A note on body autonomy from Birthing Freedom:
Choice is powerful, and ultimately you know what's best for you and your baby. What may be best for one person may differ from the next, depending on the events and experiences combined with one's values and information at hand. Based on your needs, you may request that your doula be an advocate for you. Advocacy is within Birthing Freedom's scope of practice. This is a part of offering deeply empathetic, compassionate, modern care with the mother's decisions and a positive birth experience at the forefront of our services. Importantly, this is done while maintaining respectful, trusting professional relationships with her other care providers so that we can continue to nurture a gentle, informed, harmonious and unified birth culture.
Use Your BRAIN!
In most instances, there is time to discuss every treatment or procedure with the care provider. This includes the nurses, too, not just the doctor or midwife. The reason this is a great tool is because everything that happens to a patient should include an informed choice, which includes both the option of informed consent and informed refusal. Yes, the doctor has been to medical school, but that doesn't mean that everything she says or proscribes is based on up to date scientific evidence, or that it is your only option.
I recently had a client use the B.R.A.I.N. acronym for informed consent/refusal that I had taught her and her partner! Her doctor started talking about induction at her 40 week prenatal visit, and then scheduled some dates for her at the hospital, even though he told her at 2 check-ups that she and baby were doing well. She felt very nervous about it, but also nervous because of the way the doctor talked about "what could happen" to the baby. So she went home and talked to her partner about the Benefits, Risks, Alternatives, Intuition, and Need Time aspects of the decision to induce. Then she called me and told me that the only benefit they could think of was seeing the baby sooner! Which wasn't enough to make them feel comfortable with inducing, so they decided to tell the doctor they'd like to wait until 42 weeks.
Here are some important reminders when it comes to being informed and giving consent:
- No person should give you a pelvic exam or manipulate your cervix without your prior consent.
- No person should pressure you into attempting induction unless it is medically necessary.
- No person should pressure you to dilate faster for his or her own convenience.
- No person should break your water or cut your perineum without consulting with you first and gaining your permission.
- You have the right to refuse a course of treatment that you feel is not in your or your baby’s best interest.
- No person should rush you to make a decision.
These things are true, and childbirth educators and doulas say these sort of things all the time, but they still happen. I see them happen. So it is an important thing to pass on to our clients - You have a right to consent to & refuse anything that interferes with your body or the body of your child.
There are some great informed consent role plays out there, where mom and partner can practice asserting their rights. I really like these (via Prep for Birth), because these are very difficult situations that almost every woman birthing in a hospital will find herself in:
You are laboring along slow but sure. Early labor is taking awhile. Your contractions change and seem stronger. You go to the hospital and are 5 centimeters. Baby looks good on the monitoring in triage, so you are assigned a room. The labor and delivery nurse would like you to stay in bed and not move around or get into the shower/tub. That is ALL you want to do.
What would you do?
Let's practice using our B.R.A.I.N.
What are the risks associated with staying in bed? Well, you would be extremely uncomfortable the whole time, especially if getting out is all you want to do. Another risk is that staying in bed may make your labor more painful and possibly slower. Moving in response to labor contractions and change of positions makes use of gravity and changes the shape of your pelvis, helping baby make his/her way down. The freedom to move and to use pain coping techniques like the shower gives you an increased sense of control and lessens your anxiety. (For more about the proven benefits of movement during labor, click here).
Are there alternatives to this procedure? Can we get more information about why the nurse wants you to stay in bed? If its to keep the baby on the monitor, you can request intermittent monitoring (every 45 minutes or so)? Or maybe something that is portable, like a fetoscope or a telemetry unit, and that way you can even get into the shower. If you have done your research, or if the nurse/doctor does theirs, you will know that routine continuous EFM provides no benefit for babies and increases the risk of cesarean for mothers.
Its ok to need some time to think about it. You might choose to stay on the monitor for a bit and see if you can get comfortable with that. Or, after you gathered all the information you can from your nurse and or doctor on the benefits, risks, and possible alternatives, you just want a few minutes to talk to your partner and your doula about what you're thinking and feeling. There is no rush to decide.
You have been assured that after your push out your baby, he will be placed right on your belly or chest for assessments even if he needs oxygen without separating you two. After you birth your baby, he is making good effort to breathe, is vocalizing, and his color is just right. The baby nurse wants to take him right away. You ask her to do all his assessments on you and she says no and without your consent takes him off to the warmer.
What would you do?
Some may recognize this in a different form - BRAND. I like BRAIN better because it includes Intuition, and also because the "Nothing" and the "Delay" of BRAND seem too similar to me, and are encompassed well under "Need time."
Feel free to make a wallet sized copy of the B.R.A.I.N. acronym below, to have on hand with you during informational consultations with your care providers.
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