How to Advocate for Yourself During Childbirth
Picture the scene: You're in labor. You're understandably finding it impossible to think about anything else except the baby who's rapidly insisting on leaving your body imminently. But something's not going according to plan, and it's looking like you may not have the birth you've been envisioning for the past nine months.
What do you do? How can you, or your loved ones, advocate for what you want to happen during your very personal labor?
For starters, it's helpful to consider the following situations in which you (or someone on your behalf, such as a partner, midwife or doula) might need to advocate for the labor you had planned:
- Your labor is not progressing
- You're not dilating
- Your or your baby's blood pressure or heart rate is becoming irregular
- There are umbilical cord issues
- Perinatal asphyxia
- Excessive bleeding of the uterus
- The placenta is not delivering
These are just a few of the issues that can happen during labor, according to Elizabeth King, a certified fertility health coach, birth and bereavement doula and new parent educator in Irvine, California.
When to advocate
You can advocate for yourself during childbirth in a variety of scenarios. King recommended advocating for yourself if your team of healthcare professionals is suggesting anything you aren't comfortable with or weren't planning, such as:
- Inducing labor or not inducing labor
- Receiving an epidural or not receiving one
- Undergoing a C-section or avoiding one
"You should be able to have your voice and opinion heard," King said. "You should be able to fully understand why it is that they are recommending that for the health of the baby and mother."
However, King emphasized that depending on the severity of the health risk, you may not have a lot of space for options.
"Moments for advocacy can be as small as requesting the IV be placed in the nondominant hand or as big as requesting a different nurse, freedom to move and change positions, or asking for an intervention like more pain medication or a cesarean," said Jessica Fisher-Hattey, a birth and postpartum doula, childbirth educator and owner of Attuned Doula Services in North Texas.
"If a patient is looking for a certain experience, like an unmedicated birth with as few interventions as possible, it might be very important that they advocate for things like intermittent monitoring, freedom to walk and move out of bed, and the use of tools like birthing balls or the shower," Fisher-Hattey said.
There are plenty of instances in which you may wish to advocate for yourself during childbirth regarding what you want to happen. But it's not necessarily easy for a new mother to do this herself.
The difficulty of advocating for yourself
"Labor is one of the most vulnerable times for a lot of people," Fisher-Hattey said. "They are exposed, in pain, often in a hospital and they need all of their energy to focus on labor. If they feel unsafe, unheard or afraid, advocacy can be really difficult.
"There is an unspoken power dynamic between medical professionals and laboring people that can inhibit them from feeling like they can speak up for themselves," Fisher-Hattey continued. "There can be frustration if they are trying to ask for things to be done differently…There is often only a 30- to 90-second break between contractions to catch their breath, recover, answer any questions a medical professional has [or] convey any needs, and then they're pulled into the next contraction."
"Advocating can be difficult because most people feel uncomfortable in a medical setting. It is very vulnerable, and power differences between staff, patients and providers can make it difficult to speak up," agreed Jessica Pettigrew, M.S.N., C.N.M., a midwife and co-director of the women's sexual health consultation service at the University of Colorado OB-GYN department.
"At any time, if a patient feels lost or afraid, she and her support person should speak up," Pettigrew affirmed. "'I'm sorry, can someone explain what is going on?' is totally appropriate [to ask]."
Why is advocacy so important during labor?
It's important to remember that medical professionals are medical professionals for a reason. There are situations where they may need to step in, and, needless to say, they know what they're doing.
Flexibility is a necessity for mothers in labor, "especially when giving birth in a hospital, as often, care providers here are making the choices for you. In a hospital setting, you have less control," said Laura Stein, a holistic birth and postpartum doula based in Dublin.
But advocacy is still paramount even in these situations because the new mother needs to feel she's being listened to and heard during this process.
"Even if birth doesn't go according to plan, and birth is mostly uncontrollable...mothers can still have a positive experience when they are involved in the decision-making process and they are spoken to and things are explained to them," Stein said. "Often in hospitals, women feel like things are done to them without their consent and without being consulted. Informed consent is so important. When women are listened to, this contributes to a positive experience when they don't get their ideal experience."
"Many labors don't go as planned, however, what often makes the difference between a change in plans and a traumatic birth experience is how engaged the individual and their family members felt during the experience, if they felt they had a choice and their choices were honored to the highest degree possible given the situation," Pettigrew agreed. "When plans changed, was the patient consulted? Did they agree with the care team? Were their suggestions or wishes honored?"
How to advocate for your needs during delivery
"Sometimes the barriers are just too much for the laboring person, so it's important for their support people to know their wishes and take over when they can't," Fisher-Hattey said.
This effort starts with education, both for the new mother and her loved ones.
"Educate yourself of the potential situations that can come up and ask questions the month before your due date so that you are prepared [for] exactly how you want to advocate for yourself," King advised. "Communicate with your loved ones on your preferences for yourself and your baby."
"The time to find out your provider doesn't do water birth or encourage ambulation in labor is not in the delivery room," Pettigrew agreed. "Ask questions during prenatal care visits and if you feel that your provider or practice is not a good fit, work to find a team that shares your preferences or offers the services you would like. Prior to any elective intervention that you have concerns with—epidural, induction, breaking the water, etcetera—ask what the risks are of the intervention, what is the expected outcome, what are alternatives. This can be a great role for the support person or spouse."
Advocating for yourself during childbirth begins and ends with education, and it helps to go into labor with an understanding and acceptance that circumstances may change.
This preparation is vital for a partner, if the laboring person has one. They will be speaking up more than the doula or midwife, Stein said, so it's important for them to make sure they're listening for potential scenarios that may not be what was planned.
If you opt to have a doula present, they can speak up on your behalf to healthcare professionals, too.
"As doulas, we often anticipate the needs of our clients and their partners, and sometimes we'll just ask a question or remind them of a concern or request they had prior to labor, so they can advocate for themselves," Fisher-Hattey confirmed. "The goal is never to be someone's voice but to be sure they feel heard and seen."
"Doulas do not speak for their clients," Stein concurred. "The work really happens before birth. Mum and partner learn to advocate and become really clear on what they want."
Ultimately, advocating for yourself during childbirth begins and ends with education, and it helps to go into labor with an understanding and acceptance that circumstances may change. That's when healthcare providers have the responsibility to make sure the laboring person is respected and heard.
"Going through labor is very serious, and often, we take it for granted that all goes well," King said. "It is such a beautiful experience, but be open to shifting from your original plan in the event that a change does arise. The more you ask questions and educate yourself beforehand, the more power you will have to advocate for yourself."