Autonomy in Childbirth – Why it Matters

Many women don’t seem to realise they CAN question the doctor, let alone seek another opinion or change care providers.
Part of this is the power play that occurs when visiting the doctor: 

  • The act of waiting – makes you unimportant.
  • The act of being called – makes you submissive/obedient
  • Entering the doctor’s room – you become a visitor
  • The way the doctor launches into the procedures, types little notes or avoids eye contact – dehumanises you
  • The way you are ushered out before you can ask your questions – devalues you

and before you know it, you have paid your fee and leave wondering what happened. Some people are satisfied as long as they have a script or a test to do (something to show for the consultation).  Others leave feeling powerless and confused.


You can be the most confident woman, educated in and well prepared for birth. Supported by a partner that is equally prepared and confident in birth but as soon as you enter the doctor’s room or the maternity ward something strange happens to you both – you lose your power. You can’t think straight. Is it the lighting? the questions? the suggestions for interventions? the feeling of being rushed? the sense of authority?

Some people are more comfortable and will have better outcomes (by their standards) handing over their power others are robbed of their power despite their best intentions.  And either way, this lack of autonomy matters (yes – even when the person is happy to relinquish).  It can shape how we mother, how we feel about mothering and about ourselves.  It can affect the health of our offspring.

Part of the Power Struggle associated with Childbirth is the nocebo effect: when the OB suggests a big baby (or other issue), the pregnant woman starts to doubt her ability and gives over her trust to the ‘authority’. So much weight is put on the ‘medical degree, years of study’ aspect of medicine, and women give up their autonomy (often without question).  Rhea Dempsey refers to this as the Trance of Acquiescence.

Perhaps for those who relinquish, the power of the care provider is so overwhelming, that the ‘patient’ does not even realise that they have any power.  They accept their submissive role, are seemingly happy with it, and just ‘go with the flow’. This willingness to submit may also be related to the ability to take responsibility.  Sometimes the weight of responsibility feels too much, so it is given over to the ‘more qualified’ care provider.  Sometimes the ability to take responsibility is hindered by knowledge gaps.  And yet – women are required to provide informed consent, which means the responsibility is theirs whether they feel capable or not.  It is a fine line between consent and compliance.

When the power is relinquished, the outcome is often accepted with a sense of thanks or gratitude towards the ‘heroic’ care provider. And whilst this may seem fine on the surface, it begs the question of why/how our society has gotten to the point where the majority of women do not struggle with this unbalanced power.   We know that 1 in 4 women experience this as traumatic, and even more are disappointed or feel like they somehow failed.  Birth outcomes are far more important than simply surviving.  As a society we either fear or tolerate birth, rarely do we Celebrate it.  As a society we do not value the importance of this life event or understand the reality of matrescence.

The Five Stages of Being, when speaking of childbirth, are a great way to see where we are as a society in our approach to birth, and why it is so rare to hear of birth as a celebration.
FEAR: In this Stage of Being, we experience a physical reaction (rapid rate rate, for example), feel anxious and wary, possibly even angry.  In order to avoid the experience, we will choice ‘avoidance’ options in an attempt to numb or ‘void’ this response.  It is also easier to hand the responsibility of this over to an authority.  This usually means a high intervention birth, with a belief of being saved.
TOLERANCE: In this stage there is a level of knowing that birth is a part of life, but still preferring to avoid fully experiencing it…there is a holding back and a reluctance to compromise.  There is still a feeling of avoidance, which tends to led to a ‘managed’ experience.  Birth is processed, but not experienced.  
ACCEPTANCE: This is the stage where women start to feel more open to the experience, and will seek to compromise – to make some decisions more actively and look at the options more openly.  Less likely to avoid the experience more more likely to have a ‘plan’ that states “I will have a natural birth, unless medically warranted’ (see below)
UNDERSTANDING: This is a stage where the power shifts back to the individual.  This is where agreed differences, without judgement, can exist in harmony.  This is where open communication and enjoyment come into play.  The individual becomes assertive, and able to explain their needs, whilst understanding the full context.  They may seek support, and do not seek to avoid the experience.  They are more likely to have a map (rather than a plan).
CELEBRATION: This is a Stage of Being where the individual takes full responsibility and immerses themselves in the experience.  They acknowledge the importance of this important life event, and seek to engage in the experience completely.  They bring joy and confidence, choosing care providers and supporters that fully embrace the celebration.  

Unfortunately, because our society is currently in Stage One and at best Stage Two, the small number of women who dare to question this authority may be labelled as troublemakers, or have to enter in a power struggle to retain control.  If they are fortunate they will have several genuine options for their care, and will be able to choose the one that supports them (most likely a continuity of midwifery care model). 

Autonomy starts with genuine options.  Autonomy continues with the freedom and support to make informed decisions.

Claim your Power – Seek Knowledge

Further reading (off site)
Fish can’t see water

Leave a Reply

%d bloggers like this: