You may be wondering, what does advocacy in birth even look like?
First know this: it’s crucial for any birthing person to be aware of the policies and systemic restrictions of the intended birth place. This means not only getting on the same page with your care provider about how they approach various scenarios, but also understanding how the nursing staff or birth assistants work, and the expectations of this particular institution. You won’t really know all the right questions to ask unless you’ve done your homework.
If you’re particularly worried about confrontation in labor, I encourage you to hire a doula. If you’ve learned your birth place is known for cultivating traumas, I would suggest thinking twice, and casting the net for better options. However, I do understand that, unfortunately, it’s not much of a choice for many people and privilege preempts choice. In this case a witness (such as a doula or other birth professional unassociated with your medical care givers) is worth its weight in gold, especially if you suspect any issues with respectful dialogue.
A doula cannot speak for you, but will help amplify your voice, brainstorm concerns, work through roadblocks and fears and hesitance, and suggest ideas to ask for what you want. These are common ways I help guide self-advocacy in birth. Ultimately, I want you to feel satisfied with whatever decisions you make, and at peace with whatever decisions you couldn’t.
Have you heard of the BRAIN acronym in relation to childbirth?
Save this and bring it to your birth place. Whenever you’re faced with a new decision, intervention, or proposed change of plan, just think BRAIN:
At a loss for words and unsure how to firmly yet respectfully state your desire to pause before agreeing to an action? Consider one of the following suggestions. Feel free to use as a template and tailor to your own preferences.
You can practice saying these phrases out loud during prenatal appointments (and in everyday life scenarios, without the birthy angle). Don’t just log a favorite statement into your brain, and expect to suddenly summon the courage and wherewithal to present it resolutely while in the throes of labor! (You CAN do it, I’m just saying… practice won’t hurt ya).
“I have questions before I can consent.”
“I have questions about the risks to myself, my baby, and this birth.”
“I have questions about the benefits to myself, my baby, and this birth.”
“I have concerns that I’d like addressed first.”
“I have a negative association / trigger / sensitivity related to this.”
“I have educated myself about the possible outcomes, and I’ve made my choice.”
“I need more time to make a decision.”
“I need more information to make a decision.”
“I need pray about this first.” (Legally, health providers must give you time alone for prayer upon request).
“I need to discuss this privately with my partner / doula / other support person.”
I’m Not Ready
“I’m not ready to make a decision at this time.”
“I’m not ready to agree to that option.”
“I’m not ready to sign anything.”
“What are the alternatives you offer?”
“What are the alternatives you don’t offer, and why not?”
“I would like to try all alternatives before agreeing to XYZ.”
“I would feel safer / better / more comfortable / more receptive if…. XYZ. How can you help?”
“I would like to hear about your previous experiences with this circumstance.”
“I do not consent.”
“I do not give consent for XYZ.”
“It is my right to refuse consent.”
“I cannot yet give fully informed consent.”
“I cannot give legal / true consent under duress.”
“I cannot give legal / true consent while under the influence of medications.”
“I will tell you if I need pain relief.”
“I will not rate what I’m feeling on a scale.”
“I will let you know if I change my mind.”
“I will only be able to discuss this with my partner / doula / labor support person present.”
“I will request a vaginal exam (or XYZ) if I want one.”
“I want you to ask before you touch me.”
“I want you to explain why and how you will touch me before you do so.”
“I want you to explain what you’re doing beforehand.”
“I want you to address me directly, instead of talking about me in my presence.”
“I want a different nurse to be assigned in my care.”
“I want to save XYZ option as a last resort.”
Please & Thank You
“Please do not talk to me or anyone else during a contraction, thank you.”
“Please give me privacy by keeping the door closed, knocking before entering, not following me around, etc — thank you.”
“Please do not ask me XYZ again, thank you.”
“Please do not use XYZ terminology / phrases in my birth space. I prefer XYZ instead, thank you.”
“Please let me know when to expect XYZ, thank you.”
Examples of a care giver’s red flag language include “I’ll let you…”, “I’ll allow you…” , which may hint at an attitude of dominance. Refusing to answer questions or redirecting them is another red flag (the subtext says they’re either inexperienced, don’t have time for you, or think your concerns are irrelevant).
Context is important, of course, but please keep your ears perked if the way you’re spoken to makes you feel disregarded, dismissed, punished, manipulated, inconveniencing, bullied, or belittled in any way.
You can demonstrate your understanding of who’s in charge of your birth (you!) by avoiding:
“If you let / allow me…”
“Would you let / allow me…”
“Am I allowed to…”
“Can’t I just…”
“Yes” or “No” quickly, solely due to pressure