Making empowered choices in birth

Eid Mubarak! To those readers who spent the last month fasting in the summer heat, I hope your Eid was full of family, friends, and delicious daytime food, lackadaisical toothbrushing, and Q-Tip use. That was my Eid, anyways. Now I'm wrapping up the last day of summer vacation and reluctantly preparing to get back to work. I can already tell that this fall will be intense: births, HypnoBirthing classes, my midwifery and childbirth education course, a Spinning Babies workshop, my herbalism course, my day job, and an anatomy class at Harvard's Extension day at a time. I'm reading an excellent book on childbirth education pedagogy as part of my summer homework, and came across some guidelines for what it means to make an empowered decision. One of my major goals is to support parents in feeling empowered to make decisions for themselves, to stand in their own power and to ask for what they need. This can be challenging in a culture where we've given over power to medical workers--not that they aren't competent or great or have parents' or babies' best interest in mind--but where there are gaps between parents' desires and expectations and those of medical personnel it is important to be able to exercise our voices and choices. When we have such a choice to make, here are some useful questions to consider, both for birth workers and for parents:

1. Was accurate information provided? Was it evidence-based? Where is the information from and how recent is it?

This can be a bit confusing--parents don't necessarily have access to the most recent studies, or know how and where to find them. Having a doula or working with a childbirth educator who shares parents' birth philosophy is useful. They make good resources to bounce information off of. Another one-woman powerhouse for information is Henci Goer, author of The Thinking Woman's Guide to Birth. She's also available in a forum through Lamaze International to answer parents' questions.

2. At what points in the process are there choices to be made?

Many parents don't realize that there are choices almost every step of the way. I've walked into births where women assume that they're supposed to be in bed, that they're required to be hooked up to the fetal monitor, that pain can only be managed with medication, that they must push when told, that the cord must be cut immediately, that their babies must receive eye ointment or a Vitamin K shot, etc. Each of these is a choice.

3. What are the advantages and disadvantages of the various options given?

Caregivers and hospitals have standard protocols based on medical training, hospital culture and policies, our cultural history, and so on, but given the information and evidence for why or why not to choose a given path, parents may want something different. It's totally normal for parents to choose something other than hospital protocol these days, though the sheer number of choices may seem overwhelming once we know how many there are. Developing a set of birth preferences or guidelines with a doula is a useful way of stepping choice by choice through the process.

4. Are parents given enough time to consider the physical and psychological aspects of each choice?

5. Is there sufficient information provided about potential risks flowing from different decisions, and are these risks presented in an accurate, sensitive, and non-threatening way?

I would also add that I rarely see procedures explained in full detail. For example, a doctor might explain how an epidural is administered, how long it could take to go into effect, the risks of headache or other issues, in what circumstance they might have to re-insert the epidrual, and so on, but rarely do I hear it explained that it becomes difficult if not impossible for a woman to get out of bed, that she can't eat or drink, must have a catheter inserted, and how these things can effect her labor or experience, and which may influence her and her partner's choice.

6. Who will make decisions in a crisis?

7. What emotional support is available, regardless of the decision made?


These are useful questions that I consider in my own work, and a good reminder of some of the factors at play. If, as parents, you feel as though you're not being heard in prenatal appointments, that your questions aren't given sufficient consideration, or that you feel uncomfortable asking them because of the attitude of your care provider, then there is absolutely nothing wrong with finding someone else to work with!

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