“Who’s in charge when I'm in labor at the hospital?” I asked the midwife at a “get-to-know-you” session.
“You are,” she responded.
“Yeah, but who makes the decisions? You or the staff there? Who’s in control?”
“It’s your birth,” she replied matter-of-factly, “You do.”
It’s funny that I was totally on board with the whole natural birth process, but it had never occurred to me that I would be the one “taking charge” of my birth. Women don’t do that with their births. They go in, listen to the doctor, do as they are told and don’t ask questions, right? They aren’t medical professionals. What do they know about birthing?
Wait...what do women know about birthing?
It's cliched, yes, but being that the human species has survived for however many thousands of years, I’d have to say women must know at least a little bit about birthing to keep our species in existence. But what does this mean for the modern woman? How do we balance our often implicit trust in the authority of doctors with our primal birthing instincts? Is our instinctual knowledge defunct because we can medicalize birth and its discomforts away with tubes, tools, machines, monitors and meds?
Going into my first birth, I knew I wanted to do it the “natural” way, but I initially looked to a midwife to make all the decisions and be in charge of my birth (she was naturally minded, right? She'd make sure I had a good birth). It was paradoxical, really. I wanted to rely on myself and my body to naturally birth my baby, yet it didn’t occur to me until I was sitting across from this woman for the first time that I would be the one making decisions. I would be the star of the show. She would be there with me to assist me through the process, not take charge.
As I journeyed through pregnancy, I began to realize just how many choices and options I had - options that many people don’t seem to stop to think about. Why? Don’t women want to be involved in this monumental life process? Don’t they want to personalize and individualize their birth and make it uniquely theirs? Do women really want to allow hospital policy or routine to dictate what happens during and after their birth?
And if women aren’t being proactive, why aren’t healthcare providers informing women of their choices and encouraging them to research their options and form preferences? This is what my midwife did for me, and I am so grateful that she did. She gave me a gentle push that sent me down the road of proactivity to my highly personalized birth.
Studies have shown that when women feel more control they have higher satisfaction with their births. It stands to reason, then, that if a woman wants to achieve a satisfying birth (and who doesn't?) she should enable herself to feel some measure of control. So what is being proactive in your birth? What does knowing your options really mean?
Part of it means knowing hospital and provider policies. It means knowing what those policies and routines mean to you and how you want to handle them. Obviously, the health and safety of you and your baby is of paramount importance and you will do anything to achieve that goal. There may be things that you cannot control, such as needing a c-section, fetal monitoring or a vacuum extraction when it comes to the health of you and your baby.
So to help you regain a sense of control and satisfaction when the major medical decisions are out of your hands, you should know the little things you can control. Knowing the smaller options you do have a choice in can help you regain a sense of participation and satisfaction. Some of the options you can choose are:
What to wear in labor: do you have to wear a hospital gown? No! There is nothing wrong with wearing a hospital gown, but if you want to wear a favorite outfit, a swimsuit or even a particular “labor gown”, you absolutely can.
Movement in labor. Even if you have an IV or are being continuously monitored you can get out of bed and stand to utilize the effects of gravity. Most IV poles have wheels and can be rolled around with you and some hospitals have telemetric fetal monitoring that allows you to move around without being attached to a machine.
Limiting vaginal exams if your nurse or provider is doing them often, as long as your labor is progressing normally and there are no medical problems. Vaginal exams are often over utilized and can be invasive, painful and discouraging.
What position do you want to push in? While lying flat on your back with your legs up in stirrups is the most popular position, it is rarely the most comfortable or beneficial position to use. Even if your provider wants you in bed for the delivery of your baby you can sit, squat or assume hands and knees to birth.
When should you cut the cord? While the benefits of delayed cord clamping are becoming more acknowledged, many caregivers still cut it soon after birth. You can request it not be cut until after it stops pulsating if you want.
To see your placenta after its delivery. You grew a whole other organ during your pregnancy - one that nourished and grew your baby - and it just gets thrown out after its delivery. Request that you be allowed to see if it if you are curious.
You can delay baby’s first bath so as to maximize the effects of vernix on baby’s skin. In many hospitals, it is routine to whisk your baby away soon after birth to give it a bath. You may choose to delay the first bath so that you have time to bond, breastfeed and because vernix is good for your baby’s skin.
You can also delay baby’s first immunizations, like the Hepatitis B shot, and even refuse the erythromycin eye ointment if you find it isn’t needed for your situation.
Some of these choices may seem small, inconsequential even, but they are all important and highly dependent on your particular situation. They are important because you shouldn’t hand over your care to others without a thought as to your options.
Why is it so important to know these options and your preferences beforehand? The truth is that even though you do have a choice in all these matters (your right to informed consent), healthcare providers aren’t going to ask every patient on every issue, “do you want to do this, or that? Would you like option A or option B?” nor should they. They simply don’t have the time and shouldn’t have to provide that information in the moment. Women and couples need to inform and empower themselves ahead of time.
It’s time women and men began to take responsibility and initiative in their labors, births and postpartum. It’s time families knew their options and choices, and made decisions instead of blindly following hospital or doctor routine.
Women instinctively know how to birth. They have been birthing since the dawn of time, and modern obstetrics with all its interventions can't change that. What it can do is keep women and babies from suffering and dying in birth, as they have been for millennia. This is the beauty of modern birth and medical knowledge.
It's your birth. Personalize it, even if it's just the small details. Own it, even if that means you simply know your options going into it. Don't let hospital policy dictate your birth, unless you are at peace with the way things are done there. Make your own choices. You know how to birth, you have modern medicine to back you up and you can be an informed, empowered woman.