Giving birth is a powerful experience, but it can also be a vulnerable one—you're naked, in pain, and you can't just get up and leave. While a lot of airtime is given to the physical pain of birth, the emotional trauma that can come with labor and delivery (and all parts of pregnancy care) is very real and deserves to be talked about, for all parents, but especially Black women, who statistically are more likely to experience serious complications or die during childbirth.
The Code of Medical Ethics of the American Medical Association specifically states, "A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights." And yet, so many women leave the birth experience feeling that they were not heard.
You can say no
HeHe Stewart, a doula and founder of Tranquility By HeHe Maternity Concierge, said, "First and foremost, you should understand that you can say no to anything and everything. It's your legal right." This "no" applies to induction, C-section, monitoring, any sort of labs, pushing positions, pain management, the use of Pitocin, IVs, episiotomies and so much more.
"So much of the trauma from birth comes from not feeling heard or feeling like they made it very clear that they didn't want something and they got it anyway, or that they couldn't say no," Stewart said. One of the number-one complaints she hears from birthing parents is they wanted to push in a different position, but they were told they couldn't.
"To that I say, then you need to move your body. It doesn't matter what anyone else says—you are not asking for permission. You're letting the room know how to best support you," she said. She also clarified that if you have an epidural and cannot feel your legs, it's time to enlist the support of a doula, partner or nurse.
You have time to decide
Even if you cannot physically step away from the delivery, you almost always have time to think about how you'd like to proceed, and barring cases of potential harm to you or your child, your doctor's job is to accommodate that request even if it goes against their recommendation.
"True emergencies in birth are rare. We can expect that with most births, we will have the time to step away and make a decision," Stewart said. If a provider attempts to use their education or their experience as a way "to negate your instinct and your preferences, that is directly violating your human rights and your bodily autonomy."
If you are feeling pressured to go along with something the doctor is saying, that may be a cue that you need a few minutes to think or discuss with your support team.
"Birth has worked for millions of years," Stewart said. "Your provider is not someone who is guiding the ship. They are simply a consultant. You have chosen this person because of their expertise and because you trust them to help you make decisions."
Fashion entrepreneur Rachel McCord speaks with Marisa Sullivan about the importance of an advocate in the delivery room, even with COVID-19 restrictions in place. Watch the full interview here.
You are a paying customer
Most births in the U.S. are in hospitals, which largely operate as for-profit institutions. (Of course, it's worth noting that there are also costs associated with home births and birthing centers.) As Stewart noted, "[Hospitals] have policies that are written in their best interest to keep them protected that do not always consider patient experience. This is reflected in the way that we see [most] trauma carried out."
Just as you would ask a server to clarify the wine list at a restaurant in which you are a paying customer, you also have the right to informed consent during labor and delivery. This makes it your legal right to understand why your doctor is making a certain recommendation, the benefits and side effects associated with the suggestion, any alternatives and the health risks if you decline.
You may hear that something is "policy" during your labor; this can be anything from administering Pitocin, a medication that causes uterine contractions to jump-start labor, to mandating a cesarean after a certain amount of time laboring. However, Stewart pointed out that science changes much faster than hospital policies are updated. This is why, if you have the means and time, it can be helpful to read a book or take a class to educate yourself on recent evidence-based birth outcomes, so you or your partner know when something that is policy is actually based on outdated science.
Know who your advocates are
Data compiled from the World Health Organization in 2017 found that parents giving birth who received "continuous support" during their labor and delivery were more likely to be satisfied with their birth experience. They had shorter labors, were less likely to need pain medication, and had fewer cesarean, forceps or assisted vacuum births. It's always wise to be prepared to advocate for yourself should you need to, but having a partner or a doula who can advocate on your behalf is helpful.
"Your doula can not only help keep you on track for whatever your preferences are, but they can also help you understand what the research says about the decisions that you're making in the moment," Stewart said.
'While many people believe that the nurse's role is as a physician's assistant, that is not true. They are actually your patient advocates.'
This is a person who you can trust has done the evidence-based research, and, as Stewart notes, the best doulas will be "unconnected" to your birth outcome. Instead, they'll prioritize "that you feel heard and respected and supported, and that you never feel alone."
If you do not have a doula, remember your nurse is also there for you. "While many people believe that the nurse's role is as a physician's assistant, that is not true. They are actually your patient advocates. So you should be able to let them know [your wishes], and they should be able to honor that for you," Stewart said.
Remember that many hospital births go well
It needs to be said very clearly: Not all hospital births are bad or result in trauma.
"I'm a hardcore birth nerd and had always envisioned one of those candlelit, drug-free birth center births you see on Instagram," Jen*, a writer and mother of a 1-year-old boy in Portland, Oregon, said. "So when I experienced PPROM [preterm premature rupture of the membranes] at 34 weeks and ended up at a major hospital, I was on the defensive, ready to have to advocate for myself. But, ultimately, that wasn't necessary. They were very supportive of my wishes and facilitated my intervention-free birth. Many of my birth preferences were standard practice there."
She said she declined most of their suggestions with "zero pushback," including receiving a hep-lock, which is a catheter inserted into the vein to give easy IV access, if needed.
How to set yourself up for success
Take a freestanding birth course
The number-one recommendation that Stewart makes is to take a freestanding birth course, meaning one that is not connected to a hospital. "Be an educated consumer, and right there, you've already reduced your risk of not only birth trauma, but also unnecessary interventions and the risk of C-section," she said.
Have a birth plan
Many people find it helpful to have a birth plan or a written document that dictates how they'd like their birth to go in regard to positions, pain management, special facilities (like birthing tops), who is able to be present in the room and more. This can be helpful to have on hand in moments of pain or fatigue, when it becomes difficult to articulate your thoughts.
If at any point in your reproductive care you feel like you're not being listened to or that your wishes are being overridden, Stewart said one of the best things you can do for yourself (and this can feel understandably daunting and annoying) is to change providers.
"Everything in reproduction strikes you in a little bit deeper way than, let's say, building a business. You need to find a provider that is able to not only deliver care in a way that makes you feel heard and respected, but also receive you as a patient because you want them to be trusting of you as well," Stewart said. Above all, it is your right to be trusted.
*Name has been changed.