fits-all and that harmony is certainly a goal in the business of birth. But should you feel the desire to ready yourself for whatever lies ahead, read on for a better understanding of your birth rights and how to be your own best advocate.
What are my Rights in Pregnancy and Childbirth?
The easy answer is there are no easy answers. Each state has policies and regulations that can affect a woman’s birth experience, through a patchwork of provider practice laws, the legal status of birth settings (such as a hospital, birth center, or home birth), and systematically enforced compliance with value-driven norms.
A review from the Harvard Law Review on the legal infrastructure of childbirth explains it as follows:
“Decisions about where, how, and with whom to give birth are meaningful reproductive health decisions. For many, they involve intimate considerations about the experience of bringing life into the world and meeting one’s baby, connection with one’s partner, self-empowerment, and connection with the divine. Such choices implicate the kinds of deeply held values that constitutional law has protected in decisions about reproduction, procreation, and parenting. Importantly, childbirth decisions often involve significant medical uncertainty: they cannot be easily resolved by reference to infant or maternal outcomes. Thus, when a pregnant person, a provider, or the state makes a decision about birth, they must fall back on their beliefs about the appropriate balance between competing values rather than scientific consensus.”
A primary example of this is deciding on a place of birth, as different birth settings—often accompanied by different types of physicians—can offer vastly different labor and delivery experiences and outcomes. A mother should be able to choose the setting she feels fundamentally embodies the approach and understanding of birth that aligns with her core values.
“Being informed is crucial when choosing where and who to birth with,” says Carson Meyer, a DONA International certified birth doula in Malibu, California, and member of LOOM, a reproductive and sexual health education platform. “Information has the power to help alleviate unnecessary fear and give parents the tools to make choices with confidence and unwavering support.”
The White Ribbon Alliance, a non-profit organization that advocates for women’s and girls’ health, rights, and gender equality, compiled a list of universal rights for people giving birth that has been shared by various maternity care outlets, including Lamaze International and Every Mother Counts. According to the organization, all childbearing women have the right to the following:
Right to freedom from harm and ill-treatment.
Abuse is not permitted, not by your provider, a medical staff member, or any other person associated with your birth team.
Right to information, informed consent and refusal, and respect for choices and preferences, including the right to companionship of choice wherever possible.
This means no one can force you to do something without your knowledge and consent. By law, you deserve to know and make your own decisions regarding medical procedures, tests, and treatments. The problem, though, is women often aren’t aware that informed consent is required in the first place.
“A mother’s right to informed consent is often not explained to her,” explains Meyer. “In my experience, hospital policy, insurance companies, and standard of care dictate the way obstetrics are practiced, and going against a doctor’s recommendations can be a logistical and emotional challenge. Some doctors will even deny care to mothers who stray from conventional birth practices.”
A companion guide written by the New York City Department of Health states providers should:
- Share clear explanations and information about all medical interventions, procedures, tests, and treatments (such as cervical checks, manually breaking your bag of waters, getting an epidural or episiotomy, or whether to agree to a C-section)
- Provide information that is accurate, judgment-free, and in a language you can understand
- Provide interpretation services if you need them
- Give you all the information you need about a procedure, test, or treatment, including:
- Why they recommend it
- The benefits and possible side effects
- Any alternatives
- The opportunity to ask questions and make sure you understand their answers
- Any health risks if you do not receive it
- Never make you feel forced to make a specific decision.
Not only that, but after you make your decision, you have the right to change your mind, even if your provider disagrees with your choice. If your provider does not approach your care with this consideration, they are not fully upholding your right to informed consent. Even in an emergency situation, a mother’s rights are still meant to be upheld.
Right to confidentiality and privacy.
No one can expose you or your personal information.
Right to treatment that’s respectful and dignified.
No one can humiliate or verbally abuse you.
Right to equality, freedom from discrimination, and equitable care.
No one can discriminate against you because of something they do not like about you, including race, religion, gender, sexual orientation, gender identity, age, disability, HIV status, immigration status, housing status, income level, or form of insurance.
Right to timely health care and to the highest attainable level of health.
No one can prevent you from getting the high-quality maternity care you need.
Right to liberty, autonomy, self-determination, and freedom from coercion.
No one can detain you or your child without legal authority.
Sadly, these universal rights are not common knowledge amongst expectant women, and history plays a major role, according to Meyer.
“[A lack of information] stems from generations of mistreatment of women in the health care system. When our grandmothers were born, their mothers weren’t allowed to vote, let alone feel comfortable asserting their needs or advocating for their own rights in the birth space. Most of our grandmothers who birthed in the U.S. hospital system did so under “twilight sleep” and were not even physically conscious. Fortunately, progress has been made in that regard, but I do think that history [affects] the way women birth today.”
How Can I Best Advocate for Myself During Pregnancy and Birth?
Possessing knowledge of your rights as a birthing woman is only part of the equation: You have to speak up when necessary, even when it’s uncomfortable or causes conflict.
A great way to avoid potential future problems with your provider is by carefully vetting your doctor or midwife before you start receiving care.
“Becoming informed early in pregnancy can help you to know what kind of birth experience you are looking for and how to set yourself up for a well-supported, healthy, and successful journey, whatever that means to you,” says Meyer.
“When interviewing a doctor or midwife, ask about their philosophy and approach to birth, induction rate, cesarean rate and perspective on due dates. Ask about any hospital policy that may interfere with your vision, such as laboring in the water, delayed cord clamping, intermittent fetal monitoring with a doppler, etc. Make sure you feel heard and respected in these conversations. Be specific about the things that are important to you and [discuss your birth plan beforehand].”
By knowing what to expect from your birth facility’s policies and protocols, you’ll be better prepared to advocate for yourself if needed. And when it comes to feeling worried about being labeled as a “difficult patient,” Meyer says it shouldn’t be a concern for mom.
“Communicating with kindness and compassion goes a long way in finding harmony,” she says, and notes that the book Babies Are Not Pizzas is a great resource that outlines the challenges many medical providers face, and how patients and support members can meet them with empathy. In addition, she notes, “the last thing you want is to be having difficult conversations with providers while in labor. Hiring a birth doula and making sure your partner is informed and ready to advocate for you is a great way to be supported in your wishes throughout labor.”
If a conflict of interest is present or persistent before birth, Meyer says that it’s never too late to switch providers, but if a mom is committed to staying with her doctor, then she simply must be willing to assert herself and advocate for what she feels is right. While easier said than done, it’s sometimes the only way to uphold her autonomy, which Meyer says is crucial in the overall childbirth experience.
“Michelle Odent once said, ‘To change the world we must first change the way babies are born.’ I love this quote because I think it really encapsulates how profoundly important gentle birth is, not just for a mother and her child, but the ripple effect it has on all of humanity,” explains Meyer. “Birth can be an empowering and transformative experience that sets a woman up for confidence and trust in motherhood. When babies are born into an environment of respect, they carry that positive imprint with them into the world.”
As someone who had a range of birthing experiences, I believe this to be true. I went on to have a very healing delivery through a local birth center a few years later. They respected my body and my boundaries, without a single cervical check from start to finish!
I transitioned from that birth with a renewed sense of self and trust in my thoughts and capabilities. No matter what the birth looked like, the point is that I felt in control and had a team of providers who wanted that for me as a birthing woman and a new-again mother.
All women deserve quality maternity care centered around their personal desires and values, but it requires education and support. By informing women, we can influence the process of childbirth one delivery at a time.