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Why bother knowing your rights in pregnancy?

Updated: Nov 27, 2019

Why do birth rights matter? 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.’

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’.

If you are still not sure if birth rights are important, think, have you, or someone your know, ever thought ‘Am I allowed?’ Am I allowed to eat in labour? Am I allowed to give birth to the placenta in the pool? Am I allowed to give birth at home? Am I allowed to have skin to skin with my baby on the operating table after giving birth by caesarean? The answer is YES. You have the right to make decisions about your body, and your baby.

Or ‘do I have to’? Do I have to see a consultant? Do I have to go for the scan? Do I have to be induced? Do I have to give birth on a consultant led unit? Do I have to have continuous fetal monitoring (belt with monitors)? The answer is NO. All these things are offered to you. It is up to you to accept or decline.

Or have you ever heard ‘what we’ll do with you is this’, or ‘here’s the date for your induction’, or ‘we’ll only allow you to go to 41 weeks’, or ‘you need to go for a glucose tolerance test/give birth in the next 30 mins’. I’m not very good at being told what to do, especially with my own body, and my own children. If I think it is a good idea, I’ll do it, but I want to know all the facts and the alternatives before I decide. And I want to be involved in that decision. I have never been more patronised that when I was pregnant with my first baby. Now most health professionals you’ll meet don’t mean to come across like that, 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.

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.

Hopefully, by now, you are now nodding away, agreeing that knowing your birth rights is important. However, there may still be an underlying niggle. Many women want to be seen as being a nice person, cooperative, rational, and a ‘good mum’. Our upbringing emphasises and rewards being a ‘good girl’. We attribute our success in life to following the rules, adhering to instructions, obeying authority. We often don’t want to upset anyone, especially someone who will be caring for us. Our maternity care system is set up for compliance; if you are a ‘good girl’ and attend all your appointments, take all the tests, we will reward you with a healthy baby. Which isn’t true, but we hold on to it, like a modern talisman, as if questioning it, or stepping off the path, would put our baby at risk. Better to do as you are told. But, as a mother, won’t you be polite but forthright when dealing with a school that is not meeting your child’s needs? As a shopper don’t you check you are getting the right product for you, or the service that meets your individual needs? American doctor and midwife Ariva Romm explains that being a good girl can be hazardous to your health. You don’t need to be aggressive. You don’t need to have a fight. In fact I strongly recommend you don’t have a battle; it’s not good for you or your baby. But you can still be nice and be assertive, and if necessary, a bit bolshy. For many years I supported women and their partners to prepare for giving birth again after a previous difficult or traumatic birth. The number one thing I heard was ‘I’m going to be more bolshy this time.’

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). You can get support from national organisations such as AIMS or Birthrights and from your local positive birth group or doula. 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. If you would like more tips about discussing things download my Negotiating your care leaflet.

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. This is why I started a Birth Rights Advent Calendar in 2016, sharing a statement a day about rights in pregnancy, birth and postnatally. I’m doing it again this year.

Sign up here to receive a printable pdf and a shareable jpeg each day. All I ask is a donation to AIMS and/or Birthrights, or to a birth rights charity where you live. More details in the link. We can focus on women and birth rights as we count down to the most famous birth of all, and the most famous birthing woman.

UPDATE Nov 2019: I'm doing the Birth Rights Advent Calendar again this year, for the fourth year. Last year we raised over £400 and posts were shared from Australia to Brazil. I've updated the links in the paragraph above. Please sign up, be informed and confident in your birth rights/and supporting women in theirs. If you signed up last year there is no need to sign up again. But please donate again. Peace on earth begins at birth.


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